Fundamentals of Radiation Oncology

Physical, Biological, and Clinical Aspects

4th Edition - June 20, 2024
Editor: Hasan Murshed
Language: English
Paperback ISBN:
9 7 8 - 0 - 4 4 3 - 2 2 2 0 8 - 5
eBook ISBN:
9 7 8 - 0 - 4 4 3 - 2 2 2 0 9 - 2

Fundamentals of Radiation Oncology: Physical, Biological, and Clinical Aspects, Fourth Edition, is written by a team of renowned experts. This book is a must-have resource for an… Read more

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Fundamentals of Radiation Oncology: Physical, Biological, and Clinical Aspects, Fourth Edition, is written by a team of renowned experts. This book is a must-have resource for anyone practicing radiation oncology. From basic principles to more-advanced planning and delivery of radiation therapy to treat cancer, this book is a go-to resource for mastering the art and science of radiation oncology.

Title of Book
Cover image
Title page
Table of Contents
Copyright
Dedication
Contributors 3rd edition
Contributors 4th edition
Reviewers 4th edition
About the editor
Foreword—James Bonner
Foreword—Thomas Buchholz
Preface
Part I. Basic Science of Radiation Oncology
Chapter 1. Radiation Physics, Dosimetry, and Treatment Planning
Fundamental Physical Quantities
Mass
Energy
Charge
Force
Atomic Structure
Atomic Models
Electron Binding Energy
Atomic Shell Filling Rules
Characteristic Radiation
Auger Electrons
Nuclear Binding Energy
Nuclear Structure
Radioactive Decay
Modes of Radioactive Decay
Alpha Decay
Beta Decay
Gamma Emission
Isomeric Transitions
Internal Conversion
Mathematics of Radioactive Decay
Activity
Equilibrium
Electromagnetic Radiation and Properties of Interaction
Photon Interaction Process, Kerma, Absorbed Dose
Modes of Photon Interaction
Particulate Radiation Properties and Interactions
Interactions of Electrons
Interactions of Neutrons
Interactions of Heavy Charged Particles
The Physics of Dosimetry
Inverse Square Law
Backscatter Factor (BSF)
Peak Scatter Factor (PSF)
Depth of Maximum Dose (dmax)
Percentage Depth Dose (PDD)
Tissue-Air Ratio (TAR)
Scatter-Air Ratio (SAR)
Tissue-Phantom Ratio (TPR), Tissue-Maximum Ratio (TMR)
Linac Calibration
Types of Calibration
Field Size Correction Factors
Collimator Scatter Factor and Phantom Scatter Factor
Beam Modifier Factors
Patient Attenuation Factors
Calculation of Treatment Monitor Units
Electron Beam Dosimetry
The Physics of Radiation Treatment Planning and Delivery
External Beam Radiation
Internal Radiation
Radiation Treatment Planning
External Beam Radiation Therapy
3-D Conformal Radiation Therapy (3-D CRT)
Intensity Modulated Radiation Therapy (IMRT)
Volumetric Modulated Arc Therapy (VMAT)
Image-Guided Radiation Therapy (IGRT)
Brachytherapy
Interstitial Brachytherapy
Intracavitary Brachytherapy
Other Radiation Therapy Modalities
Chapter 2. Radiation Protection and Safety
Measurement of Radiation Quantities
Radiation Exposure
Air Kerma
Absorbed Dose
Effective Dose Equivalent
Measurement of Radiation Quantities/Radiation Protection Principles
Effective Dose
Radiation Protection Principles
Organizations
Regulations
Occupational and General Public Dose Limits
ALARA and Radiation-Induced Biological Effects
Treatment Room Design
Signage, Labeling, and Packeging Requirements
Equipment and Area Monitoring
Personnel Monitoring
Chapter 3. Radiation Biology
Radiobiological Quantities
Directly and Indirectly Ionizing Radiation
Deposition of Ionizations Along Tracks
Direct and Indirect Action of Radiation
Linear Energy Transfer (LET)
Relative Biological Effectiveness (RBE)
Therapeutic Ratio
Radiation Effects on Chromosomes
Chromosome-Type Aberrations
