Search

Spatially Fractionated Radiation therapy (SFRT) has a history of over 100 years. The principle of SFRT is distinctive from the standard radiation approaches, as it treats the total tumor with a non-uniform dose, effectively treating the tumor while staying within normal tissue tolerance of the surrounding structures. Historically, SFRT is frequently used to treat bulky malignant tumors with a high radiation dose in the stereotactic radiosurgery (SRS)/stereotactic body radiotherapy (SBRT) dose range (10–20 Gy per fraction) using megavoltage x-ray beams. The application of SFRT, historically known as GRID therapy, has produced dramatic relief of severe symptoms, significant objective regression, above average local control rates and minimal toxicity in palliative settings [1]. The advancement of physics and technology has provided more techniques to deliver SFRT. Some understandings of radiobiology and immunology have been generated from studies of SFRT. These promising clinical results have generated a renewed interest in this technique at many centers in the United States and internationally. A series of novel application of SFRT in clinical trials are being anticipated in the near future. Here, we summarize the history, the present and the future of SFRT. As current reviews of SFRT are lacking, we present a comprehensive review of SFRT and its clinical implications.

Purpose Little is known about the financial burden experienced by patients receiving radiation therapy. Furthermore, currently, no financial toxicity screening tools have been validated for use in radiation oncology. Methods and Materials Physician surveys were used to gauge provider understanding of treatment costs and their willingness to adopt the use of financial toxicity screening tools. Post-treatment patient surveys were used to investigate the covariates of treatment-induced financial risk. Results Of the 210 radiation oncologists who completed our survey, 53% reported being “very concerned” with treatment-related costs negatively affecting their patients, and 80% believed that a financial toxicity screening tool would be useful in practice. An analysis of patient surveys using logistic regression found age and cancer site to be the most important variables associated with financial toxicity. Thirty-four patients (22%) experienced financial toxicity related to treatment. The financial toxicities experienced were loss of job (28%), loss of income (24%), difficulty paying their rent or mortgage (20%), difficulty paying for transportation (15%), and difficulty paying for meals (13%). Conclusions Financial toxicity is an important measure for patients and providers and is experienced by approximately one quarter of patients. Further studies to improve models to predict financial toxicity and how financial toxicity is related to patient outcomes and quality of life are warranted.

Background Measuring patient-reported outcomes (PROs) requires an individual’s perspective on their symptoms, functional status, and quality of life. Digital health enables remote electronic PRO (ePRO) assessments as a clinical decision support tool to facilitate meaningful provider interactions and personalized treatment. Objective This study explored the feasibility and acceptability of collecting ePROs using validated health-related quality of life (HRQoL) questionnaires for prostate cancer. Methods Using Apple ResearchKit software, the Strength Through Insight app was created with content from validated HRQoL tools 26-item Expanded Prostate Cancer Index Composite (EPIC) or EPIC for Clinical Practice and 8-item Functional Assessment of Cancer Therapy Advanced Prostate Symptom Index. In a single-arm pilot study with patients receiving prostate cancer treatment at Thomas Jefferson University Hospital and affiliates, participants were recruited, and instructed to download Strength Through Insight and complete ePROs once a week over 12 weeks. A mixed methods approach, including qualitative pre- and poststudy interviews, was used to evaluate the feasibility and acceptability of Strength Through Insight for the collection and care management of cancer treatment. Results Thirty patients consented to the study; 1 patient failed to complete any of the questionnaires and was left out of the analysis of the intervention. Moreover, 86% (25/29) reached satisfactory questionnaire completion (defined as completion of 60% of weekly questions over 12 weeks). The lower bound of the exact one-sided 95% CI was 71%, exceeding the 70% feasibility threshold. Most participants self-identified with having a high digital literacy level (defined as the ability to use, understand, evaluate, and analyze information from multiple formats from a variety of digital sources), and only a few participants identified with having a low digital literacy level (defined as only having the ability to gather information on the Web). Interviews were thematically analyzed to reveal the following: (1) value of emotional support and wellness in cancer treatment, (2) rise of social patient advocacy in online patient communities and networks, (3) patient concerns over privacy, and (4) desire for personalized engagement tools. Conclusions Strength Through Insight was demonstrated as a feasible and acceptable method of data collection for ePROs. A high compliance rate confirmed the app as a reliable tool for patients with localized and advanced prostate cancer. Nearly all participants reported that using the smartphone app is easier than or equivalent to the traditional paper-and-pen approach, providing evidence of acceptability and support for the use of remote PRO monitoring. This study expands on current research involving the value of digital health, as a social and behavioral science, augmented with technology, can begin to contribute to population health management, as it shapes psychographic segmentation by demographic, socioeconomic, health condition, or behavioral factors to group patients by their distinct personalities and motivations, which influence their choices. Trial Registration ClinicalTrials.gov NC03197948; http://clinicaltrials.gov/ct2/show/NC03197948

