Technical Basis of Radiation Therapy: Practical Clinical Applications (Medical Radiology Radiation Oncology)

This book, now in its fourth edition, is unique in detailing in depth the technological basis of radiation therapy. Compared with the previous edition, all chapters have been rewritten and updated. In addition, new chapters have been included on various topics, including the use of imaging in treatment planning, second malignant neoplasms due to irradiation, and quality assurance in radiation oncology. The book is divided into two sections. The first covers basic concepts in treatment planning, including essential physics, and explains the various approaches to radiation therapy, such as intensity-modulated radiation therapy, tomotherapy, and high and low dose rate brachytherapy. The second part documents the practical clinical applications of these concepts in the treatment of different cancers. All of the chapters have been written by leaders in this field. This book will provide an invaluable guide to the basic technological factors and approaches in radiation therapy. Cover......Page 1 Foreword......Page 6 Preface......Page 7 Part I: Basic Concepts in Treatment Planning......Page 8 Part II: Practical Clinical Applications......Page 9 Part I - Basic Concepts in Treatment Planning......Page 11 Glossary......Page 13 1.1 Introduction......Page 16 1.2 The Simplest Modeling......Page 17 1.3 The Seven Steps to LQ Heaven – The Details......Page 18 1.4 Rejoining Point for Those Who Skipped: How to Evaluate a New Schedule – Brief Summary......Page 25 1.5 Now Let Us Study Some of the Best-Known Schedules for Head-And-Neck Tumor Radiotherapy......Page 26 1.6 Hypofractionation for Prostate Tumors......Page 32 1.7 Summary......Page 33 1.8 Appendix: Is This a Mistaken Dose Prescription?......Page 34 1.9 Line-by-Line Worked Examples: Details of Calculations of the Schedules Discussed in This Appendix......Page 37 References......Page 39 2.1 Introduction......Page 43 2.2 The Impact of IMRT on the Incidence of Radiation-Induced Second Cancers......Page 46 2.4 The Bottom Line......Page 47 References......Page 48 3.1 Clinical Principles......Page 49 3.2 Specific Chemotherapeutic Agents......Page 53 3.3 Clinical Use of Chemoirradiation in Specific Sites......Page 54 3.5 Urinary Bladder......Page 57 3.7 Esophagus......Page 58 3.8 Rectum......Page 59 References......Page 61 4.1 Introduction......Page 67 4.2 Imaging Modalities......Page 68 References......Page 76 5.1 Introduction......Page 79 5.3 Monitor Unit and Dose Calculation Methods......Page 85 5.4 Dose Calculation Algorithms and Correction Factors......Page 88 5.5 Correction for Tissue Inhomogeneities......Page 89 5.6 Clinical Photon-Beam Dosimetry......Page 91 5.7 Treatment Planning: Combination of Treatment Fields......Page 96 5.8 Field Shaping......Page 101 5.9 Compensating Filters......Page 105 5.11 Treatment-Planning Process......Page 106 5.12 Separation of Adjacent X-Ray Fields......Page 110 References......Page 113 6.1 Introduction......Page 117 6.2 Technology Overview......Page 119 6.3 Multimodality Imaging......Page 128 6.4 Patient Positioning and Immobilization......Page 129 6.5 Simulation Process......Page 134 6.6 Discussion and Conclusion......Page 141 References......Page 142 7.2 Historical Perspective......Page 145 7.3 Electron Interactions......Page 146 7.4 Central Axis Percentage Depth-Dose Distributions......Page 147 7.5 Isodose Curves......Page 150 7.6 Effect of Inhomogeneities on Electron Distributions......Page 153 7.7 Clinical Applications of Electron Beams......Page 156 7.8 Special Electron Techniques......Page 169 References......Page 174 8.1 Introduction......Page 177 8.3 Immobilization......Page 178 8.4 Collimation......Page 180 8.5 Compensation Systems......Page 182 References......Page 187 9.1 Introduction......Page 189 9.2 Three-Dimensional Radiation Therapy Treatment Planning......Page 190 9.3 Volume and Dose Specification