The UCLA Brachytherapy Division is one of the most experienced and advanced centers in the United States. It was established in 2010 after D. Jeffrey Demanes was recruited to UCLA and brought his longstanding practice California Endocurietherapy to Los Angeles from Northern California.
We are one of the few centers in the United States that has expertise in using brachytherapy to treat all types of cancers.
We also have state of the art equipment and facilities including a brachytherapy suite in the Department of Radiation Oncology, a portable CT scanner to allow for imaging during implants, real-time ultrasound planning for prostate brachytherapy, a new Flexitron afterloader and a Xoft unit for intra-operative breast radiation.
Brachytherapy is a specialized skill and we’ve dedicated ourselves to building a team to take the best care of our patients as possible. Our team includes two nurses, a physician assistant, brachytherapy fellows, a dosimetrist, a physicist, two therapists, scrub techs, and front office staff. There are few other Brachytherapy centers in the United States that commit this level of resource to caring for brachytherapy patients.
Brachytherapy is a form of internal radiation treatment where radioactive sources are placed on or into cancer tissues. Sometimes the radiation is put in place through a larger metal or plastic tube called an applicator.
During the treatment, implants are placed in the body through the applicators. Some implants are permanent, while others are left in for a short period. The applicator may be removed at the same time as the implant, or it may be left in place until all the treatments are finished. Applicators can be placed either during surgery or by your physician using an imaging test to view the intended location. If the applicators need to be held in place, stitches may be used.
This is not a new technique. It has actually been around for over 100 years as can be seen in the below timeline:
Specific implants are selected based on the location of the tumor, the extent of the tumor, and several other factors. These types are:
Low Dose Rate (LDR) Implants
LDR was once the only type of brachytherapy available. In this type of brachytherapy, the source of radiation stays in place for one to seven days. Most patients are hospitalized for the duration of this treatment, and once the treatment is completed, the radiation source is removed.
High Dose Rate (HDR) Implants
During HDR brachytherapy, the radiation source is in place for 10 to 20 minute periods and then removed. Depending on cancer type, HDR treatments may occur once or twice a day for two to five days or once a week for two to five weeks. During the course of treatment, the applicator may stay in place, or it may be put in place before each treatment. As with LDR implants, the applicator will be removed once treatment is finished.
HDR is performed using a single tiny (1mm x 3 mm) highly radioactive source of Iridium-192 that is laser welded to the end of a thin, flexible stainless steel cable. The source is housed in a device called an afterloader. The computer-guided afterloader directs the source into the treatment catheters placed in and around the prostate by the brachytherapy physician. The source travels through each catheter in 5 mm steps, called "dwell" positions. The distribution of radiation and dose is determined by the dwell positions the source stops at and the length of time it dwells there. This ability to vary the dwell times is like having an unlimited choice of source strengths. This level of dose control is possible only with HDR.
After the treatment(s) have been given, the implant is removed. Intracavitary and intraluminal applicators are simple to remove and the patient goes home soon after removal. With interstitial implants, sutures holding the template and/or catheters in place are cut and the implant is gently removed. Some minor bleeding usually occurs, which is quickly stopped by applying direct pressure to the implant site with gauze pads. Post- implant skin care instructions are given by the nurses before the patient is discharged. A date for a follow-up appointment will also be given.
Our team at UCLA has some of the most clinical experience using brachytherapy for the treatment of all sites in the nation. We’ve safely delivered over 25,000 HDR treatments. Below is a table summarizing the types of cases that we’ve treated through March 2015. This table includes cases treated at CET as well as those treated since 2010 when CET moved to UCLA.
|UCLA and CET||Total Number of Implants|
|Anal & Rectal Interstitial||237|
|GI Intracavitary (Esophagus, Liver and Bile Duct)||151|
|Soft tissue Sarcomas||27|
|UCLA and CET||Total Number|
|Total Number Dosimetry Plans Performed||14183|
|Total HDR Treatment Delivered||27270|
|Total Implants Performed||12806|
*Statistics as of end of September 2016
Brachytherapy is a specialized skill and we've dedicated ourselves to building a team to take the best care of our patients as possible. Our team includes radiation oncologists, fellows, physician assistant, physicist, dosimetrist, nurses, radiation therapists, scrub tech, and the front office staff. There are only a few other Brachytherapy centers in the United States that commit this level of resource to caring for brachytherapy patients.