Chromatid-Type Aberrations
Telomeres and Telomerase
Repair of Radiation Damage
Cell Survival Curves
Target Theory
The Linear-Quadratic Model (L-Q)
The Four “Rs” of Radiobiology
Altered Fractionation Protocols Used in Clinical Radiotherapy
Dose Rate Effect and Repair of Damage
Sublethal Damage (SLD)
Potentially Lethal Damage (PLD)
The Oxygen Effect and Reoxygenation
Radiosensitizers and Radioprotectors
Cell and Tumor Cell Kinetics
Molecular and Biology Techniques
MicroRNAs
Cell Cycle Kinetics
Effects on Tumor Cells
Normal Tissues Kinetics and Proliferation Status
Effects on Normal Tissues
Functional Subunits (FSU)
Michalowski's H-type, and F-type Classification
Radiation and Cytokines
Early and Late Reacting Tissues: Specific Organs
Early Reacting Tissues
Late Reacting Tissues
Acute Effects of Whole-Body Irradiation
Prodromal Syndrome
Hematopoietic Syndrome
Gastrointestinal Syndrome
Central Nervous Syndrome/Cerebrovascular Syndrome
Deterministic and Stochastic Effects of Radiation
Deterministic Effects
Stochastic Effects
Carcinogenesis
Effects of Radiation on the Embryo and Fetus
Radiation-Induced Heritable Changes
Sources of Radiation Exposure
Chapter 4. Molecular Cancer Biology
Cell Cycle Control
G1 → S
G2 → M
Carcinogenesis and Metastasis
Matrix Metalloproteinases
Integrins
Tumor Suppressor Genes
DNA Repair Genes
Proto-Oncogenes and Oncogenes
Receptor Tyrosine Kinases
Regulatory GTPases
Other Kinases
Transcription Factors
Apoptosis
Intrinsic Apoptotic Pathway
Extrinsic Apoptotic Pathway
Necroptosis
Angiogenesis
Therapeutics
Chemotherapeutics
Targeted Therapies
Part II. Techniques and Modalities of Radiation Oncology
Chapter 5. Brachytherapy
Techniques of Brachytherapy
Physics and Biology of Brachytherapy Sources
Radioactive Sources
Source Strength Specifications
Source Strength Calibration
Brachytherapy Dose Calculation: Calculation of Dose Using TG-43 (or TG-186) Formalism
Brachytherapy Dose Rate
Radiobiology of LDR and HDR
HDR Remote Afterloader
Computerized Treatment Planning Process
Clinical Indication of Brachytherapy
Breast Cancer
Prostate Cancer
Endometrial Cancer
Cervical Cancer
Soft Tissue Sarcoma
Palliative Brachytherapy
Chapter 6. Intensity Modulated and Image Guided Radiation Therapy
Target Volumes, Margins, and Dose Volumes
Inverse Planning IMRT
Volumetric Moulated Arc Therapy
Image Guided Radiotherapy (IGRT)
Clinical Experience and Technique of IMRT and VMAT
Brain Cancer
Head and Neck Cancer
Breast Cancer
Lung Cancer
Prostate Cancer
Chapter 7. Stereotactic Radiation Therapy: Cranial Lesions
Radiobiology of Stereotactic Radiation
SRS Technique
Patient Immobilization and Setup
Imaging
Target Volume Delineation
Delineation of OAR Volumes
Treatment Planning
Treatment Plan Assessment
Clinical Indication of Cranial Stereotactic Radiation
Brain Metastases
Acoustic Neuroma
Pituitary Adenoma
Skull-Based Meningioma
Arteriovenous Malformation and Cavernous Hemangioma
Trigeminal Neuralgia
Parkinson’s Disease
SRS Toxicity
Selected Clinical Trials of SRS for Metastatic Brain Cancer
Chapter 8. Stereotactic Body Radiation Therapy: Lung Cancers
Lung Cancer
SBRT for Central & Ultracentral Lesions
Treatment Planning
CT Simulation & Motion Management
Contouring
Planning & Evaluation
QA & Treatment Delivery
Dose & Fractionation
Selected Clinical Trials for Lung SBRT
Ongoing or Pending Clinical Trials
Consensus Guideline
Chapter 9. Proton Radiation Therapy
Proton Beam Depth Dose
Proton Relative Biological Effectiveness
Beam Production, Delivery, Treatment Planning and QA
Clinical Use of Proton Radiotherapy
Central Nervous System
Chordoma
Chondrosarcoma