for 3D CRT......Page 198 9.5 Three-Dimensional Dose Calculation Algorithms......Page 203 9.6 Dose-Volume Histograms......Page 204 9.7 Biological Models......Page 207 9.8 Management of Three-Dimensional Treatment Planning Data......Page 208 References......Page 210 10.1 Introduction......Page 213 10.2 Basic Physical Principles of IMRT......Page 217 10.3 Inverse Treatment Optimization (Cost Func-tion and Search Algorithm)......Page 219 10.4 IMRT Treatment Delivery Systems......Page 220 10.5 IMRT Quality Assurance (Commissioning and Clinical)......Page 222 10.6 Clinical Studies with IMRT......Page 227 10.8 Additional Challenges for IMRT Implemen-tation......Page 234 References......Page 235 11.2 Origins of Radiosurgery......Page 243 11.3 Descriptive Overview......Page 244 11.4 Equipment Required for Stereotactic Radio-surgery and Stereotactic Radiotherapy......Page 246 11.5 Specific Treatment Techniques......Page 248 11.6 Intracranial Stereotactic Radiosurgery Devices......Page 252 11.7 Extracranial Stereotactic Radiotherapy Devices......Page 258 11.8 Quality Assurance......Page 260 References......Page 261 12.1 Introduction......Page 265 12.2 Classifications of Brachytherapy......Page 266 12.3 Physical Characteristics of Brachytherapy Sources......Page 268 12.4 Sources Used in Brachytherapy......Page 269 12.5 Dose Calculations in Brachytherapy......Page 271 12.6 Gynecological Intracavitary Implant......Page 276 12.7 Interstitial Implant Dosimetry Systems......Page 278 12.8 Process of Brachytherapy Treatment Planning and Delivery......Page 280 12.9 Transrectal Ultrasound-Guided Permanent Prostate Brachytherapy......Page 284 12.10 High Dose Rate Remote-Afterloading Brachytherapy......Page 289 12.11 Radiation Protection and Regulatory Compliance in Brachytherapy......Page 295 References......Page 298 13.1 Absorption of Radiation......Page 301 13.3 Chromosomal Aberrations......Page 302 13.4 Cell Survival Curves......Page 303 13.5 The Dose-Rate Effect......Page 305 13.6 The Inverse Dose-Rate Effect......Page 307 13.8 Early- and Late-Responding Tissues......Page 308 13.9 The Dose-Rate Effect and Clinical Data......Page 309 13.10 Dose-Rate Effects from a Retrospective Analysis of the Iridium Implant Data......Page 310 13.12 Rationale for LDR Brachytherapy......Page 311 13.14 Experimental Validation of the PDR Concept......Page 312 13.15 Practical Clinical Schedules for PDR......Page 314 13.16 HDR Versus LDR......Page 315 References......Page 317 14. Clinical Applications of Low Dose Rate and Medium Dose Rate Brachytherapy......Page 319 14.2 Radionuclides......Page 320 14.3 Afterloading Interstitial Brachytherapy......Page 321 14.4 Templates......Page 324 14.5 Molds......Page 326 14.7 Implantation Techniques......Page 329 14.8 Low Dose Rate Brachytherapy Techniques for Specific Sites......Page 331 14.8.2 Implants with Multiple Iridium-192 Sources......Page 332 14.10 Quality Assurance and Radiation Safety in Brachytherapy......Page 377 References......Page 380 15.1 Abstract......Page 389 15.3 How to Design a New HDR Protocol......Page 391 15.4 Common Uses of HDR Brachytherapy......Page 392 15.5 Discussion......Page 400 References......Page 401 16.1 Introduction......Page 405 16.2 Goals and Structure of a QA Program......Page 406 16.3 Dosimetry Instrumentation QA......Page 409 16.4 Medical Linear Accelerator QA......Page 410 16.5 Linac Advanced-Technology QA......Page 415 16.6 Quality Assurance of Cobalt Teletherapy Units......Page 422 16.7 Treatment-Machine Maintenance......Page 423 16.8 Treatment-Planning Computer System QA......Page 424 16.9 Treatment-Planning QA......Page 425 16.10 Clinical Aspects of QA......Page 428 16.11 Conclusion......Page 430 References......Page 431 Part II: Practical Clinical Applications......Page 433 17.2 Natural History......Page 435 17.3 Workup and Staging......Page 440 17.4 General Management......Page 441 17.5 General Concepts of Modern Radiation Therapy Technique......Page 