It’s the Details That Make Cesium-131 The Better Choice

By Brian J. Moran, M.D. FABS Medical Director, Prostate Cancer Foundation of Chicago

I am a radiation oncologist who, like many of you, has always looked for opportunities to do more for those I treat. That is how I first learned about Cesium-131 brachytherapy. In the 1990s, I saw the potential for prostate brachytherapy and that led me to Cesium-131.

My usage of what I recognized as an innovative isotope ultimately brought me to the Cesium Advisory Group or “the CAG”. We are a group of physicians and physicists that first met in 2009 when Cesium-131 had just been made available for prostate brachytherapy. At that time, we knew the technical details related to the Cesium-131 isotope, but there was little practical experience with using it in the treatment of prostate cancer.

As a group of professionals who would be involved with the practical application in treating actual patients with this new isotope, we had a number of thought-provoking discussions. We discussed what we thought would be of importance to the larger brachytherapy community in terms of offering information and suggestions that we believed might be helpful in understanding and using this isotope. The information we put together was published in 2010 in the scientific journal I know so many of you are familiar with, Brachytherapy.

Now, flash forward to 2020. Ten years later the CAG decided to reconvene. At this point, we recognized that a number of the fundamental questions about Cesium-131 as a prostate cancer treatment had been answered. For example, we knew by 2020 that Cesium-131 was highly effective at treating localized prostate cancer.

Existing information made it clear for those that had either little or no familiarity or experience that it was at least as effective as the older isotopes. Scientific evidence in two long-term clinical series had been published by 2020 establishing this effectiveness.

Still, because we in the CAG were now experienced implanters, we thought it was important to look at what lessons had been learned at this point that would be beneficial to share.

This discussion ultimately led to the submission of two study summaries to the American Brachytherapy Society annual 2022 meeting.  I presented these before the meeting attendees in Denver in June.

My presentation focused on two abstracts. The first abstract is entitled, Technique and Preferences for Permanent LDR Prostate Brachytherapy Using Cesium-131. In this study from the CAG, we found that although all of the members intended to reach the same result – to implant the prostate gland of our patients with a cancer defeating dose of Cesium-131 – we all did it in a bit of a different way. All these differences might fill up a few blogposts, but the key overarching result we all took away from this analysis was that there are several ways to accomplish our objective of implanting Cesium-131, and that personal preferences are likely here to stay. We all believe this is important because we recognize the value in the flexibility of usage that embraces a variety of personal preferences and maintains effectiveness.

The second abstract was Permanent LDR brachytherapy using Cesium-131 Monotherapy: Updated Recommendations from the Cesium Advisory Group. Interestingly, some of the findings from the group varied somewhat from the CAG’s original recommendations in 2010.

We found that we agreed that the Cesium-131 implant should be more “homogenous” than was originally thought. Simply put, physicians implanting Cesium-131 for their prostate cancer patients could avoid areas of the “overdose” and still obtain very good cancer control outcomes. And by avoiding overdose, it might be possible to achieve aggravation to the prostate gland (that might lead to urinary symptoms), and the best possible implant might be attained.

At the time of this writing, the abstracts were awaiting publication in the journal, Brachytherapy. I hope you will have the opportunity to carve out a a little time from what I know all too well is a very busy schedule to take a look.

Ultimately, as clinicians, I encourage you to look at Cesium-131 if you aren’t currently using it and, whether you are or are not now using this isotope, I am hopeful that the CAG’s insight will prove beneficial.

It all boils down to this. You know the statistics. Prostate cancer is the second leading cause of cancer death in American men. We in the CAG hope the information we provide will offer you further insight because we have found that Cesium-131 provides a valuable treatment option for prostate cancer.


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