BACKGROUND Measuring patient-reported outcomes (PROs) requires an individual’s perspective on their symptoms, functional status, and quality of life. Digital health enables remote electronic PRO (ePRO) assessments as a clinical decision support tool to facilitate meaningful provider interactions and personalized treatment. OBJECTIVE This study explored the feasibility and acceptability of collecting ePROs using validated health-related quality of life (HRQoL) questionnaires for prostate cancer. METHODS Using Apple ResearchKit software, the Strength Through Insight app was created with content from validated HRQoL tools 26-item Expanded Prostate Cancer Index Composite (EPIC) or EPIC for Clinical Practice and 8-item Functional Assessment of Cancer Therapy Advanced Prostate Symptom Index. In a single-arm pilot study with patients receiving prostate cancer treatment at Thomas Jefferson University Hospital and affiliates, participants were recruited, and instructed to download Strength Through Insight and complete ePROs once a week over 12 weeks. A mixed methods approach, including qualitative pre- and poststudy interviews, was used to evaluate the feasibility and acceptability of Strength Through Insight for the collection and care management of cancer treatment. RESULTS Thirty patients consented to the study; 1 patient failed to complete any of the questionnaires and was left out of the analysis of the intervention. Moreover, 86% (25/29) reached satisfactory questionnaire completion (defined as completion of 60% of weekly questions over 12 weeks). The lower bound of the exact one-sided 95% CI was 71%, exceeding the 70% feasibility threshold. Most participants self-identified with having a high digital literacy level (defined as the ability to use, understand, evaluate, and analyze information from multiple formats from a variety of digital sources), and only a few participants identified with having a low digital literacy level (defined as only having the ability to gather information on the Web). Interviews were thematically analyzed to reveal the following: (1) value of emotional support and wellness in cancer treatment, (2) rise of social patient advocacy in online patient communities and networks, (3) patient concerns over privacy, and (4) desire for personalized engagement tools. CONCLUSIONS Strength Through Insight was demonstrated as a feasible and acceptable method of data collection for ePROs. A high compliance rate confirmed the app as a reliable tool for patients with localized and advanced prostate cancer. Nearly all participants reported that using the smartphone app is easier than or equivalent to the traditional paper-and-pen approach, providing evidence of acceptability and support for the use of remote PRO monitoring. This study expands on current research involving the value of digital health, as a social and behavioral science, augmented with technology, can begin to contribute to population health management, as it shapes psychographic segmentation by demographic, socioeconomic, health condition, or behavioral factors to group patients by their distinct personalities and motivations, which influence their choices. CLINICALTRIAL ClinicalTrials.gov NC03197948; http://clinicaltrials.gov/ct2/show/NC03197948

Purpose To study the impact of seed localization, as performed by different observers using linked 125I seeds, on postimplant dosimetry in prostate brachytherapy and, to compare transrectal ultrasound (TRUS)-based with CT-based approach for the dosimetric outcomes. Methods and Materials Nineteen permanent prostate implants were conducted using linked 125I seeds. Postimplant TRUS and CT images were acquired and prostate glands were, after implantation, delineated on all images by a single oncologist, who had performed all 19 seeding procedures. Six observers independently localized the seeds on both TRUS and CT images, from which the principle dosimetric parameters V100 (volume of prostate that received the prescribed dose), V150 (volume of prostate that received 150% of the prescribed dose), and D90 (minimal dose delivered to 90% of the prostate) were directly calculated for each patient. A single-factor analysis of variance was first applied to determine interobserver variability in seed localization. A nonparametric comparison of the approach using TRUS and CT was then carried out by the Wilcoxon paired-sample test. Results Analysis from the analysis of variance for TRUS showed that the null hypothesis for equal means, could not be rejected for all six observers based on a significance level α = 0.05. TRUS-based and CT-based approaches were then cross compared by the Wilcoxon paired-sample test, which suggested that the null hypothesis was insignificant for V100 and D90, but was significant for V150. Conclusions Both TRUS- and CT-imaging modalities provided indistinguishable postimplant dosimetry results as far as V100 and D90 were concerned. There was comparable observer independence between TRUS- and CT-based seed localization for linked-seed implant procedures. With other advantages that TRUS-imaging modality had over CT in the evaluation of postimplant dosimetry, TRUS would be a preferred choice in conjunction with linked seeds for intraoperative procedures in prostate brachytherapy.

