Demanes D Jeffery MD

Physicians & Surgeons, Physicians & Surgeons, Breast Care & Surgery, Physicians & Surgeons, Family Medicine & General Practice

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Mon - Fri:	9:00 am - 5:00 pm

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Neighborhoods: Central Oakland, Pill Hill
AKA: California Endocurietherapy
Categories: Physicians & Surgeons, Physicians & Surgeons, Breast Care & Surgery, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Gynecologic Oncology, Physicians & Surgeons, Internal Medicine, Physicians & Surgeons, Oncology, Physicians & Surgeons, Radiology, Physicians & Surgeons, Surgery-General, Physicians & Surgeons, Urology, Skin Care

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Phone: (310) 206-2510

Address: 3012 Summit St # 2675, Oakland, CA 94609

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Demanes D Jeffery MD

General Practitioners

Urinary Incontinence
Fig 4: This view evaluates the implant from the top. The red areas are the small portions of the target volume that are spared the full prescription dose: the bladder neck and the lower bulbous urethra to prevent urinary incontinence and urethral stricture respectively.

Internal Medicine
Dr. Demanes is extremely experienced in using HDR brachytherapy to treat a wide variety of cancers and is regarded as one of the leading HDR implant specialists. It is important that a physician be Board Certified in his/her speciality. Dr. Demanes is Board Certified in three areas; radiation oncology, medical oncology, and internal medicine.
Urology
*Departments of Radiation Oncology and Urology, William Beaumont Hospital, Royal Oak, MI; †California Endocurietherapy Cancer Center, Oakland, CA; and ‡Departments of Radiation Oncology and Urology, Kiel University Hospital, Kiel, Germany
Cervical Cancer
CET Cancer Center - D. Jeffrey Demanes, M.D.; High Dose Rate (hdr) Brachytherapy Specialist with 25 years of experience: High Dose Rate (hdr) Brachytherapy for Gynecologic Cancers (Cervical Cancer, Endometrial Cancer, Vaginal Cancer, Vulvar Cancer)
Endoscopy
Interstitial implants are required for more advanced stage gynecologic malignancies. Generally, two implants are performed, a week apart, with each implant receiving two to three HDR treatments. The implants are done under spinal anesthesia in the operating room. Hollow plastic catheters are inserted through the perineum, guided with ultrasound, fluoroscopy and endoscopy, to fully encompass the tumor. The catheter placement is secured by a rubber template which is sutured against the perineum. The patient is transferred to the recovery room and following recovery, transported to our clinic for the simulation radiography, computerized treatment planning and treatment. After the first treatment, the patient goes to her hospital room, stays overnight, and the next one or two treatments are given the next day. After the last treatment, the implant is removed and the patient is discharged with home care instructions. The procedure is repeated for the second implant. Expected side effects from interstitial brachytherapy for gynecologic malignancy include a temporary increase in urinary frequency, some burning with urination, and possibly blood-tinged urine for 2-3 days following implant removal. Bowel function may also be affected by radiation, antibiotics and pain medications. Perineal or pelvic discomfort is treated with oral pain medication as needed and sitz baths. Possible long term side effects are related to the radiation dose delivered to surrounding organs and will be discussed with the patient at the time of consultation.
Prostate Cancer
CET Cancer Center - D. Jeffrey Demanes, M.D.; High Dose Rate (hdr) Brachytherapy Specialist with 25 years of experience: Prostate Cancer Publications Section I, Studies of High Dose Rate Brachytherapy for Prostate Cancer
Lung Cancer
CET Cancer Center - D. Jeffrey Demanes, M.D.; High Dose Rate (hdr) Brachytherapy Specialist with 25 years of experience: High Dose Rate Brachytherapy for Lung Cancer

