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.

Gynecologic Cancer Publications

Studies of High Dose Rate Brachytherapy for Gynecologic Cancer


Gynecologic Publications

  1. The American Brahytherapy Society Recommendations for High-Dose-Rate Brachytherapy for Carcinoma of The Cervix
  2. High Dose Rate Transperineal Interstitial Brachytherapy for Cervical Cancer: High Pelvic Control and Low Complication Rates
  3. The Use and Advantages of a Multichannel Vaginal Cylinder in High Dose Rate Brachytherapy
  4. Low Dose Rate Brachytherapy in Vaginal Carcinoma: Long Term Outcome and Morbidity

Back to Top1. The American Brachytherapy Society Recommendations for High-Dose-Rate Brachytherapy for Carcinoma of The Cervix


Article Name: The American Brachytherapy Society Recommendations for High-Dose-Rate Brachytherapy for Carcinoma of The Cervix

Author: SubIr Nag, M.D., Beth Ericson, M.D., Bruce Thomadsen, M.D., Colin Orton, Ph.D., Jeffrey D. Demanes, M.D., and Daniel Petereit, M.D., for the American Brachytherapy Society.
Instution: Ohio State University, Columbus, OH; Medical College of Wisconsi, Milwaukee, WI; The University of Wisconsin, Madison, WI; Wayne State University, Detroit, MI; Califrnia Endocurietherapy Cancer Center, Oakland, CA

Published Date: February 2000

Medical Journal: International Journal of Radiation Oncology Biology Physics Volume 48 Issue 1, 1 Augues 2000, Page 2001-211

Abstract:

Purpose:


This paper describes California Endocurietherapy’s (CET) high-dose-rate (HDR) multichannel cylinder, the rationale for its design, procedure for its insertion, and the dosimetry involved in its use. A study was done that compared the doses achieved using the CET multichannel cylinder to the same cylinder if it only had a central channel.

Methods and Materials:


The CET multichannel vaginal cylinder was inexpensively constructed, using parts from various suppliers. After insertion in the patient, the cylinder is affixed to a base plate to prevent displacement. Two sets of orthogonal films (without and with rectal barium) are taken in preparation for digitization of the catheters, bladder, rectal, and pelvic sidewall points. Using HDR brachytherapy planning software, the dose distribution is adjusted to achieve the prescribed dose (5 Gy HDR) 5 mm lateral to the cylinder surface, 5 mm lateral at the proximal parametrial tissue, and 4 mm superior to the vaginal apex. Doses to the bladder and rectum are limited to approximately 85% and 75%, respectively, of the prescribed dose. The plan is optimized on geometric parameters. For dose comparison to treatment using a central channel cylinder, the lateral channels are de-activated, leaving only the central channel activated. Dose points are placed 5 mm laterally and superiorly from the cylinder surface, and the plan is optimized to deliver a uniform dose to the defined dose points. The doses and treatment volumes are statistically compared.

Results:


The CET multichannel cylinder allows much better dose control than the central channel cylinder. The multichannel cylinder achieves lower bladder and rectal doses by 14% and 15%, respectively, when compared to the central channel cylinder. By increasing the dwell times of certain dwell positions, the prescription dose is achieved in the vaginal apex and proximal parametrial tissues and along the length of the cylinder.

Conclusion:


The multichannel cylinder enables more flexibility in isodose shaping and dose control to various points and structures when compared to the conventional central channel cylinder.


Back to Top2. High Dose Rate Transperineal Interstitial Brachytherapy for Cervical Cancer: High Pelvic Control and Low Complication Rates


Article Name: High Dose Rate Transperineal Interstitial Brachytherapy for Cervical Cancer: High Pelvic Control and Low Complication Rates

Author: D. Jeffrey Demanes, MD, , Ph.D., MD, Dhananjay D. Bendre, MD, Thomas L. Ewing, MD

Published Date: 1999

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

Abstract:

Purpose:


To report the clinical outcome for cervical carcinoma treated with external beam pelvic radiotherapy and interstitial high dose rate (IS-HDR) brachytherapy.

Methods and Materials:


Between July 1991 and June 1996, 62 patients with locally advanced stage cervical carcinoma or early stage carcinoma that precluded satisfactory tandem and ovoid insertion were treated. Most patients received 36 Gy (range: 25 Gy–45 Gy) external beam radiotherapy (EBRT) to the pelvis prior to brachytherapy implant. EBRT was continued, with central shielding, to a dose of 50 Gy to the pelvic sidewalls. HDR Iridium-192 brachytherapy was given in 6 fractions of 5.5 to 6.0 Gy. The mean follow-up was 40 months.

