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

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CET Cancer Center

Oakland California

High Dose Rate (HDR) Brachytherapy

Gynecological Cancer

D. Jeffrey Demanes M.D

jdemanes@cetcancercenter.com


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Brachytherapy

Radiation is given directly to target

Gradient effect– relatively little dose to surrounding tissue

CET


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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


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A Four Step Process

Applicator Placement

3 Dimensional Scan Imaging

Virtual Image Computer Dosimetry

High Dose Rate Robotic Treatment

CET


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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



Various example devices l.jpg
Various Example Devices

CET

jdemanes@cetmc.com


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HDR Interstitial

Direct tissue access

Catheter scaffolding ‘matrix’

Encompass extensive disease

CET

jdemanes@cetmc.com











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3 Dimensional Dosimetry

Normal Tissue

Dose Constraints

Anterior rectum: 75 %

Posterior bladder

and urethra: 80%

Transluminal View Rectum

CET


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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

.


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Cervical CancerRadiation and Chemotherapy

Chemotherapy

Cisplatinum weekly

Not given during HDR

Acute ChemoRadiation Toxicity

Hypokalemia

Dehydration

Pancytopenia

CET


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Previously Untreated Cervix5 Year Results 204 Pts 1991-1999

Median age 55

jdemanes@cetmc.com


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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


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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

jdemanes@cetmc.com


Chronic morbidity cervix l.jpg
Chronic Morbidity Cervix

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

CET


Previously untreated vagina cancer 8 year results 53 patients 1991 2001 l.jpg
Previously Untreated Vagina Cancer8 Year Results 53 Patients 1991-2001

Median age 64

jdemanes@cetmc.com


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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

jdemanes@cetmc.com


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Chronic Morbidity Vagina Ca

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

CET

jdemanes@cetmc.com


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.

D. Jeffrey Demanes M.D

jdemanes@cetcancercenter.com

Thank You.

CET Cancer Center