To investigate interobserver variability in contouring the prostate on postimplant transrectal ultrasonography (TRUS) images and its effect on dosimetric parameters that quantify implant quality.Twenty preplanned peripherally loaded prostate implants were performed using 125I seeds and spacers linked together in linear arrays that maintain precise seed spacing and prevent seeds from rotating about their longitudinal axis. A set of two-dimensional transverse images spaced at 0.50-cm intervals was obtained with a high-resolution TRUS probe at the conclusion of the procedure with the patient still under anesthesia. A high percentage of the seeds (85%) were localized based on their visible echoes. The remaining seeds were identified based on the known locations of the "missing" seeds in the arrays. Two experienced ultrasonographers and a prostate brachytherapist independently contoured the prostate on the postimplant TRUS images. The prostate volumes defined by each observer were used to calculate the minimal dose received by 90% of the prostate volume (D90) and the percentage of the prostate volume receiving 100% of the prescribed minimal peripheral dose (V100). The observers also contoured the prostate on six preimplant TRUS studies to compare the variability in defining the prostate on pre- and postimplant TRUS images.The mean postimplant prostate volumes ranged from 20.8 to 66.9 cm3 (median: 45.7 cm3). The standard deviations (SDs), which reflect the variation in the volumes of the three observers, ranged from 1.4% to 26.1% of the mean (median: 11%). Multiple pairwise comparisons showed that the prostate volumes delineated by observer 3 differed significantly from those of observers 1 and 2 (p0.003). The volumes of observers 1 and 2 were not significantly different (p0.5). The mean values of D90 ranged from 124.2 to 171.1 Gy (median: 154.7 Gy) having SDs that ranged from 0.6% to 24.4% of the mean D90 (median: 7.8%). The mean values of V100 ranged from 82.3% to 95.1% (median: 92.8%) having SDs that ranged from 0.4% to 11.2% of the mean V100 (median: 4.0%). The values of both D90 and V100 calculated from the volumes of observer 3 were significantly (p0.003) different from those of observers 1 and 2, which did not differ significantly (p0.5). There was less interobserver variability in contouring the preimplant TRUS volumes. The mean volumes ranged from 20.3 to 54.3 cm3 having SDs that ranged from 1.9% to 14.1% (median: 8.6%).Significant interobserver differences in delineating the prostate volume on postimplant TRUS images were observed; however, these differences were less than generally reported for postimplant CT images. The interobserver differences in contouring the prostate in both TRUS and CT images produced significant differences in the dosimetric parameters, D90 and V100.

Melanoma exhibits heterogeneous growth patterns and widely varying sensitivities to multiple treatment modalities. This variability may reflect intrinsic genetic differences in factors giving rise to altered metabolism. Glucose is the primary energy source of tumours, including melanoma, and glucose transporter isoform 1 (Glut-1) and hexokinase are key rate-limiting factors in glucose metabolism. The levels of Glut-1 and total hexokinase activity were measured in 31 melanoma biopsies to determine the extent of tumour-to-tumour variability in these parameters. Relative Glut-1 levels were determined by Western immunoblot analysis using human anti-Glut-1 rabbit polyclonal antibody, and hexokinase activity was measured in the same samples by an enzymatic assay monitoring the reduction in the oxidized form of nicotinamide adenine dinucleotide phosphate (NADP+) (in nmol NADP+ reduced/min per mg protein). All melanomas were from patients who had received no therapy prior to surgery. Immediately after excision, tumour biopsies were disaggregated to single cells by collagenase and DNase and frozen in liquid nitrogen. Thirty human melanomas exhibited a 22-fold variation in levels of Glut-1 and 29 exhibited a nine-fold variation in total cellular hexokinase activity. Glut-1 levels and hexokinase activity were not correlated with one another. The broad range in Glut-1 levels and hexokinase activity observed between melanomas suggests that these glycolytic rate-limiting parameters that influence the rate of glucose metabolism may contribute to the variability in melanoma response to treatment modalities.