Ultrasound
3, were included. Flexible cystoscopy, fluoroscopy and transrectal ultrasound (TRUS) were used and 17 flexiguides were inserted through the perineum. Dosimetry was carried out using localization films. Treatment volume was defined at 4–6 mm outside the peripheral catheters. BT consisted of two implants, separated by 1 week, with two fractions given per implant for a total of four HDR fractions. Dose prescription to the treatment volume was 6 Gy (HDR) per fraction, with an additional dose of 0.5 to 0.75 Gy given where required.
MRI
Endo-Rectal Coil MRI (ERC-MRI) A magnetic resonance imaging scan is a procedure that uses a magnetic field to create detailed pictures of the body. In this case, a special device is inserted into the rectum to get a detailed image of the prostate and the surrounding structures.
Radiology
³ T2b. A total of 1,260 patients were treated, and 934 meet the criteria. Kiel University Hospital treated 198 patients; William Beaumont Hospital, 315; and California Endocurietherapy Cancer Center, 459 patients. Brachytherapy dose regimes were somewhat different between centers and the dose was escalated from 5.5 x 3 to 15 Gy x 2 Gy. Patients were divided for analysis between the 406 who received up to 6 months of androgen deprivation therapy and the 528 patients who did not. All patients had a minimum follow-up of 18 months (3 times the exposure to androgen deprivation therapy). The American Society for Therapeutic Radiology and Oncology biochemical failure definition was used.
X-Rays
Computed Tomography
Computed tomography imaging post-balloon inflation showed 8, 14, and 21 patients with 5–6 mm, 7–9 mm, and >10 mm of skin spacing, respectively. Two patients were explanted because of inadequate skin spacing and 7 because of suboptimal conformance of the surgical cavity to the applicator balloon. One patient was explanted because of positive nodal status and another because of age. The most common side effects related to device placement included mild erythema, drainage, pain, and echymosis. No severe side effects related to implantation, brachytherapy, or explantation occurred. Side effects related to radiation therapy were generally mild with erythema, pain, and dry desquamation being the most common. At 1 month, 88% of patients were evaluated as having good-to-excellent cosmetic results.
Chemotherapy
Next, selection of the type of local radiation therapy and determination of whether other measures (such as hormones or chemotherapy) are needed. If the tumor is small (3 centimeters or about an inch and a half or less), then only the area where the tumor was removed needs to be treated.
Radiation Therapy
High Dose Rate brachytherapy is used to give an added radiation dose to lung cancers that are located in the major bronchi ( the breathing passages). While increasing the dose to the tumor, HDR, due to its short treatment distance, minimizes the radiation dose given to sensitive nearby tissues such as adjacent normal lung, heart, esophagus and the spinal cord. HDR brachytherapy is also used to treat recurrent endobronchial tumors where additional surgery and external beam radiation therapy are no longer options. "In cases of the tumor being in the lung tissue, rather than the bronchi, external beam radiation therapy, not HDR, is the appropriate therapy."
Radiation Oncology
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

General Surgery
Hysterectomy
Postoperative brachytherapy may be needed following a hysterectomy for endometrial (uterine) cancer. Treatment is delivered with brachytherapy to the upper vaginal area, an area at high risk for recurrence. The CET vaginal cylinder is a smooth, plastic cylinder, measuring a little over 1 inch in diameter. It has 7 channels through which the radioactive source can travel. The multichannel cylinder allows for greater dose control and radiation dose shaping than the central channel only cylinder. CET published a study ( The Use and Advantages of a Multichannel Vaginal Cylinder in High-Dose-Rate Brachytherapy, Int. Journal Radiation Oncology, Biology, Physics, 1999 Vol.44, pps 211-219 ) which demonstrated the multichannel cylinder can reduce bladder and rectal doses by 15% more than the commonly used central channel cylinder. The physician inserts the cylinder and secures it in position. Special x-ray films are taken that show the cylinder in relationship to the surrounding organs. Using these films, a computerized treatment plan is then created by the dosimetrist, who tailors the radiation doses to treat the areas at risk to the prescribed doses while sparing the nearby normal structures from excessive radiation dose. Only after the plan is reviewed and approved by the physician is the treatment given. The radioactive source travels in and out of the 5 to 7 channels in the cylinder, delivering the radiation dose according to the approved treatment plan. The treatment takes approximately 30-90 minutes depending upon the size and complexity of the implant and the activity of the source. After the treatment, the vaginal cylinder, bladder and rectal catheters are removed. The nurses make sure the patient has recovered from any sedation before the patient leaves the clinic.

Plastic Surgeons

Breast Surgery
Back to Top 4. Side Effects Some women have experienced minor bruising, redness and discomfort. All of these side effects are common in breast surgery and radiation treatment and usually last 2-4 weeks.

Skin Care
Step 5: Implant Removal 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 clipped 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 leaves the CET clinic. A date for a follow-up appointment will also be given.

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