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CET Cancer Center Oakland California

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intracavitary multi-channel vaginal cylinder - PowerPoint PPT Presentation


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CET Cancer Center Oakland California. High Dose Rate (HDR) Brachytherapy Gynecological Cancer D. Jeffrey Demanes M.D [email protected] Brachytherapy. Radiation is given directly to target Gradient effect– relatively little dose to surrounding tissue. CET.

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slide1

CET Cancer Center

Oakland California

High Dose Rate (HDR) Brachytherapy

Gynecological Cancer

D. Jeffrey Demanes M.D

[email protected]

slide2

Brachytherapy

Radiation is given directly to target

Gradient effect– relatively little dose to surrounding tissue

CET

slide3

Robotic High Dose Rate (HDR) Brachytherapy

  • Source position x Time = Effective Source Strength
    • HDR is given in 1-2 sessions per day
  • Radiation is confined to patient
slide4

A Four Step Process

Applicator Placement

3 Dimensional Scan Imaging

Virtual Image Computer Dosimetry

High Dose Rate Robotic Treatment

CET

intracavitary multi channel vaginal cylinder
Intracavitary Multi-Channel Vaginal Cylinder

Decreases dose to bladder and rectum by 15%

Cylinder cross section

*IJROBP Vol. 44, No. 1, pp.211-219, 1999

hdr interstitial
HDR Interstitial

Direct tissue access

Catheter scaffolding ‘matrix’

Encompass extensive disease

CET

[email protected]

3 dimensional dosimetry
3 Dimensional Dosimetry

Normal Tissue

Dose Constraints

Anterior rectum: 75 %

Posterior bladder

and urethra: 80%

Transluminal View Rectum

CET

applicator selection
Applicator Selection
  • Intracavitary (T&O, Vaginal cylinders etc.)
  • Small lesion, good response to EBRT, adequate anatomy
  • If applicator fits
  • Interstitial (Template etc.)
    • Bulky disease, parametria or vaginal involvement
    • Anatomy not suitable for intracavitary

.

cervical cancer radiation and chemotherapy
Cervical CancerRadiation and Chemotherapy

Chemotherapy

Cisplatinum weekly

Not given during HDR

Acute ChemoRadiation Toxicity

Hypokalemia

Dehydration

Pancytopenia

CET

5 year results cervix cancer local control by stage
5 Year Results Cervix CancerLocal Control by Stage

100

90

85%

80

70

60

%

50

40

30

20

10

0

ALL

IB1 1B2 IIA IIB IIIA IIIB IVA

Patient Group

slide23

CET Cervix 5 Year Results

100

85%

90

81%

80

66%

70

60%

60

%

50

40

22%

30

20

10

0

Local

Control

Pelvic

Control

DFS

OS

DM

Patient Group

CET

Patient Group

[email protected]

chronic morbidity cervix
Chronic Morbidity Cervix

Total Bladder and Rectal = 11/204 (5%)

CET

slide26

CET Vagina 5 Year Results

100

87%

90

83%

80

62%

70

52%

60

%

50

40

30

17%

20

10

0

Local

Control

Pelvic

Control

DFS

OS

DM

Patient Group

CET

Patient Group

[email protected]

slide27

Chronic Morbidity Vagina Ca

Total Bladder and Rectal = 4/53 (7.5%)

CET

[email protected]

slide28
.

D. Jeffrey Demanes M.D

[email protected]

Thank You.

CET Cancer Center

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