Chao: Practical Essentials of Intensity Modulated Radiation Therapy 2nd Edition

1. IMRT Physics and Quality Assurance
2. Optimization for Planning of IMRT
3. CT and MR Imaging of Brain and H&N Cancers
4. CT and MR Imaging of Abdomen and Pelvis
5. PET Imaging for IMRT
6. Posterior Fossa and Skull Base Tumors
7. Nodal Target Volume for Head and Neck Cancer
8. Nasal Cavity and Paranasal Sinuses
9. Nasopharynx
10. Oral Cavity
11. Oropharynx
12. Hypopharynx and Larynx
13. Metastatic Carcinoma in Neck Node with Unknown Primary
14. Breast Cancer
15. Thoracic Cancer
16. Pelvic and Para-aortic Nodal Target Delineation
17. Prostate Cancer
18. Gynecological Cancer
19. Index 

Intensity modulated radiation therapy (IMRT) offers an excellent opportunity to optimize the therapeutic ratio in radiation oncology through maximizing tumor coverage and sparing normal tissue by appropriate clinical input and precise computer algorithms. This cutting edge technology is being used not only in academic institutions, but also in community clinics. The increasing need for essential practical guidelines to address clinical indication, imaging interpretation, target delineation, and plan optimization has inspired the genesis of the 2nd edition of Practical Essentials of Intensity Modulated Radiation Therapy.

In this book, a practical overview of IMRT physics, quality assurance, and treatment planning and optimization are first given in Chapters 1 and 2. Because successful implementation of IMRT depends on proficient understanding in anatomical imaging (computed tomography and magnetic resonance imaging), pertinent information to update readers on this topic is provided in Chapters 3 and 4 for brain, head and neck, urological, and gynecological cancers. Further, integrating functional imaging to assist in more accurate target delineation or for dose escalation may soon be a clinical reality, we elicit the process and caution of incorporating functional images for IMRT planning in Chapter 5.

In the first edition, we provided practical guidance for IMRT in the management of head and neck cancer patients. Because IMRT utilization has become more widespread, the 2nd edition expands the breadth of coverage to include concise, relevant overviews of the natural course, diagnostic criteria, therapeutic options, as well as up-to-date IMRT treatment guidelines for other various tumor sites. Chapters 6, 7, 8, 9, 10, 11, 12, 13 and 14 provide updated information and results on head and neck cancers with a new Chapter 13 on thyroid carcinoma. New chapters encompassing breast, thoracic, esophageal, prostate, and gynecological cancers are included with high quality of illustration to assist reader in target determination and delineation (Chapters 15, 16, 17, 18 and 20, 21).

We emphasize the importance of understanding basic anatomy and the corresponding imaging sections that are being used for target and normal tissue determination and delineation. Accordingly, more than 350 full-color, detailed illustrations are provided to clarify each step in the clinical implementation of IMRT. We believe this new edition will assist residents, fellows, and clinicians of radiation oncology in learning the practical essentials for the clinical evaluation, decision-making, and technical proficiency of IMRT for multiple disease sites. The information presented in this book will continue to be refined, as rapid accumulation of clinical experience and evolution of imaging and targeting techniques have become so evident.

