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.

Breast Cancer Publications

Studies of High Dose Rate Brachytherapy for Breast Cancer


Breast Publications

  1. The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy
  2. Accelerated partial breast irradiation using MammoSite brachytherapy: a multidisciplinary approach to breast-conservation therapy
  3. Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy

Back to Top1. The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy


Article Name: The use of high-dose-rate brachytherapy alone after lumpectomy in patients with early-stage breast cancer treated with breast-conserving therapy

Author: Kathy L. Baglan M.D., Alvaro A. Martinez M.D., F.A.C.R., Robert C. Frazier M.D., Vijay R. Kini M.D., Larry L. Kestin M.D., Peter Y. Chen, M.D., Greg Edmundson M.S., Elizabeth Mele M.S., David Jaffray Ph.D., and Frank A. Vicini M.D.

Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI
Published Date: July 15, 2001

Medical Journal: International Journal of Radiation Oncology Biology and Physics (IJROBP) Vol. 45, No.1 pp. 105-112, 1999

Abstract:

Purpose:


We present the preliminary results of our in-house protocol using outpatient high-dose-rate (HDR) brachytherapy as the sole radiation modality following lumpectomy in patients with early-stage breast cancer.

Methods and Materials:


Thirty-seven patients with 38 Stage I–II breast cancers received radiation to the lumpectomy cavity alone using an HDR interstitial implant with 192Ir. A minimum dose of 32 Gy was delivered on an outpatient basis in 8 fractions of 4 Gy to the lumpectomy cavity plus a 1- to 2-cm margin over consecutive 4 days.

Results:


Median follow-up is 31 months. There has been one ipsilateral breast recurrence for a crude failure rate of 2.6% and no regional or distant failures. Wound healing was not impaired in patients undergoing an open-cavity implant. Three minor breast infections occurred, and all resolved with oral antibiotics. The cosmetic outcome was good to excellent in all patients.

Conclusion:


In selected patients with early-stage breast cancer, treatment of the lumpectomy cavity alone with outpatient HDR brachytherapy is both technically feasible and well tolerated. Early results are encouraging, however, longer follow-up is necessary before equivalence to standard whole-breast irradiation can be established and to determine the most optimal radiation therapy technique to be employed.


Back to Top2. Accelerated partial breast irradiation using MammoSite brachytherapy: a multidisciplinary approach to breast-conservation therapy


Article Name: Accelerated partial breast irradiation using MammoSite brachytherapy: a multidisciplinary approach to breast-conservation therapy

Author: Kim N. Vu, M.D., Anthony E. Dragun, M.D., David J. Cole, M.D., and Joseph M. Jenrette, M.D.

Departments of Radiation Oncology and General Surgery, Medical University of South Carolina, Charleston, SC
Published Date:November/December 2005

Medical Journal:Community Oncology, Volume 2, Number 6, Pages 477-482

Abstract:

MammoSite balloon brachytherapy (MBT) is a relatively new technique for the delivery of adjuvant radiation therapy in the setting of breast conservation. Its application is gaining widespread popularity for its ease of reproducibility and its capacity to reduce the overall treatment time and morbidity traditionally associated with whole-breast radiotherapy. The Medical University of South Carolina was one of the first institutions in the country to adopt the use of MBT, and over the past 3 years we have treated almost 100 patients with this system. Initiation of an MBT program requires close coordination between the treating radiation oncologist and breast surgeon in order to maximize the potential advantages of MBT and minimize its pitfalls. This article will describe the steps that we have used for successful MammoSite implantation and treatment and will detail how our technique has evolved with time and experience.

Back to Top3. Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy


Article Name: Initial clinical experience with the MammoSite breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy

Author: Martin Keisch M.D., Frank Vicini M.D., Robert R. Kuske M.D., Mary Hebert M.D., Julia White M.D., Coral Quiet M.D., Doug Arthur M.D., Troy Scroggins M.D., and Oscar Streeter M.D.

Department of Radiation Oncology, Mount Sinai Medical Center, Miami Beach, FL; Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI; Department of Radiation Oncology, University of Wisconsin, Madison, WI; Department of Radiation Oncology, US Oncology, Sherman, TX; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, Arizona Oncology, Phoenix, AZ; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA; Department of Radiation Oncology, Ochsner Clinic, New Orleans, LA; Department of Radiation Oncology, University of Southern California Norris Cancer Center, Los Angeles, CA

Published Date: February 1, 2003

Medical Journal: International Journal of Radiation Oncology Biology and Physics (IJROBP) Vol. 55, No.2, pp. 289-293

Abstract:

Purpose:


We present the results of the previous initial clinical testing of the MammoSite balloon breast brachytherapy applicator in women with early-stage breast cancer treated with breast-conserving therapy.

Methods and Materials:


Seventy patients were enrolled in a multicenter prospective trial testing the applicator for safety and performance. Fifty-four patients were implanted, and 43 patients were ultimately eligible for and received brachytherapy as the sole radiation modality after lumpectomy. Patients were staged T1N0M0 with negative pathologic margins and age >45 years. A dose of 34 Gy was delivered in 10 fractions over 5 days prescribed to 1 cm from the applicator surface using 192Ir high-dose-rate brachytherapy. A minimum skin-to-balloon surface distance of 5 mm was required for treatment. Device performance, complications, and cosmesis were assessed.

Results:


Computed tomography imaging post-balloon inflation showed 8, 14, and 21 patients with 5–6 mm, 7–9 mm, and >10 mm of skin spacing, respectively. Two patients were explanted because of inadequate skin spacing and 7 because of suboptimal conformance of the surgical cavity to the applicator balloon. One patient was explanted because of positive nodal status and another because of age. The most common side effects related to device placement included mild erythema, drainage, pain, and echymosis. No severe side effects related to implantation, brachytherapy, or explantation occurred. Side effects related to radiation therapy were generally mild with erythema, pain, and dry desquamation being the most common. At 1 month, 88% of patients were evaluated as having good-to-excellent cosmetic results.

Conclusion:


The MammoSite balloon breast brachytherapy applicator performed well clinically. All eligible patients completed treatment. Side effects were mild to moderate and self-limiting. Skin-balloon surface distance and balloon-cavity conformance were the main factors limiting the previous initial use of the device.



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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