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Dennis R. Hill MD HDR Prostate Brachytherapy Specialist Compares Prostate Cancer Treatment Options: Not All Low Dose Rate Brachytherapy Isotopes Are the Same
Date:5/25/2013

Since high dose rate brachytherapy for prostate cancer is a temporary implant there is no radioactive source left in the patient. Cesium 131 is still a permanent seed implant with the same limitations compared to high dose rate brachytherapy. The Cesium 131 seeds are all of uniform strength so it is very difficult to get uniformity of dose with proper spacing of the seeds. The seeds are implanted into deformable tissue and once the seed is implanted it can’t be moved. The dose plan is still done as an estimated pre-plan prior to surgery or on the fly with “real time intra-operative planning” at the time of surgery. In either case the doses are calculated AFTER the implant. In contrast, with high dose rate brachytherapy the implant catheters and treatment positions are known and the dose can be designed in advance of the source delivery. The final treatment plan is completed and approved by the physician before rather than during or after the source is administered.

Dr. Hill notes that other disadvantages of a permanent seed implant are unchanged by the type of isotope. There can be anatomic changes or migration of seeds during the time it takes the permanent seeds to emit the dose, the permanent seeds cannot be placed at the capsule because there is no anchoring tissue, there are prostate size limitations, the bony pubic arch may limit the implant, and so on.

Although Cesium 131 appears to have an advantage over other permanent seed isotopes, in Dr. Hill’s opinion the overall advantage still goes to temporary interstitial high dose rate brachytherapy.

About Dennis R. Hill MD

Dr. Hill has been doing High Dose Rate Brachytherapy exclusively since 2004. He has done over five hundred High Dose Rate Prostate Brachytherapy implants and has published scholarly art
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