Clifford K.S. Chao MD 

Book Review 

A revolution has been taking place in radiation oncology over the last 15 years. Although it began many years before, the evolution of conformal radiation therapy (CRT) escalated dramatically between 1993 and 1996. Treatment planning for CRT migrated from very progressive individual institutions to commercial availability and widespread use in the radiation oncology community. Treatment planning systems have continued to evolve over the past decade and treatment delivery capability has largely caught up with the planning capability. It has also become possible to archive three-dimensional images including dose distributions. This permits research relating normal tissue volumes to toxicity and holds the promise of better defining normal tissue complication probabilities based on volumes irradiated.
Whereas three-dimensional CRT has become standard, intensity modulated radiation therapy (IMRT) is still evolving. The broad field of image guided radiation therapy of which IMRT is an important part, is constantly developing as a function of improved imaging of tumors and surrounding normal tissues. The ability to fuse images, especially anatomic and metabolic images, is only beginning to be appreciated with reference to specific clinical problems. Although there is broad availability of IMRT planning and delivery capability, there is still much uncertainty about proper use of IMRT. In addition, limited numbers of medical physicists limit implementation of IMRT.
The second edition of Practical Essentials of Intensity Modulated Radiation Therapy is very ambitious. It sets the stage for a contemporary exposé of IMRT physics, treatment planning, and quality assurance. It explores the imaging techniques available for image-guided radiation therapy in multiple anatomic locations. Great emphasis is placed on malignant tumors arising in the head and neck. The anatomic constraints and issues related to target delineation in these locations help define the problems and possibilities clearly when there is no motion related to the tumor location day to day. However, in the thorax, and even in the pelvis, tumor motion is a matter of concern. The anatomic location of the tumor must be established daily or the tumor must be immobilized with a great degree of certainty. These efforts are progressing at a very rapid rate, to assure optimal utilization of IMRT and even set the seen for proton beam therapy in the few institutions where such capability is or will be available.
As was the case for the first edition of this important textbook, the reader will find a clear articulation of current state of the art in advanced treatment planning, target determination, target delineation, and dose delivery with the heaviest emphasis on IMRT. It provides a strong foundation upon which the medical community is continuing to build. Practical issues and constraints related to target delineation are elaborated extensively in this text. What also becomes clear is the continued evolution in this exciting and demanding domain in radiation oncology. Although it is critical to have such capability articulated carefully and fully in the second edition of this important work, the need for additional editions is apparent from the rate of change, indicated by the progress that has been made between the first and second editions of this work.

- by James Cox MD -

Book Details

• Hardcover: 324 pages
• Publisher: Lippincott Williams & Wilkins; Second edition (September 28, 2004)
• Language: English
• ISBN-10: 0781752795
• ISBN-13: 978-0781752794

List Price: $190.50 
 

Kavanagh: Stereotactic Body Radiation Therapy

Stereotactic Body Radiation Therapy (SBRT) represents the newest plateau in the art and science of radiation oncology. Previously unimaginable radiation doses are administered precisely and non-invasively in an aggressive, decisive action to eradicate a discrete focus of cancer.
SBRT has evolved as a result of enormous technological advances in image-guided therapy. As the name implies, the technology involves the use of external fiducial markers referenced in 3-D space to internal targets, allowing stereotactic guidance of treatment to targets within the body. Previously applied monikers included the term “Stereotactic Radioablation,” which conveyed the sense that the high-dose treatment is intended to ablate, or completely eradicate, targeted tumors. “Extracranial Radiosurgery” is another popular term, appealing insofar as it reflects the debt SBRT owes to cranial radiosurgery, through which the concept of stereotactic localization has been refined. However, as discussed in the book, “radiosurgery” generally implies a single fraction course of treatment, whereas SBRT is quite commonly administered in a hypofractioned regimen of 3-5 fractions.
Equally important for the development of SBRT have been the accomplishments in diagnostic imaging and systemic therapy during the last decade. High-quality CT, MRI, and PET scans can provide very accurate information about the exact locations of measurable deposits of tumor cells within a cancer patient's body. Newer chemotherapy combinations and novel growth factor-targeted drugs have achieved significant improvements in progression-free survival for many solid tumors. The complementary role of SBRT, then, is to provide directly cytotoxic treatment focally to the clinically evident disease sites that are unlikely to be cleared with systemic agents alone. Competing with SBRT in this regard are the numerous invasive methodologies for accomplishing this same goal, namely surgical resection and temperature-based therapies (radiofrequency ablation and cryosurgery). The advantage of SBRT in many cases is the greatly reduced toxicity profile, lack of invasiveness, and capacity to deliver the treatment entirely on an outpatient basis.
This book is partly constructed as an educational tool for all oncologists to promote understanding of the power and elegance of SBRT as a new and important weapon in the cancer-fighting arsenal. Modern multidisciplinary management strategies mandate input from radiation, medical, and surgical oncologists—and we all need to keep sight of the expanding frontiers of each other's primary modalities.
At the same time that we acknowledge that SBRT is made possible by technological progress in medical physics, we must concede that SBRT will only be implemented safely and effectively with an appreciation of the underlying basic and clinical radiobiology. In their learned contribution to this book, Dr. Fowler and colleagues explain that to attain a high probability of actually killing off a tumor with radiation, it requires a biologically very potent dose—much more than is generally given with conventionally fractionated treatment.
Here is the catch: if you give the tumor a large dose of radiation, then some adjacent normal tissue will get a large dose as well. Fortunately, with careful attention to technique, it is frequently possible to steer the radiation toward the tumor from enough different directions that only a very small rim of normal tissue is affected noticeably. Just how much radiation can really be given with SBRT remains to be seen, and the radiation oncology community needs to continue careful clinical-biologicalphysics-inclusive translational research to establish where the reasonable safe limits really are. In seeking great success, we risk great failure, so we are compelled to work together.
The book is also, then, intended to be a primer for radiation oncologists, physicists, radiobiologists, dosimetrists, therapists, and other invaluable members of the team who wish to become comfortable with emerging techniques that raise radiotherapy to bold new heights.