444 17.6 Simulation Procedures......Page 447 17.8 Dose Prescriptions......Page 457 17.9 Future Directions......Page 458 References......Page 459 18. Head and Neck Cancer......Page 463 18.1 Larynx......Page 464 18.2 Hypopharynx......Page 466 18.3 Oropharynx......Page 467 18.5 Tonsillar Area......Page 469 18.7 Nasopharynx......Page 470 18.8 Oral Cavity......Page 472 18.9 Floor of Mouth......Page 473 18.10 Oral Tongue......Page 475 18.11 Nasal Cavity, Paranasal Sinuses, and Nasal Vestibule......Page 478 18.12 Major Salivary Gland......Page 482 18.13 Unknown Primary......Page 484 18.14 Design of Low Neck Portal......Page 485 18.15 IMRT......Page 488 References......Page 493 19.1 Introduction......Page 495 19.3 Anatomy......Page 496 19.4 Patterns of Spread......Page 498 19.5 Work-Up......Page 499 19.6 Staging......Page 500 19.7 Radiation Therapy – General Concepts......Page 502 19.8 Breast Conservation Radiation Therapy......Page 503 19.10 Boost to Primary Site......Page 505 19.11 Supraclavicular Nodal Irradiation......Page 507 19.12 Prone Position Breast Conservation Radiation Therapy......Page 509 19.13 Partial Breast Irradiation......Page 510 19.15 Regional Nodal Failure......Page 511 19.16 Postoperative Chest Wall Tangential Photon Fields......Page 513 19.17 Electron Beam Chest Wall Fields......Page 514 19.19 Anterior Supraclavicular–Axillary Photon Field......Page 515 19.21 Internal Mammary Chain Radiation......Page 517 19.23 Posterior Axillary Field......Page 518 References......Page 519 20.1 Natural History of the Disease......Page 521 20.4 Target Volume Definition......Page 528 20.6 Beam Selection and Design......Page 529 20.7 Plan Evaluation......Page 530 20.8 Plan Implementation and Quality Assurance......Page 531 References......Page 532 21.3 Anatomy and Pathologic Features......Page 535 21.4 Natural History and Symptoms......Page 536 21.5 Staging......Page 537 21.8 General Management of Non-Small Cell Lung Cancer......Page 538 21.9 Radiation Therapy Management......Page 539 21.10 Dose, Fractionation, Volume......Page 541 21.11 Radiation Therapy Technique......Page 543 21.12 Patterns of Failure......Page 546 21.13 Management of Small Cell Carcinoma......Page 547 References......Page 549 22.1 Diagnostic Evaluation......Page 555 22.2 Anatomy......Page 556 22.3 Pathways of Spread......Page 557 22.4 Patterns of Recurrence after Potentially Curative Resection......Page 558 22.5 Adjuvant Irradiation for Rectal Cancer......Page 559 22.6 Locally Advanced and Locally Recurrent Colorectal Cancer......Page 562 22.7 Primary Treatment of Anal Cancer......Page 563 22.8 Therapeutic Ratio......Page 565 References......Page 567 23.1 Natural History of the Disease (Patterns of Spread)......Page 571 23.2 Work-Up and Staging......Page 572 23.3 Prognostic and Predictive Factors......Page 573 23.4 General Management......Page 574 23.5 Radiation Therapy Techniques (General Description)......Page 578 23.7 Target Volume and Organs at Risk (Critical Structures)−Specifications (Including Tolerance Doses)......Page 579 23.8 Dose Prescription Beam Selection/Design Isodoses Plan Evaluation/Implementation......Page 580 23.9 Future Directions......Page 583 References......Page 585 24.1 Natural History of Cervical Cancer and Patterns of Spread......Page 589 24.2 Workup and Staging......Page 590 24.3 General Management......Page 591 24.6 LDR Brachytherapy......Page 596 24.7 Sequelae......Page 604 24.8 Results......Page 605 References......Page 606 25.2 Anatomy......Page 609 25.4 Clinical Presentation and Diagnostic Evaluation......Page 610 25.6 Clinical and Surgical Staging – FIGO Pathological Staging System......Page 611 25.7 Adjuvant Therapy – Early Stage (FIGO I–II) Endometrial Adenocarcinoma......Page 614 25.9 RT Techniques......Page 617 25.10 Medically Inoperable Early Stage Endometrial Cancer......Page 625 25.11 Recurrent Endometrial Cancer......Page 630 25.12 Palliative Therapy in Endometrial Cancer......Page 632 25.13 