By Peter T. Heiberger, M.S. DABR, RSO
Lead Medical Physicist, Radiation Oncology, Aurora Health Care, Green Bay, WI
When I think about Cesium-131 an old expression comes to mind. “It’s the little details that are vital. Little things make big things happen.” When it comes to Cesium-131 the details are what made my decision to make a change in radioisotope choice. Cesium-131 is the better choice.
But before I go further, I want you to know that I have become a consultant to Isoray. That figures into my narrative but not in the way you might think. For many years, I chose Palladium-103 for prostate brachytherapy. Neither I nor my colleagues were familiar with Cesium-131. Like so many, I was comfortable with my choice, and I had the mindset of if it’s not broken, why fix it. I wasn’t looking for an alternative. But then I was introduced to Cesium-131.
It quickly became apparent that Cesium-131 provided important differentiators for the prostate cancer patient and for me as a clinician. Due to the shorter half-life and technology of Cesium-131, we can dosimetrically reach our goals better using fewer seeds. The higher energy and specifications of Cesium-131 allow for more ideal dose optimization throughout the prostate gland, achieving all dosimetric qualities while safely sparing the urethra. This radioisotope lends itself to very standard peripheral loading with simple isodose shaping internally.
It is equally important to look at the quality of life for these patients undergoing prostate seed implants. This one and done procedure is ideal for so many patients, however it is only a quality-of-life improvement if they aren’t suffering from potential side effects for a length of time. Due to the shorter half-life, experience has shown that patients recover from side effects much sooner than competing radioisotopes. This allows them to get back to their normal lifestyles and move on from this cancer diagnosis. There is also a safety benefit to Cesium-131. As a radiation safety officer, we understand the importance of radiation education to the patient and their family. The patient must keep a distance from children and pregnant family members. Cesium-131 greatly shortens this timeframe and allows them to get back to their loved ones sooner.
The thought of change can be daunting so when I hear that some clinicians are hesitant to make a change, I understand. There is an established comfort level that begins with your training and continues. But as a clinician, I urge you to have an open mind. I believe you find Cesium-131 is easy to use and its planning benefits appealing. In short, it is quite easy to make the switch.
We all recognize that patients and their clinical health choices are important. I chose to share my thoughts in this blog with other clinicians because I feel strongly that it is important to understand the high value of Cesium-131 and how it improves dosimetric quality and goals. That it brings beneficial improvement for the patients’ quality of life represents yet another compelling argument for change.
I am hopeful that the near effortless transition and the availability of resources to support that transition, will encourage you to take a meaningful look at Cesium-131. You have nothing to lose by learning about Cesium-131 and I am confident you will see how much there is to gain; it is the best option.
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