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.
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