CET Cancer Center, High Dose Rate (hdr) Brachytherapy Specialist with 25 years of experience
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As of January 4, 2010 Dr. Demanes and the program have relocated to UCLA.

HDR Brachytherapy for Head and Neck Cancer

Mark


Back to Top1. Introduction


Head and neck cancers include tongue, buccal mucosa (cheek), floor of mouth, oropharynx, palate, tonsil, parotid gland, nasopharynx, and lymph nodes in the neck. Brachytherapy can be done either with an interstitial implant or intracavitary implant but most implants done in this region are interstitial implant.

Table of Content

  1. Introduction
  2. Type of Implant for Head and Neck Cases
  3. Computer Dosimetry
  4. Benefit of HDR Brachytherapy for Head and Neck Cancer

Back to Top2. Type of Implant for Head and Neck Cases

1. Interstitial Implants

In interstitial implants, the catheters are inserted through tissue to encompass the tumor. Tongue, floor of mouth, tonsil, cheek , soft palate and neck nodes are examples of interstitial implants. Interstitial head and neck patients are treated with one implant. This type of complex brachytherapy is done in the operating room with the patient under general anesthesia. Six to 10 treatments are given over a period of 3 to 5 days during which time the patient is hospitalized.

2. Intracavitary Implants

Intracavitary means that catheters are inserted into the oral or nasal cavities to reach the tumor. Topical anesthetic is used to make the insertion of the catheters more comfortable. After the treatment is finished, the patient goes home. Usually, 3 to 6 treatments are given, separated by at least two days.

Back to Top3. Computer Dosimetry

Figure 1: 3-D image of an interstitial implant for base of tongue cancer and right neck lymph node. The treatment catheters are aqua and the 100% radiation dose "cloud" is blue. The rapid dose reduction outside the implant, plus HDR's ability to shape the radiation dose ensures that the doses to normal tissues such as the spinal cord and salivary glands are kept to a minimum.
Figure 2: 3-D image is of an intracavitary implant for a nasopharyngeal cancer. Two treatment catheters are inserted through the nose and curve down the back of the throat. The shape of the isodose cloud is controlled by the ability to adjust the dwell times that the source spends in each catheter.
Figure 3: Salvage Case This is a radiograph of an interstitial implant for a recurrent cancer in the oropharynx. The patient had previously received external beam radiation therapy. CET physicians were asked to perform salvage brachytherapy. Catheters were inserted to treat both sides of the neck and the posterior oropharynx. The radiation doses were shaped so that the spinal cord dose was not exceeded. This is achieved by the high level of dose control possible with the HDR brachytherapy system.

Back to Top4. Benefit of HDR Brachytherapy for Head and Neck Cancer

  1. Potential surgical disfigurement may be avoided and the structure and function is preserved.
  2. Nearby critical structures such as brain, spinal cord and eyes are spared from excessive radiation dose.
  3. In previously irradiated tumors where no further external radiation can be given, HDR brachytherapy can still be used to treat the tumor (salvage brachytherapy).


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Back to TopGeneral Frequently Asked Questions


1. What is Brachytherapy?


The prefix "brachy" is the Greek word for "short" distance. Brachytherapy is a form of internal radiation treatment where radioactive sources are placed on or into cancer tissues. There are two kinds of brachytherapy. The radiation sources may be inserted either permanently or temporarily. The two most common forms of treatment are low dose rate (LDR) permanent seeds for prostate cancer and high dose rate (HDR) temporary brachytherapy, that can be used for prostate, gynecologic, breast, head and neck, lung, esophageal, bile duct, anorectal, sarcoma, and other cancers.

2. What is high dose rate (HDR) Brachytherapy?


High dose rate (HDR) is a technically advanced form of brachytherapy. A high intensity radiation source is delivered with millimeter precision under computer guidance directly into the tumor killing it from the inside out while avoiding injury to surrounding normal healthy tissue. For a more in depth explanation please visit the understanding HDR Brachytherapy page.

3. How does radiation kill cancer?


Cancer is made of abnormal cells that tend to grow without control. Cancer DNA is more sensitive to radiation than are normal cells, so radiation kills cancer directly or when the cells attempt to multiply while normal tissue in the region is able to repair and recover.


4. What are the advantages of HDR Brachytherapy?

  • Short course of treatment compared to other types of radiation treatment (1 week)
  • Preservation of organ structure and function
  • Fewer side effects
  • Excellent coverage of possible microscopic extension of cancer
  • Knowledge of radiation dose distribution before treatment is given
  • Accuracy and precision of tumor specific radiation dose delivery
  • Minimizes areas of radiation overdose (hot spots) or underdose (cold spots)
  • Organ motion (target movement) is not a problem for HDR as it is with external beam
Prostate Specific
Breast Specific
  • Conserves the breast and yields excellent cosmetic results
  • Reduces radiation dose to the heart, lungs, and opposite breast
  • Doesn't cause a delay in other treatments such as chemotherapy

For more information on the advantages for specific cancer sites please click on the appropriate link below:
Prostate cancer | Breast Cancer | Gynecologic Cancer | Head & Neck Cancer
Esophageal and Bile Duct Cancer | Lung Cancer | Soft Tissue Sarcoma Cancer

5. How successful is HDR Brachytherapy?


HDR Brachytherapy is effective treatment of local disease in many forms of cancer including prostate, gynecological, breast, head and neck, esophagus, lung, anorectal, bile duct, sarcoma, and other primary cancer or localized metastasis as reported in medical literature. CET's publication on prostate cancer, for example has demonstrated 90% 10-year tumor control. Success rates for other tumors vary according to the type and stage of cancer being treated.

6. How many treatments has CET administered?


As of 12/31/2009, CET has performed 10,267 HDR implants and delivered 21,878 HDR treatments. Please see our treatment statistics for further details.

7. Why is HDR less well known than other forms of cancer treatment?


HDR Brachytherapy is a relatively new form of advance radiation technology. Fewer physicians have been trained to perform HDR procedures compared to seed implants or external beam radiation. Few centers, other than CET have been dedicated to the development of HDR brachytherapy to its full potential. Dr. Demanes has devoted his career to the advancement of brachytherapy and has pioneered the use of HDR and established CET as a center of excellence with specially trained and experienced staff and physicians.

8. Why should I select CET?

Please see CET Advantage for more information.

Back to TopAbout Us

Membership and affiliations
American Society for Therapeutic Radiology And Oncology
Chair - Health Policy and Economics Practice Management Subcommittee,
Chair - Regulatory Subcommittee, Member - Health Policy and Economic Committee,
Member - Health Policy and Economics Code Development and Valuation Subcommittee,
Member - Code Utilization and Application Subcommittee.
American Brachytherapy Society
Chair - Socioeconomic Committee.
American College of Radiation Oncology
President - 2005 to 2007
American College of Radiology
Fellow - 2007