Brian Kavanagh, Robert Timmerman

Contents 

Prologue: The Clinical Transition from Cranial to Extracranial Stereotactic Radiation Therapy

I. The Radiobiology of Extracranial Stereotactic Radiation Therapy (SBRT)

• Tumor Dose-Response Relationships in SBRT: Do traditional Models Apply?
• The intracellular signaling response to high dose radiation
• Normal tissue Dose-constraints in Lung SBRT
• Normal tissue Dose-constraints in Liver SBRT
• Radiation-induced cytokine production: mechanisms and potential clinical implications
• Special topics: the dose rate effect, margin selection, and resistant subpopulations

II. The Physics and Dosimetry of SBRT

• Immobilization, Localization, and Repositioning Methods in SBRT
• Treatment Planning
• Quality Assurance in SBRT

III. Initiating an SBRT Program

• Equipment and physical layout
• Commissioning and accreditation
• Personnel Training

IV. Clinical Applications of SBRT approx.

• SBRT for lung tumors
• Case Studies in Lung SBRT 
• SBRT for Liver Tumors
• Case Studies in Liver SBRT
• SBRT for renal cell carcinoma
• SBRT in retroperitoneal and pelvic tumors
• Case Study in Pelvic SBRT
• Spinal Radiosurgery
• Case studies in spine Radiosurgery

Epilogue: Group Protocols and Future Directions in SBRT 

Product Details
Hardcover: 160 pages

Publisher: Lippincott Williams & Wilkins; 1 edition (September 21, 2004)

Language: English

ISBN-10: 0781754208 / ISBN-13: 978-0781754200

List Price: $163.95

DeLaney: Proton and Charged Particle Radiotherapy

The two fundamental and evolving themes of radiation therapy have been the increase in knowledge regarding the location and behavior of tumor cells in the patient and the increasingly selective delivery of radiation to those tumor cells, therby improving the therapeutic ratio of the treatment.
The physical properties of protons and heavier charged particles, whereby dose is largely deposited in the narrow Bragg peak at a fixed depth in tissue without dose beyond this peak, provide clinicians with a tool to sharply conform the radiation dose around the tumor, thereby permitting selective delivery of external radiation to the tumor. It is anticipated that ongoing improvements in tumor imaging with molecular imaging will further improve the clinician's ability to understand where viable tumor cells are and where radiation dose needs to be deposited. Charged particles are ideal tools for taking full advantage of these improvements in tumor imaging and are expected to permit dose painting areas to tumor where hypoxia, accelerated tumor proliferation, or other tumor profiles that might be associated with radiation resistance are imaged.