Early stage, medically inoperable non-small-cell lung cancer is a treatable disease. A thorough clinical work-up is necessary to optimize management for this group of patients. Thoracic radiation therapy has been used for such patients with achievement of durable local control and prolonged survival. To improve upon the results of standard fractionation radiation therapy, novel approaches are needed. Dose escalation may further enhance local tumor control and survival rates. Efforts to minimize irradiation to normal lung parenchyma are necessary. Multiple strategies to optimize the therapeutic ratio are being investigated. Elimination of elective nodal irradiation may reduce late toxicity of treatment but may compromise locoregional control. Other strategies, such as intensity-modulated radiation therapy with dose volume histograms will help minimize lung parenchyma irradiation, which will reduce the probability of radiation pneumonitis. Chemotherapy appears to play a minimal role in the treatment of inoperable limited disease, but researchers continue to conduct investigational trials with active chemotherapeutic agents in the hopes of reducing local and distant tumor failures.

Lovastatin is a widely used anticholesterolemic drug which exercises its effect by inhibiting hepatic cholesterol synthesis and up-regulating low density lipoprotein (LDL) receptors. In the present study, we determined that the drug has no adverse effects on the expression of three cell surface antigens of human monocytes, i.e. high affinity Fc receptors (Fc gamma RI), low affinity Fc receptors (Fc gamma RII) and CD14 antigen. We have shown previously these antigens are regulated by cholesterol and lipoproteins. At 0.5 micrograms/mL of culture medium, lovastatin did not reduce the percentage of receptor-positive cells or the average number of receptor molecules per cell. These observations add to the attractiveness of the drug as an anticholesterolemic agent and also indicate that endogenous cholesterol biosynthesis by monocytes is not required for expression of Fc gamma RI, Fc gamma RII, or CD14.

Plasma lipoproteins have been implicated in immunoregulation. Here we report that LDL and VLDL up-regulate high affinity Fc receptors (Fc gamma RI) in normal human monocytes. Adherent monocytes were cultured for 4 days in media containing fetal calf serum or delipidated serum. Immunofluorescence analysis showed a significant decrease in percentage of Fc gamma RI-positive cells from 85 +/- 3 in medium containing normal serum to 54 +/- 9 in medium containing delipidated serum. The decrease in the fraction of cells expressing Fc gamma RI was parallel to a decrease in the average number of receptor molecules per cell as indicated by a decrease in the mean value fluorescence intensity from 234 +/- 20 to 112 +/- 14. The inhibition of Fc gamma RI expression was overcome by addition to the culture medium of LDL or VLDL. Since pure cholesterol is ineffective, it is proposed that these lipoproteins deliver a component(s) such as apolipoprotein B-100 which triggers a signal leading to up-regulation of Fc gamma RI in monocytes and macrophages.

Context Pilomatrixoma is a common head and neck neoplasm in children. Its malignant counterpart, pilomatrix carcinoma, is rare and found more often in men. Method Case report of a 21-year-old man with pilomatrixoma of the thoracic spine that underwent malignant degeneration to pilomatrix carcinoma. Findings The appearance of a painless mobile axillary mass was followed by severe back pain 1 year later. Imaging revealed a compression fracture at the T5 level. The patient underwent resection of the axillary mass and spinal reconstruction of the fracture; the pathology was consistent with synchronous benign pilomatrixomas. Three months later he presented with a recurrence of the spinal lesion and underwent further surgical resection; the pathology was consistent with pilomatrix carcinoma. He received adjuvant radiotherapy and at his 1-year follow-up examination had no sign of recurrence. Conclusion/clinical relevance Pilomatrix carcinoma involving the spine is a rare occurrence. It has a high incidence of local recurrence, and wide excision may be necessary to reduce this risk. Radiotherapy may be a helpful adjuvant therapy. Clinicians should be aware of this entity because of its potential for distant metastasis.