Uterine Papillary Serous and Clear Cell Carcinoma......Page 634 References......Page 638 26.1 Anatomy......Page 641 26.2 Natural History......Page 642 26.3 Diagnostic Workup......Page 643 26.5 Pathological Classification......Page 644 26.6 Prognostic Factors......Page 646 26.7 General Management......Page 647 26.8 Radiation Therapy Techniques......Page 650 26.9 Sequelae of Treatment......Page 658 26.12 Treatment of Other Vulvar Malignant Neoplasias......Page 659 26.13 Chemotherapy......Page 660 References......Page 662 27.1 Anatomy......Page 667 27.3 Natural History......Page 668 27.4 Clinical Presentation......Page 669 27.5 Prognostic Factors Influencing Choice of Treatment......Page 670 27.6 General Management: Treatment Options......Page 672 27.8 Salvage Therapy......Page 685 27.9 Treatment Complications and their Management......Page 688 27.10 Palliative RT......Page 690 References......Page 692 28.1 Anatomy......Page 697 28.2 Natural History......Page 698 28.3 Prognostic Factors......Page 704 28.4 Radiation Therapy Techniques......Page 705 28.5 Prostate Brachytherapy......Page 725 28.6 High-Dose-Rate Brachytherapy......Page 734 References......Page 739 29.1 Introduction......Page 749 29.3 Seminoma: General Management......Page 750 29.4 Radiotherapy Treatment......Page 752 29.5 Intratubular Germ Cell Neoplasia......Page 756 29.6 Special Considerations......Page 757 29.7 Treatment Sequelae......Page 758 References......Page 760 30.1 Abstract......Page 765 30.3 Clinical Evaluation......Page 766 30.4 Pathology......Page 769 30.5 Staging......Page 771 30.6 Management of the Primary Tumor......Page 772 30.7 Treatment of Metastatic Disease......Page 788 30.8 Summary......Page 789 References......Page 790 31. Total Body Irradiation Conditioning Regimens in Stem Cell Transplantation......Page 795 31.1 Conditioning Regimen......Page 796 31.2 Fractionation and Dose Rate......Page 797 31.6 Simulation and Patient Measurements......Page 798 31.7 Compensator Design......Page 801 31.8 Anteroposterior TBI......Page 804 31.9 Normal Tissue Shielding......Page 808 31.10 Gonad Shielding......Page 810 References......Page 812 32.1 Diagnostic Evaluation and Staging......Page 815 32.2 Histopathological Classification......Page 818 32.3 General Treatment Considerations......Page 819 32.4 Radiation Therapy Techniques......Page 824 32.5 Limited Field (Involved Field/Regional Field)......Page 834 32.6 Limited Field Above the Diaphragm......Page 836 32.7 Limited/Regional Field Below the Diaphragm......Page 838 32.8 Radiation Dose and Fractionation......Page 839 32.9 Normal Tissue Tolerance and Complications......Page 840 References......Page 842 33.1 Introduction......Page 847 33.2 Beta-Cath System for Coronary In-Stent Restenosis......Page 848 References......Page 851 B......Page 853 C......Page 854 E......Page 856 G......Page 857 I......Page 858 M......Page 859 O......Page 860 P......Page 861 R......Page 862 S......Page 863 T......Page 864 V......Page 865 Z......Page 866 List of Contributors......Page 867 The New Edition Of This Book Is Divided Into Two Sections. The First Covers Basic Concepts In Treatment Planning, Including Essential Physics, And Explains The Various Approaches To Radiation Therapy, Such As Intensity-modulated Radiation Therapy, Tomotherapy, And High And Low Dose Rate Brachytherapy. The Second Part Documents The Practical Clinical Applications Of These Concepts In The Treatment Of Different Cancers. All Of The Chapters Have Been Written By Leaders In This Field. This Book Should Provide An Invaluable Guide To The Basic Technological Factors And Approaches In Radiation Therapy. S.h. Levitt ... [et Al.], Eds. ; With Contributions By R.r. Allison ... [et Al.] ; Series Editor's Foreword By L.w. Brady, H.-p. Heilmann, M. Molls. Rev. Ed. Of: Levitt And Tapley's Technological Basis Of Radiation Therapy / Edited By Seymour H. Levitt ... [et Al.]. 3rd Ed. C1999. Includes Bibliographical References And Index.