Meningioma
Diffuse Glioma
Glioblastoma
Head and Neck Cancer
Lung Cancer
Esophagus Cancer
HCC
Prostate Cancer
Gynecological Cancer
Breast Cancer
Pediatric Cancer
Medulloblastoma
Adolescent and Young Adults (AYA)
Limitations of Proton Beam Therapy
Chapter 10. Adaptive Radiotherapy
Rational for ART
Workflow of ART
Technologies for ART
Offline and Online Adaptive Planning
Commercial Online ART Systems
MRI-Based Online ART System
CBCT-Based Online ART System
PET-Based Online ART System
Clinical Applications of ART
Head and Neck Cancer
Lung Cancer
Pancreatic Cancer, Liver Cancer, and Abdominal Oligometastasis
Prostate Cancer
Cervical Cancer
Chapter 11. Artificial Intelligence in Radiation Therapy
Basic Concepts of AI
General Role of AI in Radiation Oncology
Image Generation and Enhancement
Image Segmentation, Treatment Planning, and Outcome/Toxicity Prediction
Quality Assurance and Error Detection
Medical Records, Patient Management, and Decision Support
Role of AI in Image Segmentation
Role of AI in Treatment Planning
Advanced AI Methods and 3D Dose Prediction
Other Treatment Planning Applications
Role of AI in RT Toxicity Prediction and Outcome Assessment
Challenges and Considerations for Integrating AI Tools into Clinical Workflows
Chapter 12. Immunotherapy
Immune System Components
Anatomy of the Immune System
Cells of the Immune System
The Immune Synapse
The Immune Tolerance Mechanisms
Immunotherapy
Vaccine Immunotherapy
Antibody Immunotherapy
Cytokine Immunotherapy
Adoptive T-Cell Immunotherapy
Immune Checkpoint Inhibitor Immunotherapy
Radiation and the Immune System
Combination Radiation and Immunotherapy Trials
Selective Site-specific Cancer Immunotherapy
Melanoma
Ipilimumab
Nivolumab
Pembrolizumab
Ipilimumab in Combination with Nivolumab
Nonsmall Cell Lung Cancer
Pembrolizumab
Nivolumab
Durvalumab
Small Cell Lung Cancer (SCLC)
Atezolizumab
Durvalumab
Head and Neck Cancer
Nivolumab
Pembrolizumab
Lymphoma
Pembrolizumab
Nivolumab
Renal Cell Carcinoma
Nivolumab
Pembrolizumab
Avelumab
Esophageal Cancer
Pembrolizumab
Nivolumab
Gastric Cancer
Pembrolizumab
Nivolumab
Colorectal Cancer
Pembrolizumab
Nivolumab
Urothelial Carcinoma
Pembrolizumab
Nivolumab
Merkel Cell Carcinoma (MCC)
Pembrolizumab
Avelumab
Cervical Cancer
Pembrolizumab
Endometrial Cancer
Pembrolizumab
Dostarlimab
Large B Cell Lymphoma
Chimeric Antigen Receptor T-Cell Therapy (CAR-T): Yescarta (Axicabtagene Ciloleucel) and Kymriah (Tisagenlecleucel)
Immunotherapy Toxicity
Chapter 13. Radiation and Combined Modality Therapy
Radiation Therapy
Surgery Combined with Radiation Therapy
Side Effects of Combined Modality of Radiation and Surgery
Chemotherapy Combined with Radiation Therapy
Side Effects of Combined Modality Radiation and Chemotherapy
Site-specific Chemotherapeutic Agents Used in Combination with Radiotherapy: Mechanisms of Action and Side Effects
Central Nervous System Cancer
Head and Neck Cancer
Breast Cancer
Lung Cancer
Gastrointestinal Cancer
Lymphoma
Chapter 14. Statistical Considerations in Radiation Oncology
Describing Data
Medians, Interquartile Range, and Box-Whisker Plots
The Mean and Standard Deviation
The Normal Distribution and Reference Ranges
Binary Data
Statistical Inference Parametric and Non-parametric Tests
Multiple Regression
Logistic Regression
Survival Analysis
Clinical Trials: Phase I, II, III, IV
Retrospective Chart Reviews
Meta-Analyses
Part III. Clinical Radiation Oncology
Chapter 15. Skin Cancers
Non-melanoma Skin Cancer
Workup
Risk Factors
Symptoms and Signs
Investigation
TNM Staging (Head and Neck)
Stage Grouping
Treatment
RT Technique
Doses
Outcomes
Complications
