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 Lung Cancer


1. Introduction

High Dose Rate brachytherapy is used to give an added radiation dose to lung cancers that are located in the major bronchi ( the breathing passages). While increasing the dose to the tumor, HDR, due to its short treatment distance, minimizes the radiation dose given to sensitive nearby tissues such as adjacent normal lung, heart, esophagus and the spinal cord. HDR brachytherapy is also used to treat recurrent endobronchial tumors where additional surgery and external beam radiation therapy are no longer options. "In cases of the tumor being in the lung tissue, rather than the bronchi, external beam radiation therapy, not HDR, is the appropriate therapy."

2. Surgery and HDR Procedure

The patient is made comfortable on the treatment table with intravenous conscious sedation that is typically used in standard bronchoscopic procedures. Topical anesthetic is applied to the back of the nose and throat. An instrument called a bronchoscope is used to locate and evaluate the extent of the tumor. A bronchoscope is a flexible tube that contains a hollow channel and a fiber-optic camera. The pulmonologist inserts the bronchoscope through the nose, past the vocal cords and into the affected bronchus. When the bronchoscope is in position near the tumor, a thin catheter that the radioactive source will travel through is inserted into the bronchoscope. The pulmonologist can see the catheter as it emerges from the end of the bronchoscope. The bronchoscope is then removed, leaving the catheter in place. Usually two catheters are inserted. Special x-ray films are taken in order evaluate the catheter placement and do the computerized treatment plan. When the plan has been approved by the physician, the protruding ends of the catheters are attached to the HDR afterloader, which directs the radioactive source to the precise location in the catheters to deliver the prescribed radiation dose.
Fig 1: AP (front) radiograph of three treatment catheters placed in the bronchi to encompass the lesion that is obstructing air from reaching the left upper lobe of this patient.
After the treatment, the catheters are removed, the patient recovers quickly and then goes home. Usually, three or four treatments are given. Successful treatment opens the bronchi, (improving breathing), and reduces bleeding (hemoptysis).

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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
- Socioeconomic Committee.
American College of Radiation Oncology
President - 2005 to 2007
American College of Radiology
Fellow - 2007