Lu: Decision Making in Radiation Oncology Volume 1

With the development of the patterns of care study chaired by Dr. Simon Kramer, the decision tree concept was initiated for a number of tumor sites including the carcinomas of the larynx, base of the tongue, the anterior two-thirds of the tongue, prostate, bladder, etc. This led to the gathering of significant information in terms of clinical presentations, clinical work-up, and decisionmaking with regard to management during pretreatment, treatment, and post-treatment phases. This concept has been widely accepted in the community of oncologists and it has been the purpose of this book to strengthen that concept and to add the supporting data that make it a very useful clinical tool.
The authors have done a superb job in presenting the information that allows for innovative approaches to management and outcome analysis not only in clinical practice but in properly designed clinical trials, and for careful assessment of current practice based on solid and credible clinical research using the concept of the patterns of care but also the concepts of evidence-based outcome studies in oncology.

Perez and Brady's Principles and Practice of Radiation Oncology 5th Edition

Radiation oncology is the discipline of human medicine which addresses the causes, prevention, and treatment of human cancer with special emphasis on the role of ionizing radiation. Approximately 60% of all cancer patients receive radiation therapy as a component of their treatment. According to American Cancer Society estimates, in 2007 1.44 million new cases of invasive cancer will be diagnosed in the United States. In Europe the incidence of all forms of cancer is 3.2 million. There will be about 560,000 cancer deaths in the United States in 2007 and about 1.7 million cancer deaths in Europe. In the United States cancer accounted for 23% of all deaths, ranking second to heart disease as the nation's leading cause of mortality.
Fortunately, mortality rates for some cancers are on the decline in the economically developed world. This is the result of reductions in smoking, improvement in cancer screening rates (particularly for colorectal cancer), and better treatment. Unfortunately, 60% of the patients who die of, or with cancer, have persistent locoregional tumors. A substantial portion of the resources in cancer care are devoted to control of the locoregional tumor, and we should optimize use of radiation therapy in these patients. The management of the cancer patient involves a complex and close integration of biological and physical sciences in conjunction with sound clinical principles to obtain the best possible therapeutic results. The fifth edition of Principles and Practice of Radiation Oncology is designed to provide the reader with a definitive, authoritative, and comprehensive review of the subject.
The addition of two new editors to the fourth edition of the book, Rupert K. Schmidt-Ullrich, M.D., and Edward C. Halperin, M.D., M.A., engendered a review of the mission and vision of the text. A thorough restructuring of the chapters, their subject matter, and their authorship was undertaken and appeared to meet with the approval of our worldwide readership.
There has been a general evolution of our basic biologic understanding of ionizing radiation and its interactions with living tissue. Increasingly, the discipline of radiation biology has become embedded into a more catholic view of the role of radiation within the field of fundamental cancer biology. The fifth edition addresses the basic science of oncology with updated chapters on molecular cancer biology, radiation biology, and the pathophysiology of solid tumors.
In addition to updated treatments of the standard topics of photon and electron beam dosimetry and treatment planning, new material has been added which comprehensively addresses three-dimensional conformal therapy, intensity modulated radiation therapy treatment planning, image-guided radiation therapy, brachytherapy, and radiation modifiers.
The chapters concerning techniques, modalities, and modifiers in radiation oncology have been updated. Entirely new treatments of stereotactic irradiation outside the central nervous system, photodynamic therapy, and oncologic imaging have also added along with updated chapters on particle therapy, intraoperative radiation therapy, and hyperthermia.
The fifth edition provide a totally revised treatment of clinical radiation oncology. The chapters discussing disease by anatomic site cover relevant background information on each tumor, including epidemiology, pathology, diagnostic workup, prognostic factors, treatment techniques, applications of surgery and chemotherapy, end results of treatment, and pertinent clinical trials. This edition was extensively revised to include updated reports on new treatment techniques and results. There is a great deal of individuality in the techniques of irradiation. Descriptions of various technical approaches, leaving to the reader the critical task of selecting the most appropriate one for the particular patient under consideration have attempted to include. The comprehensive and rigorous assessment of each tumor site set forth in this text provides the foundation for proper application of radiation therapy techniques and multimodal programs in the treatment of patients with cancer. The old chapters on breast cancer have been replaced with a more complete treatment in three chapters with new authors. Similarly, prostate cancer is addressed in two chapters with new authors. The treatment of head and neck cancer is covered by a combination of new and previous contributors. A fine new chapter on radiotherapy of benign disease has been provided by contributors from Germany.
The constantly evolving treatment of lymphoma, hematologic malignancies, and pediatric cancers has received particular attention. An outstanding revised chapter on Hodgkin's disease compliments this edition of the book as well as an exhaustive revised chapter on non-Hodgkin's lymphoma. New to the fifth edition are a series of chapters on palliative and supportive care and quality of life assessment.
Consistent evolution of our field called for other chapters which have not appeared in prior editions. Chapters on the economics of radiation oncology and radiation oncology in developing countries have added.
The new edition of Principles and Practice of Radiation Oncology will continue to advance clinical care, research, and teaching in your discipline. This new edition will contribute to the amelioration and control of cancer disease which causes suffering for many and engenders fear among even more.