Follow-up
Malignant Cutaneous Melanoma
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Melanoma of the Skin)
Stage Grouping
Treatment
RT Technique
Volumes
Elective Nodal Regions for Primary Tumor Location
Doses
Outcome
Complications
Follow-up
Merkel Cell Cancer
Workup
Risk Factors
Symptoms and Signs
Investigation
TNM Staging (Merkel Cell)
Stage Grouping
Treatment
RT Technique
Volumes
Doses
Outcome
Complications
Follow-up
Annotated Bibliography
Non-Melanoma Skin Cancer
Melanoma Skin Cancer
Chapter 16. Primary Brain Cancers
Circumscribed Astrocytic Glioma
Treatment
RT Technique
IMRT/Proton Technique
Volumes
Doses
Outcome
Complications
Follow-up
Adult Type Diffuse Glioma
Treatment
RT Technique
Volumes
Doses
Constraints
Outcome
Complications
Follow-up
Brainstem Glioma
Treatment
RT Technique
IMRT Technique
Volumes
Doses
Outcome
Complications
Follow-up
Optic Glioma
Treatment
RT Technique
Outcome
Complications
Follow-up
Ependymoma
Workup
Signs and Symptoms
Investigations
Treatment
RT Technique
IMRT Technique
Volumes
Doses
Outcome
Complications
Follow-up
Meningioma
Treatment
RT Technique
IMRT Technique
Volumes
Doses
Outcome
Complications
Follow-up
Medulloblastoma
Workup
Symptoms and Signs
Investigations
Staging
Treatment
RT Technique
IMRT/Proton Technique
Volumes
Craniospinal Axis Volume
Posterior Fossa Boosts Volume
Doses
Outcome
Complications
Follow-up
Pituitary Adenoma
Workup
Symptoms and Signs
Investigations
Treatment
RT Technique
IMRT/SRS Technique
Volumes
Doses
Constraints
Outcome
Complications
Follow-up
Craniopharyngioma
Workup
Symptoms and Signs
Investigations
Treatment
RT Technique
IMRT/Proton Technique
Proton Therapy
Volumes
Doses
Outcome
Complications
Follow-up
Annotated Bibliography
Low-Grade Glioma
High-Grade Glioma
Radiation Therapy
Chemotherapy
Ependymoma
Meningioma
Medulloblastoma
Craniopharyngioma
Chapter 17. Head and Neck Cancers
Head and Neck Lymph Node Borders1
Lymph Node Risk
Oral Cavity Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Oral Cavity)
Stage Grouping
Treatment
RT Technique
IMRT Technique
Volumes
Ipsilateral and/or Contralateral at Risk LN
Doses
Constraints
Outcomes
Complications
Follow-up
Nasopharyngeal Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Nasopharynx)
Stage Grouping
Treatment
RT Technique
IMRT Technique
Volumes
Ipsilateral and Contralateral at Risk LNs
Doses
Constraints
Outcome
Complications
Follow-up
Oropharyngeal and Hypopharyngeal Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging Oropharynx HPV+
Stage Grouping
TNM Staging Oropharynx HPV – and Hypopharynx
Stage Grouping
Treatment
Oropharyngeal Cancer
Hypopharyngeal Cancer
RT Technique
IMRT Technique
Volumes
Subclinical Disease Around GTV
Ipsilateral and Contralateral at Risk LN
Doses
Constraints
Outcome
Complications
Follow-up
Laryngeal Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Larynx)
Supraglottis
Glottis
Subglottis
Stage Grouping
Treatment
Supraglottic Cancer
Glottic Cancer
RT Technique
IMRT Technique
Volumes
Subclinical Disease Around GTV
Ipsilateral and Contralateral at Risk LNs
Doses
Constraints
Outcome
Complications
Follow-up
Nasal Cavity and Paranasal Sinuses
Workup
Symptoms and Signs
Investigations
TNM Staging (Maxillary Sinus)
Stage Grouping
Treatment
Maxillary Sinus
Nasal Cavity and Ethmoids
RT Technique
IMRT Technique
Volumes
Subclinical Disease Around Tumor Bed or GTV
HG SCCa, Maxillary Sinus, Nasopharyngeal Involvement at Risk LNs
Doses
Constraints
Outcome
Complications
Follow-up
Parotid Gland
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Parotid Gland)
Stage Grouping
Treatment
Benign Tumors
Malignant Tumors
RT Technique