Results:


Stage distribution was: Stage IB (12), Stage IIA (1), Stage IIB (26), Stage IIIA (6), Stage IIIB (13), and Stage IVA (4). The overall local tumor control was 94%. Local control rates by FIGO stage were Stage I (12/12) 100%, Stage II (25/27) 93%, Stage III (18/19) 95%, and Stage IV (3/4) 75%. The regional pelvic control rates were overall 81%, Stage I (12/12) 100%, Stage II (22/27) 81%, Stage III (15/19) 79%, and Stage IV (1/4) 25%. Distant metastasis developed in 20 patients (32%). The actuarial 5-year disease-free survival was for all patients 48%, Stage I 81%, Stage II 47%, Stage III 39%, and Stage IV 0%. Grade 3–4 delayed morbidity resulting from treatment, occurred in 6.5% (4/62) of patients. A fistula without local recurrence occurred in 1.6% (1/62) patients.

Conclusion:


We report excellent local and regional pelvic control results using a 6 fraction IS-HDR brachytherapy protocol for cervical carcinoma. The incidence of severe complications is low and suggests that a consistent brachytherapy technique and multiple HDR fractions are therapeutically advantageous to patients treated for cervical carcinoma.


Back to Top3. The Use and Advantages of a Multichannel Vaginal Cylinder in High Dose Rate Brachytherapy

Article Name: The Use and Advantages of a Multichannel Vaginal Cylinder in High Dose Rate Brachytherapy

Author: D. Jeffrey Demanes, MD, Sheila Rege, MD, , Ph.D., MD, Kathleen L. Schutz, MD, Gillian Altieri, CMD, Thomas Wong, RTT

Published Date: 1999

Medical Journal: International Journal of Radiation Oncology, Biology, and Physics (IJROBP) Volume 44, Issue 1 , 1 April 1999, Pages 211-219

Abstract:

Purpose:


This paper describes California Endocurietherapy’s (CET) high-dose-rate (HDR) multichannel cylinder, the rationale for its design, procedure for its insertion, and the dosimetry involved in its use. A study was done that compared the doses achieved using the CET multichannel cylinder to the same cylinder if it only had a central channel.

Methods and Materials:


The CET multichannel vaginal cylinder was inexpensively constructed, using parts from various suppliers. After insertion in the patient, the cylinder is affixed to a base plate to prevent displacement. Two sets of orthogonal films (without and with rectal barium) are taken in preparation for digitization of the catheters, bladder, rectal, and pelvic sidewall points. Using HDR brachytherapy planning software, the dose distribution is adjusted to achieve the prescribed dose (5 Gy HDR) 5 mm lateral to the cylinder surface, 5 mm lateral at the proximal parametrial tissue, and 4 mm superior to the vaginal apex. Doses to the bladder and rectum are limited to approximately 85% and 75%, respectively, of the prescribed dose. The plan is optimized on geometric parameters. For dose comparison to treatment using a central channel cylinder, the lateral channels are de-activated, leaving only the central channel activated. Dose points are placed 5 mm laterally and superiorly from the cylinder surface, and the plan is optimized to deliver a uniform dose to the defined dose points. The doses and treatment volumes are statistically compared.

Results:


The CET multichannel cylinder allows much better dose control than the central channel cylinder. The multichannel cylinder achieves lower bladder and rectal doses by 14% and 15%, respectively, when compared to the central channel cylinder. By increasing the dwell times of certain dwell positions, the prescription dose is achieved in the vaginal apex and proximal parametrial tissues and along the length of the cylinder.

Conclusion:


The multichannel cylinder enables more flexibility in isodose shaping and dose control to various points and structures when compared to the conventional central channel cylinder.


Back to Top4. Low Dose Rate Brachytherapy in Vaginal Carcinoma: Long Term Outcome and Morbidity


Article Name: Low Dose Rate Brachytherapy in Vaginal Carcinoma: Long Term Outcome and Morbidity

Author: D. Jeffrey Demanes, MD, Kathleen L. Schutz, MD, Jeffrey J. Quackenbush, MD, , Ph.D., MD, Thomas Ewing, MD

Published Date:

Medical Journal:

Abstract:

A retrospective analysis of 20 patients with squamous cell carcinoma of the vagina, treated between 1982 and 1991 with combination EBRT and low dose rate brachytherapy. Stage 1 patients received intracavitary implants. Stage II and III were treated with interstitial implants. The local control rate for all patients 90%; Stage I, 100%; Stage II, 87%; and Stage III, 100%. One of the local recurrences was surgically salvaged giving an overall local control rate of 95%. The overall actuarial disease free survival at 5 years was 74% and at 10 years, 56%. The overall regional control rate was 95%. The total incidence of distant metastases was 5%. Colostomy was required for 15% of patients for treatment related complications. An additional 15% of patients required a colostomy as part of subsequent surgery. No patient developed a urinary fistula.

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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