When is a change worth the trouble for brachytherapy?

Gains in engagement, conformal coverage, seamless logistics, planning, and procedural efficiency drive Wisconsin brachytherapy program’s transition to Cesium Blu™.

“If it ain’t broke, don’t fix it.” The ageless axiom holds true in so many circumstances that it will almost certainly outlive us all.

The radiation oncology team at Aurora Health in Green Bay had built a successful brachytherapy program dating to 1998 using Palladium as their isotope of choice.  Why should they take a chance and change something that had a history of benefiting patients?

“We were seeing cure rates in the 90 to 95 percent range with Palladium for our low and intermediate-risk cases,” Dr. David Rohde, a Radiation Oncologist from Aurora Health, told us. “Toxicity, inclusive of lingering frequency and urgency in urination, was not a tremendous problem.”

Why make the change?

“Remaining ‘out in front’ of new technology helps us keep our urologist partners interested in the program,” Dr. Rohde continued. “We were onboard very early with real-time dosimetry. The advent of the robotic surgery systems certainly created a lull in our program. But that system has not shown superior overall outcomes compared to radiation, including brachytherapy, especially for low-risk cases.”

“The opportunity to reduce patients’ urinary bother in half of the time thanks to Cesium Blu™’s energy and the short half-life is a benefit that merited investigation and ultimately a transition in isotopes for our practice.”

Adapting to a more efficient process for all

Cesium-131 became available for prostate brachytherapy in 2004. Encouraged in part by compelling new long-term outcomes data, Dr. Rohde’s team is part of a growing number of radiation oncologists transitioning to Cesium Blu as their isotope of choice for prostate brachytherapy.

A critical step in the transitioning process involved Medical Physicist Peter Heiberger’s visit with Dr. David Marshall’s Charleston, South Carolina practice. Dr. Marshall has been using Cesium Blu™ by Isoray for select prostate cancer cases and pioneering the advancement of the Blu Build real-time brachytherapy device from Isoray.

“Our experience with Dr. Marshall was fantastic,” Peter said. “Our techniques are quite similar to his making it very much an apples to apples transitioning experience. There are a few items we took away that we have already put into practice like capturing contours in smaller slices with higher levels of detail for example. But confirmation of what we are doing well in our program through Dr. Marshall, and what we could anticipate when transitioning isotopes, was of very high value.”

Early impressions of the power of Cesium Blu

Initial concerns about side effect severity have abated in the absence of observed and reported worsening urinary toxicity since switching to Cesium Blu. Dosimetry planning also happens more quickly, they report.

“Because of Cesium’s higher energy, fewer seeds are needed, which naturally reduces planning time,” Peter said. “Fewer seeds also means fewer needles are needed, which makes the entire implant procedure more efficient. Everyone is strapped for time. Shorter procedures mean a superior patient experience and benefits to clinicians as well.”

“Conformal coverage has been surprising,” Dr. Rohde said. “We are able to keep our distance from healthy tissues including the urethra while still getting great coverage with Cesium. It’s an ideal isotope for prostate brachytherapy.”

“When it comes to our isotope of choice, our urologists are mostly ambivalent. They are happy to place the needles where we want them. They are happy to place fewer of them per procedure, and they rely on us to keep our program at the forefront of treatment options that benefit all concerned.” Said Dr. Rhode.

Considering the Logistics of Brachytherapy

Some may think that navigating legal, order placement, shipping and safety protocols for brachytherapy seeds are arduous but necessary. How then did Dr. Rohde’s team mitigate the associated headaches?

“No one wants to go through those administrative, legal and safety requirements any more often than is necessary,” Peter said. “The Isoray team handled those elements directly in a very personal way that limited our requirements and kept our focus on our patients. Logistically the transitioning process has been seamless thanks in large part to our local sales representative and the balance of the associated Isoray team. It has been a ‘five-star’ experience.”

Just because it isn’t broken, doesn’t mean it can’t be better

“Don’t be afraid of change,” Dr. Rohde advises. “Given the benefits of efficiencies in planning, procedural delivery, dosimetry, safety and urethral sparing, I encourage my colleagues to take a deeper look at the data and potential for Cesium Blu to benefit their patients and their practice across the board.”

The views and opinions expressed in this article are those of the clinician and do not necessarily reflect the official policy or position of any other agency, organization, employer or company.