IMRT Technique
Volumes
Subclinical Disease Around Ttumor Bed or GTV
Ipsilateral and Contralateral at Risk LNs
Doses
Constraints
Outcome
Complications
Follow-up
Unknown Primary
Workup
Risk Factors
Symptoms and Signs
Investigations
Treatment
RT Technique
IMRT Technique
Volumes
Doses
Constraints
Complications
Follow-up
Annotated Bibliography
Oral Cavity Site
Nasopharynx Site
Oropharynx Site
Hypopharynx and Larynx Site
Unknown Primary Site
Chapter 18. Breast Cancers
Breast and LN Borders
RTOG Breast and LNs Volume Guidelines1 (and Differences in ESTRO)2
RISK for Axillary Nodes as Related to Invasive Tumor Size
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Breast Cancer)
Stage Grouping
Non-invasive Breast Cancer (DCIS)
Treatment
Outcome
Early Stage Breast Cancer (Stage I and II)
Breast Conservation Therapy (BCT) with Post Lumpectomy Radiation Therapy
Candidates for BCT
Contraindications for BCT
Treatment
Outcome
Post Mastectomy Radiation Therapy (PMRT)
Candidates for PMRT
Indications for RNI
Treatment
Outcome
Locally Advanced Breast Cancer (LABC)
Treatment
Outcome
Recurrent Breast Cancer
Treatment
Outcome
RT Technique
3D/IMRT Technique
Breast/Chest Wall Technique
RNI Technique
Accelerated Partial Breast Irradiation (APBI) Technique
Volumes
Doses
Constraints
Complications
Follow-up
Annotated Bibliography
Non-invasive Breast Cancer (DCIS)
Adjuvant Radiation Therapy
Adjuvant Hormone Therapy for DCIS
Early Stage Breast Cancer
Adjuvant Radiation Therapy
Chemotherapy
Adjuvant Hormonal and Targeted Therapy
Post Mastectomy Radiation Therapy
Chapter 19. Thoracic Cancers
Lung Cancer
Non-small Cell Lung Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
Screening
TNM Staging (Lung)
Stage Grouping
Treatment
Stage IA - IIA
Resectable Stage IIB–IIIB
Unresectable Stage IIB–IIIB & Stage IIIC
Pathologic N2 (Stage IIIA–IIIB)
Pleural or Pericardial Effusion
Stage IV
Superior Sulcus Tumors
Medically Inoperable Tumors
Outcomes
Small-cell Lung Cancer
Workup
Symptoms and Signs
Investigations
Staging
Treatment
Limited Stage
Extensive Stage
Outcomes
Thymoma and Thymic Carcinoma
Workup
Symptoms and Signs
Investigations
Masaoka Staging [Ref 37]
TNM Staging (Thymoma and Thymic Cancer)
Stage Grouping
Treatment
Outcomes
Malignant Mesothelioma
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Malignant Mesothelioma)
Stage Grouping
Treatment
Outcomes
RT Technique
IMRT/SBRT Technique
Volumes
Doses
Constraints
Mesothelioma IMRT Constraints
Complications
Follow-up
Annotated Bibliography
Non-small Cell Lung Cancer
Stage IA–IIA
Resectable Stage IIB-IIIB
Unresectable Stage IIB–IIIA & Stage IIIB–IIIC
Pathologic N2 (Stage IIIA – IIIB)
Stage IV
Superior Sulcus Tumors
Medically Inoperable Tumors
Small-Cell Lung Cancer
Limited Stage SCLC
Extensive Stage SCLC
Thymoma
Malignant Mesothelioma
Chapter 20. Gastrointestinal Cancers
Esophageal Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Esophageal Cancer)
Stage Grouping: Pathological
Stage Grouping: Pathological
Histologic Grade (G)
Treatment
RT Technique
IMRT Technique
Volumes
Elective Nodal Regions for Primary Tumor Location
Doses
Constraints
Outcome
Complications
Follow-up
Gastric Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Gastric Cancer)
Histologic Grade (G)
Stage Grouping
Treatment
RT Technique
IMRT Technique
Volumes
Elective Nodal Regions for Primary Tumor Location
Dose
Constraints
Outcome
Complications
Follow-up
Pancreatic Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Pancreatic Cancer)
Stage Grouping
Treatment
RT Technique
IMRT Technique
Volumes
SBRT Technique
Volumes
Doses
Constraints
Outcome
Complications
Follow-up