About the Editors

• Edward C. Halperin MD, MA : Dean of the School of Medicine, Ford Foundation Professor of Medicine Education; Professor of Radiation Oncology, Pediatrics, and History, University of Louisville, Louisville, Kentucky.
• Carlos A. Perez MD : Professor Emeritus, Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
• Luther W. Brady MD : Distinguished University Professor, Hylda Cohn/American Cancer Society Professor of Clinical Oncology; Professor, Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Brachytherapy: Applications and Techniques

Brachytherapy is the clinical use of radioactive isotopes to provide a highly conformal image-guided radiation therapy that takes advantage of the steep fall off dose characteristics and different energetic emanations to improve the therapeutic ratio. Historically it was the first mode of radiation therapy. The last 110 years has seen the full maturing of radiation oncology. Integral to this growth of radiation oncology has been the rise and fall of various types of brachytherapy, often in a reciprocal manner to the changes in external beam radiation therapy technology. Some early methods have endured to this day, including surface applications and some forms of gynecologic care. Prostate brachytherapy was practiced very early as intraurethral radium insertions, first for benign prostatic hypertrophy and then for prostate tumors. Modern prostate brachytherapy could not be farther away from this. Vascular brachytherapy has risen and fallen in a relatively short number of years, driven by huge financial pressure and eclipsed by innovative and disruptive technology, despite many randomized trials proving efficacy. Breast brachytherapy, once a part of boost therapy in the first wave of breast conservation a generation ago, is on the rise in intracavitary and interstitial forms of accelerated partial breast irradiation for early, stage breast conserving therapy.
The context for writing this textbook is that of a dedicated division of brachytherapy in a large urban teaching hospital with three core missions: excellence in clinical care of patients, excellence in teaching, and excellence in research. This textbook addresses all three goals. This textbook should be a practical source to clinical teams answering two basic questions, why and how. Ten clinical disease site chapters are preceded by chapters on practical radiobiology, practical physics considerations, and followed by a final chapter of organizational practical considerations. Chapters 3 to 12 on clinical disease sites flow generally in a cephalocaudal order. These vignette descriptions will help contextually orient the reader.

