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CET Cancer Center Oakland California

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

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  1. CET Cancer Center Oakland California High Dose Rate (HDR) Brachytherapy Gynecological Cancer D. Jeffrey Demanes M.D jdemanes@cetcancercenter.com

  2. Brachytherapy Radiation is given directly to target Gradient effect– relatively little dose to surrounding tissue CET

  3. 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

  4. A Four Step Process Applicator Placement 3 Dimensional Scan Imaging Virtual Image Computer Dosimetry High Dose Rate Robotic Treatment CET

  5. 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

  6. Intracavitary Tandem and Ovoids CET

  7. Various Example Devices CET jdemanes@cetmc.com

  8. HDR Interstitial Direct tissue access Catheter scaffolding ‘matrix’ Encompass extensive disease CET jdemanes@cetmc.com

  9. CET

  10. 2 Scan 3D Image with Implant CET

  11. 3) Virtual Image of Implant CET

  12. 3) Another Patient with CT Dosimetry CET

  13. Recurrent Pelvic Sidewall Cervix Cancer

  14. 3) Virtual Image viewed from above Left Pelvic Sidewall

  15. 4) HDR Treatment Delivery

  16. 4 HDR Treatment Delivery

  17. CET Protocol Gynecologic Cancer CET

  18. 3 Dimensional Dosimetry Normal Tissue Dose Constraints Anterior rectum: 75 % Posterior bladder and urethra: 80% Transluminal View Rectum CET

  19. 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 .

  20. Cervical CancerRadiation and Chemotherapy Chemotherapy Cisplatinum weekly Not given during HDR Acute ChemoRadiation Toxicity Hypokalemia Dehydration Pancytopenia CET

  21. Previously Untreated Cervix5 Year Results 204 Pts 1991-1999 Median age 55 jdemanes@cetmc.com

  22. 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

  23. 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

  24. Chronic Morbidity Cervix Total Bladder and Rectal = 11/204 (5%) CET

  25. Previously Untreated Vagina Cancer8 Year Results 53 Patients 1991-2001 Median age 64 jdemanes@cetmc.com

  26. 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

  27. Chronic Morbidity Vagina Ca Total Bladder and Rectal = 4/53 (7.5%) CET jdemanes@cetmc.com

  28. . D. Jeffrey Demanes M.D jdemanes@cetcancercenter.com Thank You. CET Cancer Center

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