Colon and Rectal Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Colon Cancer)
Stage Grouping
Treatment
Colon Cancer
Rectal Cancer
RT Technique
IMRT Technique
Volumes
Doses
Constraints
Outcome
Complications
Follow-up
Anal Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Anal Cancer)
Stage Grouping
Treatment
RT Technique
IMRT Technique
IMRT Dose Painting Plan per RTOG 0529 (SIB Technique)
Doses for Dose Painting (SIB Technique)
IMRT Sequential Plan (Shrinking Field Technique)
Doses for Sequential Technique
Constraints
Outcome
Complications
Follow-up
Annotated Bibliography
Esophageal Cancer
Gastric Cancer
Pancreatic Cancer
Resectable Pancreatic Cancer
Borderline Resectable Pancreatic Cancer
Unresectable Pancreatic Cancer
Rectal Cancer
Pre-op RT
Anal Cancer
Chapter 21. Genitourinary Cancers
Renal Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Renal Cancer)
Stage Grouping
Treatment
RT Technique
IMRT/SBRT Technique
Volumes
Doses
Constraints
Outcome
Complications
Follow-up
Bladder Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Bladder Cancer)
Stage Grouping
Treatment
Superficial Disease (Ta, Tis, TI)
Invasive Disease, N0, N+
Metastatic Disease
RT Technique
IMRT Technique
Volumes
Doses
Volumes
Doses
Constraints
Outcome
Complications
Follow-up
Prostate Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
International Society of Urological Pathology (ISUP) Grade Groups
TNM Staging (Prostate Cancer)
Stage Grouping
Treatment
Very Low-Risk: T1c, PSA <10, GG 1, <3 Cores with ≤50% cancer in each core and PSA density <0.15ng/mL/G
Low-Risk: T1-T2a, PSA <10 and GG 1
Favorable Intermediate-Risk: T2b-c, PSA 10–20, GG 2
Unfavorable Intermediate-Risk: T2b-c, PSA 10–20, GG 2–3
High-Risk
Very High-Risk
Regional (N+)
Post Prostatectomy RT
Post Radiation Rising PSA
Metastatic Disease
Hormonal Refractory Prostate Cancer
RT Technique
IMRT Technique
Volumes
Pelvic Elective LNs
Brachytherapy Technique
LDR Brachytherapy
HDR Brachytherapy
RT Doses for IMRT and Brachytherapy
Constraints
Outcome
Complications
EBRT
Brachytherapy
Hormone Therapy Toxicity
Follow-up
Testicular Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Testicular Cancer)
Stage Grouping
Required for Staging: Serum Tumor Markers (S)
Treatment
Seminoma
Nonseminoma
RT Technique
3D/IMRT Technique
3DCRT
IMRT
Volumes
Elective LNs
Doses
Constraints
Outcome
Complications
Follow-up
Annotated Bibliography
Renal Cell Cancer
Bladder Cancer
Neoadjuvant/Adjuvant Chemotherapy
ChemoRT Bladder Conservation
Prostate Cancer
Conservative Treatment
Brachytherapy
Lymph Node Treatment
Dose Escalation with Higher Radiation Dose Treatment
Hypofractionated Radiation Treatment
Neoadjuvant and Adjuvant Hormonal Treatment
Hormonal Treatment and Chemotherapy
Postoperative Radiation Treatment
Postoperative Radiation Treatment and Hormone Therapy
Testicular Cancer
Chapter 22. Gynecological Cancers
Endometrial Cancer
Pelvic/PA Node Risk
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Endometrial Cancer)
Stage Grouping
Treatment
Stage IA (Gr 1, 2)
Stage IA (Gr 3), IB (Gr 1, 2)
Stage IB (Gr 3), II, III
Stage IV
Medically Inoperable
Papillary Serous or Clear Cell Carcinoma
Uterine Sarcoma
RT Technique
IMRT Technique
Volumes
Vaginal Target and LNs
Doses for EBRT and Brachytherapy
Constraints
Outcome
Complications
Follow-up
Cervical Cancer
Lymph Node Risk
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Cervical Cancer)
Stage Grouping
Treatment
CIN (Cervical Intraepithelial Neoplasia)
CIS (Carcinoma in situ)
Stage IA1, IA2
Stage IB1-IIA1
Stage IB3-IVA
Stage IVB
RT Technique
IMRT Technique
Volumes
Gyn Targets and LNs
Brachytherapy Technique