Purpose: To demonstrate that 125 I seeds can be localized in transrectal ultrasound (TRUS) images obtained with a high-resolution probe when the implant is performed with linked seeds and spacers. Adequate seed localization is essential to the implementation of TRUS-based intraoperative dosimetry for prostate brachytherapy. Methods and Materials: Thirteen preplanned peripherally loaded prostate implants were performed using 125 I seeds and spacers linked together in linear arrays that prevent seed migration and maintain precise seed spacing. A set of two-dimensional transverse images spaced at 0.50-cm intervals were obtained with a high-resolution TRUS probe at the conclusion of the procedure with the patient still under anesthesia. The image set extended from 1.0 cm superior to the base to 1.0 cm inferior to the apex. The visible echoes along each needle track were first localized and then compared with the known construction of the implanted array. The first step was to define the distal and proximal ends of each array. The visible echoes were then identified as seeds or spacers from the known sequence of the array. The locations of the seeds that did not produce a visible echo were interpolated from their known position in the array. A CT scan was obtained after implantation for comparison with the TRUS images. Results: On average, 93% (range, 86–99%) of the seeds were visible in the TRUS images. However, it was possible to localize 100% of the seeds in each case, because the locations of the missing seeds could be determined from the known construction of the arrays. Two factors complicated the interpretation of the TRUS images. One was that the spacers also produced echoes. Although weak and diffuse, these echoes could be mistaken for seeds. The other was that the number of echoes along a needle track sometimes exceeded the number of seeds and spacers implanted. This was attributed to the overall length of the array, which was approximately 0.5 cm longer than the center-to-center distance between the first and last seed owing to the finite length of the seeds at the ends of the array. When this occurred, it was necessary to disregard either the most distal or most proximal echo, which produced a 0.5-cm uncertainty in the location of the array in the axial direction. For these reasons, simply localizing the visible echoes in the TRUS images did not guarantee the reliable identification of the seeds. Conclusion: Our results have demonstrated that a high percentage (>85%) of the implanted 125 I seeds can be directly visualized in postimplant TRUS images when the seeds and spacers are linked to preclude seed migration and rotation and when the images are obtained with a high-resolution TRUS probe. Moreover, it is possible to localize 100% of the seeds with the mechanism of linked seeds because the locations of the missing seeds can be determined from the known construction of the arrays.

Radiotherapy is an effective locoregional cancer treatment aimed at achieving tumor control. For almost a century, radiation has been used as a curative and/or palliative form of treatment alone or in combination with other treatment modalities for non–small-cell lung cancer. Trials are ongoing to investigate the value of altered fractionation radiation therapy alone or in combination with novel chemotherapy agents such as taxanes and gemcitabine, while monitoring for related toxicities. Attempts at minimizing the amount of normal tissue irradiated with three-dimensional treatment planning and/or protecting normal tissues with a radioprotector may allow for therapeutic escalation of radiation dose with further success at treating our nation's number one cause of cancer-related mortality.

Limited information is available in the medical literature on thoracic reirradiation for patients with recurrent/persistent lung carcinoma or new primary lung tumors. Controversy exists regarding the retreatment because of concerns regarding the risk of radiation toxicity. The medical and radiotherapeutic records of more than 1,500 patients with lung cancer seen in the Department of Radiation Oncology at Thomas Jefferson University Hospital from 1982 through 1997 were searched. Twenty-three patients with history of previous thoracic radiation therapy underwent thoracic reirradiation for either biopsy-proven and/or radiographically evident tumor recurrence, metastasis, or second lung primary. Most patients were reirradiated because of progressive dyspnea, cough, thoracic pain, or hemoptysis. Each of these symptoms was evaluated separately with regard to the subjective response to reirradiation. The median follow-up time from completion of reirradiation to last correspondence with the patient and/or family was 3.2 months, with a range of 0 to 17.5 months. In six patients with hemoptysis, a decrease or resolution of this symptom was noted. Of five patients with thoracic pain attributed to carcinoma, four noted an improvement in pain after reirradiation. Of 15 patients with cough, 9 had an improvement in cough, and of 15 patients with dyspnea, 11 had an improvement. Thoracic reirradiation is an effective modality in patients with hemoptysis, thoracic pain, cough, and dyspnea attributed to a radiographically defined recurrence and/or progression of lung cancer.

Limited information is available in the medical literature on epidemic Kaposi sarcoma (EKS) of the foot. Patients with EKS of the foot can experience severe discomfort that makes it difficult to ambulate and even wear shoes. Between 1985 and 1996, 36 patients with EKS of the foot were treated with palliative intent. Most patients were referred for radiation therapy because of foot discomfort or marked difficulty with ambulation. From the pool of 36 patients, data were available at completion of treatment for 46 sites, and at 1 month for 44 sites. Morbidity was assessed for 35 sites. The median follow-up time for the 44 sites with at least 1 month follow-up was 8 months. The most frequently used regimen was a novel fractionation schedule of three fractions a week at 3.5 Gy/fx to a total dose of 21.0 Gy. The overall response rate and complete response rate for the 44 sites with at least 1 month follow-up were 91% and 80%, respectively. The 46 treated sites evaluated at the completion of treatment had a complete response rate of only 13% and an overall response rate of 63%. Of the 35 sites assessed for acute toxicity, 63% experienced discomfort related to the radiation therapy. This discomfort usually resolved without intervention within 2 weeks of completion of radiation therapy. For patients with and without a history of opportunistic infections, complete responses were observed in 8 of 12 sites (67%) and 25 of 27 sites (93%), respectively (p = 0.06). Radiation therapy for EKS of the foot yields excellent response rates, comparable with responses seen in other cutaneous sites with EKS. Appropriate patient education and support are needed because initial responses to radiation therapy are often disappointing and pedal discomfort can be exacerbated transiently. However, the discomfort resolves and complete response occurs in most patients. The 3.5-Gy triweekly fractionation schedule is a convenient and effective regimen and minimizes treatment visits for patients with ambulatory discomfort. A history of opportunistic infections appears to be a poor prognosticator of response to radiation treatments.

