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 Soft Tissue Sarcoma Cancer


1. Introduction

Sarcomas are cancers that arise in the "connective tissue" of the body. The most common sites are muscle and bone. Soft tissue sarcomas usually occur in muscle, but can appear anywhere. Most can be treated with brachytherapy if accessible enough and in a location where the implant can be relatively immobilized. For example, sarcomas near the heart would not be treatable due to the heart motion.

2. Surgery and HDR Procedure

With the patient under general anesthesia, the surgeon removes the visible tumor. The brachytherapy physician then places the catheters that will contain the radioactive source, where the tumor was and also includes a "margin" to ensure that any microscopic spread will also be irradiated. The wound is closed, leaving the ends of the catheters to protrude through the skin. The area is anointed with antibacterial ointment and bandaged. When the physician deems the patient's wounds sufficiently healed, the imaging procedure, using either CT or radiography is done. These special x-ray films are necessary for the computerized treatment planning and radiation dose calculations. After the treatment plan has been approved by the physician, the ends of the protruding catheters are connected to "transfer tubes" which are connected to the afterloader which houses the radioactive source. The afterloader directs the source through each of the catheters to deliver the precise amount of radiation. The implant is usually treated 8 to 10 times, twice a day, then removed.

3. Benefit of HDR Brachytherapy for Soft Tissue Sarcoma Cancer

  • The ability to shape the radiation dose is especially advantageous in pediatric cases, where the growth plates in the bones must be spared from excessive radiation doses in order to avoid stunting.
  • The radiation dose can be kept away from the healing surgical scar and any surgical graft that may have been done.
  • Reduction in normal tissue injury means more rapid and complete functional recovery. HDR brachytherapy is designed to enhance local cure rates and reduce side effects of treatment.
  • After the brachytherapy implant, further external beam therapy can be given if necessary.
  • Because a much higher dose can be given to the tumor by brachytherapy, the probability of tumor control is increased.
  • Side effects usually experienced when external beam is the sole mode of treatment, such as skin fibrosis, can be avoided.

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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 8/31/2007, CET has performed 9,196 HDR implants and delivered 19,057 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