Doses EBRT and Brachytherapy
EMBRACE II Planning Target Goals
Constraints
Outcome
Complications
Follow-up
Ovarian Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Ovarian Cancer)
Stage Grouping
Treatment
Stage IA, IB (G1, 2)
All Other Stages
RT Technique
IMRT Technique
Volumes
Doses
Constraints
Outcome
Complications
Follow-up
Vaginal Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Vaginal Cancer)
Stage Grouping
Treatment
VAIN (Vaginal Intraepithelial Neoplasia)
CIS (Carcinoma in situ)
Stage I
Stage II
Stage II (Paravaginal/parametrial invasion), III, and IV
RT Technique
IMRT Technique
Volumes
Intracavitary Technique
Interstitial Technique
Doses
Outcome
Complications
Follow-up
Vulvar Cancer
Workup
Risk Factors
Symptoms and Signs
Investigations
TNM Staging (Vulvar Cancer)
Stage Grouping
Treatment
CIS (Carcinoma in Situ)
Stage IA
Stages IB, II
Stage III-IVA
RT Technique
IMRT Technique
Volumes
Gross Disease and Elective LNs
Doses
Constraints
Outcome
Complications
Follow-up
Annotated Bibliography
Endometrial Cancer
Cervical Cancer
Ovarian Cancer
Vulvar Cancer
Chapter 23. Lymphoma & Hematologic Cancers
Hodgkin Lymphoma
Workup
Risk Factors
Symptoms and Signs
Investigations
Classifications
WHO Classification
Staging
Ann Arbor Staging System Updated by Lugano Classification (2012) (Fig. 23.1)
Patients with Hodgkin Lymphoma is Classified into Groups
Risk Factors According to the GHSG, EORTC, and NCCN
PETCT Response Assessment
Treatment
Early stage Favorable (Stage I, II No Risk Factors)
Early stage Unfavorable (Stage I, II with Risk Factors, B Symptoms, Bulky)4
Advanced Stage (Stage III, IV and Occasionally Stage II Bulky)4
Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)
Outcome
International Prognostic Score (IPS) for Advanced Disease: One Point per Factor
Non-Hodgkin Lymphoma
Workup
Risk Factors
Symptoms and Signs
Investigations
Staging/Grading
B-Cell Lymphoid Proliferations and Lymphomas
T-Cell and NK-Cell Lymphoid Proliferations and Lymphomas
Follicular Lymphoma International Prognostic Index (FLIPI I and FLIPI 2)
International Prognostic Index and Revised International Prognostic Index (IPI R–IPI) for NHL (Used for DLBCL)
Treatment
Indolent/Follicular, Stage I/II
Indolent/Follicular, Stage III/IV
Follicular Grade 3B
Aggressive/DLBCL, Stage I/II
Aggressive/DLBCL, Stage III/IV
Extranodal Marginal Zone Lymphoma
Extranodal Marginal Zone Lymphoma
Mantle Cell Lymphoma
Primary CNS Lymphoma
Primary Testicular Lymphoma
Primary Mediastinal B-Cell Lymphoma
NK- T Cell Lymphoma
Outcome
RT Technique
IMRT Technique
Volumes
Doses
Constraints
Complications
Follow-up
Annotated Bibliography
Early-Stage Hodgkin Lymphoma
Advanced-stage Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Indolent NonHodgkin Lymphoma
Aggressive NonHodgkin Lymphoma
Chapter 24. Soft-Tissue Sarcomas
Annotated Bibliography
Preoperative RT
Post-Operative RT
IMRT/IGRT
Chemotherapy
Retroperitoneal Sarcoma
Chapter 25. Pediatric Cancers
Hodgkin Lymphoma
Workup
Symptoms and Signs
Investigations
Staging
COG Risk Classification and Response Definitions
Treatment
Low-Risk Hodgkin Lymphoma (Favorable Stages I, IIA)
Intermediate-Risk Hodgkin Lymphoma (Unfavorable Stage I, II, IIIA)
High-Risk Hodgkin Lymphoma (Stages IIIB/IVB, ± Unfavorable IIB)
RT Technique
IMRT Technique
Volumes
Doses
Constraints (Select OARs)
Proton
Outcome
Complications
Neuroblastoma
Workup
Symptoms and Signs
Investigations
Staging
International Neuroblastoma Staging System (INSS)
International Neuroblastoma Risk Group (INRGSS)
Treatment
Low-Risk (Stage 1, 2A/B N-MYC Nonamplified)
Intermediate-Risk (Stage 3, 4N-MYC Nonamplified)