Functional Preservation and Quality of Life in Head and Neck Radiotherapy

Treating head and neck cancer involves the treatment of tumors within a highly complex anatomical and physiological environment. Because end organs for critical sensorimotor functions such as breathing, speaking, swallowing, seeing, and hearing are found within the head and neck, the eradication of the disease is particularly challenging. Life-threatening diseases must be approached in a manner that not only maximizes survival, but also maximizes functional outcome.
While the overall goal is generally cure or palliation, a variety of treatment options exists. Treatment approaches must be balanced with planning for toxicity reduction and functional preservation. A major objective of this book is to emphasize that the evaluation of treatment methods for head and neck cancer can transcend simple measurement of survival by also considering how particular treatments affect the life of the individual patient. That is, the manner in which function is preserved must be evaluated in conjunction with more traditional measures of health and disease. Measures of function are important clinical endpoints and can serve to evaluate the extent to which a treatment affects a patient’s overall health and well-being. Chapters in this volume examine this concept from the perspective of sites of disease within the head and neck as well as treatment methodology.
Measures that take into account the patient’s perspective are particularly useful for dimensions of health in which the individual is the only person who can truly appreciate the condition. Variables such as pain and fatigue fit into this category, as do assessments of “quality of life.” As a field of study, health-related quality of life (HR-QOL) research and measurement has expanded greatly over the last 30 years. To date, there are over 125,000 articles indexed in Medline (PubMed) with the heading of “quality of life” and over 2700 of these articles are concerned with head and neck cancer. This great interest in HR-QOL with regard to head and neck cancer not only refl ects the importance of including concepts of quality of life in our research but it also shows that quality of life is an important factor influencing our treatment selection in the care of individual patients. The contributors to this volume are renowned international experts in the field of head and neck cancer. Their outstanding contributions cover a wide range of topics including epidemiological issues associated with different tumor sites, treatment outcomes and toxicities associated with different treatment techniques, and the support of quality of life and the prevention of its decrements associated with therapy. The incorporation of quality of life themes into this framework offers a patient-centered perspective to the treatment of head and neck cancer and is geared toward functional preservation.
This book is an accessible volume with state-of-the-art content focused on preservation of function in head and neck cancer patients. All chapters in this volume begin with a list of key points providing readers a synopsis of core information concerning each of the major content areas discussed. Thus, it is possible for the busy clinician to gain an appreciation of the subject matter and to follow with more in depth study as time allows.

Contents
Epidemiology and Treatment Outcome
1 Oral Cavity Cancer
2 Oropharynx: Epidemiology and Treatment Outcome
3 Hypopharynx
4 Laryngeal Cancer: Epidemiology and Treatment Outcomes
5 Nasopharynx
6 Paranasal Sinus and Nasal Cavity
7 Salivary Glands and Quality of Life
8 Head and Neck Sarcomas and Lymphomas
9 Thyroid Cancer
10 Cervical Lymph Node Metastases from Unknown Primary Tumors
Treatment Techniques with Potential Impact on QOL
11 Dysphagia-Related Quality of Life of Patients with Cancer in the Oropharynx: An Advantage for Brachytherapy?
12 Improving the Quality of Life of Patients with Head and Neck Cancer by Highly Conformal Radiotherapy
13 Advantages of Proton Beam Therapy in Functional Preservation and Quality of Life in Head and Neck Radiotherapy
14 Target Defi nition and Delineation CT/MRI/ PET-Guided Targets
15 Advanced Techniques for Setup Precision and Tracking
16 Adaptive Image-Guided Radiotherapy for Head and Neck Cancer
17 Improving Form and Function Through Surgical Care in Head and Neck Squamous Cell Carcinoma
18 The Contribution of Chemotherapy
19 Contributions of Targeted Agents
Toxicity, Quality of Life, Prevention, Rehabilitation, Supportive Care
20 Late Radiation-Induced Side Effects
21 Head and Neck Cancer Quality of Life Instruments
22 Measuring and Reporting Toxicity
23 Effects of Radiotherapy on Swallowing Function: Evaluation, Treatment and Patient-Reported Outcomes
24 Dental Prophylaxis and Care
25 Smoking Cessation
26 Supportive Therapy Including Nutrition
27 Communication and Palliative Care in Head and Neck Cancer
28 Organized Head and Neck Cancer Care

Book Details

• Authors: Paul M. Harari, Nadine P. Connor, Cai Grau, and Luther W. Brady
• Hardcover: 325 pages
• Publisher: Springer; 1 edition (July 8, 2009)
• Language: English
• ISBN-10: 3540732314
• ISBN-13: 978-3540732310
• Product Dimensions: 10.7 x 7.9 x 0.7 inches