Purpose: To study the impact of seed localization, as performed by different observers using linked I‐125 seeds, on post‐implant dosimetry in prostate brachytherapy and to compare TRUS‐based with CT‐based approach for the dosimetric outcomes. Method and Materials: Permanent prostate implant is conducted using linked I‐125 seeds. Both post‐implant TRUS and CTimages were acquired and the prostate glands were delineated on each of those images by a single oncologist, who performed the seeding procedures for all 19 patients under study. Six observers then independently localized the seeds on both TRUS and CTimages, based on which the principle dosimetric parameters V100, V150 and D90 were directly calculated for each patient. A single‐factor analysis of variance (ANOVA) is first applied to determine inter‐observer variability in seed localization. A non‐parametric comparison of the approach using the two imaging modalities, TRUS and CT, is then carried out by the Wilcoxon paired‐sample test. Results: Analysis from the ANOVA for TRUS (V100: P=0.655; V150: P=0.994; D90: P=0.734) and CT (V100: P=0.901; V150: P=0.999; D90: P=0.99) shows that the null hypothesis for equal means, cannot be rejected for all six observers based on a significance level α=0.05. TRUS‐based and CT‐based approaches are then cross‐compared by the Wilcoxon paired‐sample test, which suggests that the null hypothesis is not rejectable for V100 and D90, but is for V150. Conclusion: Both TRUS and CTimaging modalities provide indistinguishable post‐implant dosimetry results as far as V100 and D90 are concerned. TRUS‐based seed localization has comparable observer independence as CT‐based seed localization for linked‐seed implant procedures. In view of other advantages that TRUSimaging modality has over CT in the evaluation of post‐implant dosimetry,TRUS can therefore be an alternative gold standard to CT and would be a preferred choice together with linked‐seed for intra‐operative procedures ins prostate brachytherapy.

Purpose: To perform a dosimetric analysis and comparison of Cesium‐131 and Iodine‐125 for permanent prostate brachytherapy.Method and Materials:TRUS prostate volume studies of 30 patients treated in our institution with a wide range of prostate size were included in this study. The average gland size was 31.13cc (from 15.22cc to 51.49cc). Treatment plans were generated using Variseed 7.1 with both Cesium‐131 (with an activity of 2.1U, prescription of 115 Gy) and Iodine‐125 (with an activity of 0.521U, prescription of 145 Gy). Prostate, rectum, urethra were contoured by the same radiation oncologist. The Auto Source Placement tool of the software was first used to create treatment plans for both Cesium‐131 and Iodine‐125. The plans were then adjusted to meet the treatment goals and achieve the same dose coverage (V100, V90, D90) of the prostate for both isotopes. The dose to the prostate (V100, V90, V80, D90), rectum (RV100, RD10), urethra (UD10), and dose inhomogeneity (V150, V200) were reported. Results: For 30 patients, the average of V100, V90, V80, D90 for the prostate was 98.58%, 99.46%, 99.95%, 134.7 Gy and 98.49%, 99.57%, 99.87%, 170.4 Gy for Cesium‐131 and Iodine‐125 respectively. V200 and V150 of prostate were 22.06%, 49.20% for Cesium‐131, and 22.57%, 51.38% for Iodine. UD10 and RD10 were 81.17%, 127.79% of the prescription for Cesium‐131, and 82.58%, 129.44% of the prescription for Iodine. There was a decrease of 27.5% rectum RV100 (0.24cc for Cesium, and 0.33 for Iodine, with a p‐value of 0.05) when planning for Cesium‐131 as compared to Iodine‐125. Conclusion: Cesium‐131 prostate brachytherapy can provide a homogeneous dose distribution, dose coverage compared with Iodine‐125 seeds implant, while reducing the overall dose to the rectum. Large volume of patient studies is needed to validate this statement.