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.

Head and Neck Cancer Publication

Studies of High Dose Rate Brachytherapy for Head and Neck Cancer

Head and Neck Publications

  1. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for head-and-neck carcinoma
  2. Wire in Leader Technique: A method for loading implant catheters in inaccessible sites

Back to Top1. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for head-and-neck carcinoma

Article Name: The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for head-and-neck carcinoma

Author: Subir Nag, M.D., Elmer R. Cano, M.D., D. Jeffrey Demanes, M.D., Ajmel A. Puthawala, M.D., and Bhadrasain Vkram, M.D., for the American Brachytherapy Society

Instutions: Department of Radiaton Oncology, Ohio State University, Columbus, OH; Department of Radiation Oncology, Presbyterian University Hospital, Pittsburg, PA; Department of Radiation oncology, The California Endocurietherapy Cancer Center, Oakland, CA; Department of Radiation Oncology, Long Brach Memorial Medical Center, Long Brach, CA,; Department of Radiation oncology, Montefiore Medical Center, Bronx, NY

Published Date: March 2001

Medical Journal: International Journal of Radiation Oncology Biology Physics Volume 50, Issue 5, 1 August 2001, Pages, 1190-1198



To develop recommendations for use of high-dose-rate (HDR) brachytherapy in patients with head-and-neck cancer.

Methods and Materials:

A panel consisting of members of the American Brachytherapy Society (ABS) performed a literature review, added information based upon their clinical experience, and formulated recommendations for head-and-neck HDR brachytherapy.


The ABS recommends the use of brachytherapy as a component of the treatment of head-and-neck tumors. However, the ABS recognizes that some radiation oncologists are reluctant to employ brachytherapy in the head-and-neck region because of the complexity of the postoperative management and concerns about radiation safety. In this regard, HDR eliminates unwanted radiation exposure and thereby permits unrestricted delivery of clinical care to these brachytherapy patients. The ABS made specific recommendations for previously untreated and recurrent head-and-neck cancer patients on patient selection criteria, implant techniques, target volume definition, and HDR treatment parameters (such as time, dose, and fractionation schedules). Suggestions were provided for treatment with HDR alone and in combination with external beam radiation therapy. It should be recognized that only limited experiences exist with HDR brachytherapy in patients with head-and-neck cancers. Therefore, some of these suggested doses have not been extensively tested in clinical practice. Hence, these guidelines will be updated as significant new outcome data are available. Any clinician following these guidelines is expected to use clinical judgment to determine an individual patient’s treatment.


Little has been published in the clinical literature on HDR brachytherapy in head-and-neck cancer. Based upon the available information and the clinical experience of the panel members, general and site-specific recommendations were offered. Areas for further investigations were identified.

Back to Top2. Wire in Leader Technique: A method for loading implant catheters in inaccessible sites

Article Name: Wire in Leader Technique: A method for loading implant catheters in inaccessible sites

Author: D. Jeffrey Demanes, MD, , Ph.D., MD, Nisar Syed, MD, Ajmal Puthawala, MD

Published Date: October 1997

Medical Journal: Journal of Brachytherapy International, Vol. 13, Number 4, October, 1997

Interstitial brachytherapy has traditionally been used in visibly accessible sites only. Expansion of the role of brachytherapy to the management of cancers in less exposed regions is now possible. The "wire in leader" technique allows loading of interstitial catheters when the stainless steel trocar tips are not visibly exposed for direct insertion of the leader portion of the catheter. The method is described in several figures and descriptions related to the base of tongue, an illustrative but not unique example.

Printable Material

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 10/31/2009, CET has performed 10,217 HDR implants and delivered 21,747 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