Radiotherapy for Hodgkin Lymphoma

• 1 History of Radiotherapy of Hodgkin’s Disease (Now Hodgkin Lymphoma).
• 2 Background and Rationale for Radiotherapy in Early-Stage Hodgkin Lymphoma.
• 3 Background and Rationale for Radiotherapy in Advanced-Stage Hodgkin Lymphoma.
• 4 Salvage Therapy for Relapsed and Refractory Hodgkin Lymphoma.
• 5 Principles of Chemotherapy in Hodgkin Lymphoma.
• 6 Management of Lymphocyte Predominant Hodgkin Lymphoma.
• 7 Pediatric Hodgkin Lymphoma, the Rationale for Radiation Therapy.
• 8 The Role of Imaging in Radiotherapy for Hodgkin Lymphoma.
• 9 Target Definitions for Hodgkin Lymphoma: The Involved Node Radiation Field Concept.
• 10 Traditional and Modern Techniques for Radiation Treatment Planning.
• 11 Quality Assurance of Radiotherapy for Hodgkin Lymphoma.
• 12 Evaluation of Response After Radiotherapy for Hodgkin Lymphoma.
• 13 Hodgkin Lymphoma in Special Populations and Rare Localizations.
• 14 Acute and Long-Term Complications of Radiotherapy for Hodgkin Lymphoma.
• 15 Proton Therapy for Hodgkin Lymphoma.
• 16 Future Prospects for Radiotherapy for Hodgkin Lymphoma.
• Index.

The major goal of developing this book is to optimize radiotherapy for Hodgkin lymphoma by providing clinicians who treat patients with this disease with a comprehensive account of the background for radiotherapy for Hodgkin lymphoma, the rationale for radiotherapy in a modern combined modality setting, and the data that document its contribution to the best outcome for patients. Special emphasis is given to the changes in volume and dose that have evolved over the past 2 decades, and the use of modern advanced technologies in imaging and radiotherapy planning and delivery in order to accurately target involved sites and protect adjacent organs.

Radiotherapy was the first curative treatment modality for this previously lethal disease, and the achievements of the pioneers of curative radiotherapy for Hodgkin lymphoma represented some of the earliest success stories of the non-surgical treatment of cancer. With the advent of effective multiagent chemotherapy regimens, the role of radiotherapy changed. Radiotherapy now became part of multimodality treatment. Moreover, the long-term toxicity of the very extensive radiation fields of the past became apparent. This led to a virtual scare of radiotherapy in certain circles, and efforts were made to replace combined modality treatment with chemotherapy alone, almost no matter how intensive, with surprisingly little regard for the long-term toxicity of chemotherapy itself.

Recent evidence on the consequences of omitting radiotherapy altogether in the treatment of Hodgkin lymphoma demonstrates that such a strategy is not yielding the best possible results with regard to cure. In early-stage disease, the interim analysis of the large H10 trial of the EORTC/GELA/IIL demonstrates that in patients who were rendered PET-negative after two cycles of ABVD, the substitution of radiotherapy with more chemotherapy in favorable and unfavorable patients results in significantly higher relapse rates than standard treatment with less chemotherapy followed by involved node radiotherapy (INRT). In advanced disease, where many regarded radiotherapy as of no additional value, the recent analysis of the British LY09 trial demonstrates that the omission of radiotherapy seemed to be to the detriment of the chance of cure also in these patients. Finally, the concept of mini-chemotherapy with mini-radiotherapy has been shown to yield excellent results in patients with favorable and unfavorable early-stage disease, as demonstrated by the final analyses of the German Hodgkin Study Group HD10 and HD11 trials.

Radiotherapy remains the most effective single modality for the treatment of Hodgkin lymphoma. The modern application of this treatment modality, with lower doses and with very much reduced volumes, has proved effective and reduced the toxicity of this treatment tremendously. Highly advanced technologies within imaging, e.g., PET/CT-scanning, image co-registration, four-dimensional scanning and motion compensation, and within treatment planning and delivery, e.g., intensitymodulated radiotherapy, arc-therapy, image-guidance and motion gating or tracking, have revolutionized radiotherapy. These techniques allow highly conformal radiotherapy, sparing large volumes of normal tissues while maintaining target coverage. Such techniques can and should be employed in the treatment of Hodgkin lymphoma.

