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Radiation Oncology

High-Tech HDR Brachytherapy: Safe and effective radiation for cancer patients

09/30/2010

CU-HDR BrachytherapyBrachytherapy is the direct application of radiation therapy on or into tissue. It is used to treat primary or recurrent tumors in almost any part in the body. In 2010, UCLA augmented its brachytherapy service by offering high-dose-rate (HDR) brachytherapy.

HDR is distinguished from other forms of brachytherapy in that the source of radiation moves within the target under robotic computer control. A tiny radiation source at the end of a fine cable is inserted temporarily into or on the tumor for precisely calculated periods of time. Accurate control over both time and location of radiation exposure allows UCLA’s experienced brachytherapy team to adapt the shape and strength of the radiation exposure and to conform exactly to the tumor target while normal organs are relatively protected. HDR uses the radionuclide Iridium 192 as its radiation source, and similar treatment is offered at UCLA using an electronic brachytherapy source.

HDR is given over a relatively short period of time, so it is convenient for patients. Side effects typically come and go more quickly than other forms of radiation therapy. The treatments are often given on an outpatient basis, though they may require a short hospital stay.

HDR is effective in many kinds of cancers, such as head and neck, breast, prostate, soft tissue tumors, gynecological, gastrointestinal, pulmonary tumors, and even rare or recurrent cancers. HDR is used alone in some cases, but it is often used in combination with other treatments, such as surgery, chemotherapy and external beam radiation.

Treatment Procedure: Four Basic Steps

Applicator Insertion The first step is insertion of small hollow applicators that are like little straws into the target. This procedure is usually done through the skin with image guidance (X-ray, ultrasound, fluoroscopy or endoscopy) without the need to make an incision. If an incision is necessary, it may be done in the office or may require a surgical procedure under anesthesia. The implant is often in the form of a 3-D grid through the treatment target, allowing freedom to select the best possible positions for the radiation source.

3D Image Acquisition The second step is to obtain a CT (computed tomography) or MRI (magnetic resonance imaging) of the implanted region. A treatment planning computer uses the data to create a virtual image of the target area.

Virtual Image Computer Planning In the third step, this information is used in a set of calculations (called dosimetry) to determine the best distribution of radiation and provide the electronic instructions that specify the prescribed source locations (dwell positions) and times (dwell times).

HDR Treatment Delivery In the final step, a computerized robotic delivery device called a “remote afterloader” sequentially inserts the single radiation source with millimeter precision into the desired dwell positions within each of the catheters in the grid. A specially trained therapist controls the treatment, which may last for 15 to 40 minutes. The robotic procedure does not expose medical personnel or family members to radiation. HDR brachytherapy is usually divided into multiple sessions to allow normal tissue to recover from the effects of radiation and to minimize the long-term effects of treatment.

HDR Brachytherapy at UCLA

UCLA’s highly skilled HDR brachytherapy team includes radiation oncologists, physicists, nurses and therapists who are among the most experienced in the nation in applying HDR brachytherapy to the treatment of both routine and highly complex cases. A new specialized brachytherapy suite at UCLA will allow more procedures to be done in the radiation oncology treatment area, leading to improved efficiency and greater convenience for patients.

The HDR Brachytherapy Advantage

D. Jeffrey Demanes, M.D., chief of the UCLA Division of Brachytherapy, describes some of the benefits of HDR brachytherapy:

  • Can be used alone or with surgery, external radiation or chemotherapy
  • Short treatment course (1-2 weeks)
  • Preserves organ structure and function 
  •  Few side effects
  • Excellent coverage of local microscopic cancer spread
  • Radiation doses known and adjusted before treatment
  • Accurate and precise tumor-specific dose delivery
  • Controls dose within target (avoids hot or cold spots)
  • Organ and target motion do not affect radiation delivery
  • No radiation exposure to other persons Prostate
  • No radiation seed migration to other organs
  • Controlled dose to bladder and rectum Breast
  • Conserves breast for excellent cosmetic results
  • Low dose to heart, lung, and opposite breast
  • No treatment delay for hormone or chemotherapy

Team Members

D. Jeffrey Demanes, M.D.
Professor and Chief of the Division of Brachytherapy
UCLA Department of Radiation Oncology

Mitchell Kamrava, M.D.
Brachytherapy Fellow and Clinical Instructor
UCLA Department of Radiation Oncology

Michael Steinberg, M.D.
Professor and Chair
UCLA Department of Radiation Oncology

Patrick Kupelian, M.D.
Professor and Vice-Chair
UCLA Department of Radiation Oncology

Christopher King, M.D., Ph.D.
Associate Professor
Director of Residency Program UCLA
Department of Radiation Oncology

Steve P. Lee, M.D., Ph.D.
Associate Professor
Director of Extramural Affairs
UCLA Department of Radiation Oncology

Lalaine Borja, PA-C
Physician Assistant to the Division
of Brachytherapy
UCLA Department of Radiation Oncology

Contact Information
(310) 206-2510 Information and appointments
(310) 794-9795 Fax
http://radonc.ucla.edu





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