Book Details

• Hardcover: 214 pages
• Publisher: Springer; 1st edition (November 30, 2010)
• Language: English
• ISBN-10: 3540784551
• ISBN-13: 978-3540784555
• Product Dimensions: 10.2 x 7.9 x 0.6 inches

List Price: $179.00 

 

Practical Radiotherapy Planning 4th Edition

Radiotherapy treatment can only produce good effects if it is delivered in an appropriate clinical context. Attempting radical treatment for a patient with metastatic disease, or one who is likely to die soon from cardiac or lung disease is inappropriate. These decisions require a fine balance of judgement between therapeutic optimism and nihilism and must be firmly based in good clinical history taking and examination. The clinician must then be able to synthesise all the information about the patient, tumour, investigations and previous treatment to make a decision about whether radiotherapy should be given and if so, with radical or palliative intent. Comorbidities, such as diabetes or vascular disease, which would affect the toxicity of treatment, must also be considered.
Since the last edition of Practical Radiotherapy Planning in 1999, the practice of radiotherapy has changed radically. Advances in imaging have been integrated with technological developments in radiotherapy delivery so that 3D planning of volumes has replaced 2D field arrangements. Major developments in tumour localisation have included the publication of ICRU reports on target definition (Report 62 in 1999 and Report 71 in 2004) and the possibility of registration of different imaging modalities including CT, MRI and PET. In treatment delivery, multi-leaf collimation has enabled treatments to be shaped to tumours and intensity-modulated dose plans have provided solutions to previous planning dilemmas. Accuracy of treatment delivery has been ensured by development of portal imaging and daily image-guided and adaptive radiotherapy techniques.

This is therefore a completely new book, with new introductory chapters and a changed structure within each tumour site chapter. We have been able to make much more use of clinical images to illustrate important planning concepts. The aim of the book, however, remains unchanged: to provide a guide to radiotherapy treatment planning that is based on sound pathological and anatomical principles. Complexity of treatment planning has increased greatly but this new edition continues to emphasise the underlying principles of treatment, which can be applied to conventional, conformal, and novel treatments, taking into account advances in imaging and treatment delivery.

Much treatment is now given according to local, national or international protocols and these should always be consulted and used when appropriate. Details of drug and of some radiotherapy regimens are not given as they change frequently. Again we have largely excluded recommendations for treatment of benign disease.

The ICRU report proposed a colour convention for outlining target volumes, but with regret we have chosen different colours to ensure optimal reproduction of plans. We have used the following scheme in all illustrations:

GTV dark blue

CTV cyan (light blue)

CTV2 magenta (purple)

PTV red

PTV2 lime green

OAR yellow, light yellow, light green, dark green

Two authors from the first three editions have been joined by two younger colleagues from our departments to ensure that they continue to reflect the most up-to-date approach to treatment planning. It would have been impossible to produce a book like this one, in the age of site-specialised practice and multidisciplinary team working, without relying very heavily on expert colleagues within our respective departments.

This small textbook cannot describe all the research which has been undertaken to develop treatment schedules. The author aim always to use evidence-based solutions where they exist and have suggested, in a short list of information sources at the end of each chapter, where more detailed data may be found. Some fields of research, such as the use of gating and adaptive therapy, 3D rotational arc therapy, and stereotactic radiotherapy are still undergoing evaluation and are therefore beyond the scope of this book. The author give a brief introduction to the principles and practice of brachytherapy but details must be found elsewhere. Commonly used abbreviations have been spelled out only at first mention in the book but are included in the appendix for further reference.

Trainees in radiation oncology and radiographers, working within a multidisciplinary team, will continue to use this book to produce safe and appropriate plans for common tumours.

Book Details

• Authors: Ann Barrette, Jane Dobbs, Stephen Morris, and Tom Roques
  
• Paperback: 468 pages
• Publisher: Oxford University Press, USA; 4th edition (September 7, 2009)
• Language: English
• ISBN-10: 0340927739
• ISBN-13: 978-0340927731
• Product Dimensions: 9.1 x 6.1 x 0.9 inches