High-Risk (Stage 3N-MYC Nonamplified Unfavorable Histology, Stage 2A/B, 3, 4N-MYC Amplified)
Stage 4S
RT Technique
IMRT/Proton Technique
Volumes
Doses
Constraints
Outcome
Complications
Wilms’ Tumor (Nephroblastoma)
Workup
Symptoms and Signs
Investigations
Histology
Favorable
Unfavorable
Staging
Children's Oncology Group Staging System
Treatment
Stage I Favorable Histology (FH)
Stage I Unfavorable Histology (UH), Stage II Favorable Histology
Stage II UH, Stage III, IV FH/UH
Stage IV
Stage V
Unresectable
Clear Cell Sarcoma
Rhabdoid
RT Technique
IMRT Technique
Tumor Bed Field (Flank)
Volumes
Doses
Whole Abdomen Field
Volumes
Doses
Whole Lung Field
Volumes
Doses
Constraints
Outcome
Complications
Rhabdomyosarcoma (RMS)
Workup
Symptoms and Signs
Investigations
Histology
Favorable
Unfavorable
Staging
TNM Pretreatment Staging System
Clinical Group Staging
Risk Grouping
Treatment
Local Control
Chemotherapy
Radiation Therapy
RT Technique
IMRT Technique
Volumes
Doses
Constraints
Outcome
Complications
Ewing’s Sarcoma
Workup
Symptoms and Signs
Investigations
Treatment
Chemotherapy
Surgery
Radiotherapy
RT Technique
IMRT/Proton Technique
Volumes
Doses, No Chemo
Doses, Post-op
Constraints (Per NCCN V2.2023 Hodgkins Lymphoma)
Outcome
Complications
Follow-up
Retinoblastoma
Workup
Symptoms and Signs
Investigations
Staging
Reese–Ellsworth Classification
International Classification for Intraocular Retinoblastoma
Treatment
Limited Disease <4 Disc Diameters
Advanced Unilateral Disease
Bilateral Disease
External Beam Technique
Outcome
Complications
Annotated Bibliography
Low-Risk Hodgkin Lymphoma
Intermediate-Risk Hodgkin Lymphoma
High-Risk Hodgkin Lymphoma
Neuroblastoma
Wilms’ Tumor
Rhabdomyosarcoma
Ewing’s Sarcoma
Retinoblastoma
Chapter 26. Benign Tumors
Skin and Connective Tissue Disorders
Keloid
Desmoid Tumor/Aggressive Fibromatosis
Peyronie's Disease
Dupuytren's Contracture
Gynecomastia
Benign Neoplasms of the Brain, Head, and Neck
Meningioma
Pituitary Adenoma
Craniopharyngioma
Acoustic Neuroma
Chordoma
Paraganglioma/Pheochromocytoma (Glomus Tumor)
Eye/Orbit Diseases
Pterygium
Graves Ophthalmopathy
Vascular Disorder
Arteriovenous Malformation/Cavernous Hemangioma
Functional Disorders
Trigeminal Neuralgia
Parkinson's Disease
Diseases of the Bone
Heterotopic Ossification
Osteoarthritis
Part IV. Palliative Care and Radiation Treatment Toxicity Management
Chapter 27. Radiation Emergencies and Common Indications for Palliative Radiotherapy
Brain Metastases
Workup
Symptoms and Signs
Investigations
Treatment
RT Technique
Volumes/Borders
IMRT Technique
Volumes
Doses
Constraints
Outcome
Complications
Follow-up
Spinal Cord Compression
Workup
Symptoms and Signs
Investigations
Treatment
RT Technique
Volumes
Doses
Outcome
Complications
Follow-up
Painful Bone Metastases
Workup
Symptoms and Signs
Investigations
Treatment
Treatment Planning
Volumes
Doses
Constraints
Outcome
Complications
Follow-up
Superior Vena Cava Syndrome
Workup
Symptoms and Signs
Investigations
Treatment
Volumes
Doses
Outcome
Complications
Follow-up
Annotated Bibliography
Metastatic Brain Cancers
Spinal Cord Compression
Metastatic Bone Cancers
Chapter 28. Radiation Treatment Toxicity and their Managementa
Skin
Early Radiation Dermatitis & Focal Pruritus
Dry and Moist Desquamation
Ulceration–Slow Healing
Antibiotics/Wound Infection Treatment
Antifungals/Antivirals
Generalized Pruritus
Head and Neck
Eye
Dry Eye
Ear
Mucositis
Oral Infection & Candidiasis
Sialadenitis
Sinuses
Teeth and Osteoradionecrosis
Xerostomia
Thorax
Air Hunger
Obstructive Airways Disease (Asthma, COPD)
Cough
Infectious Processes
Radiation Pneumonitis and Pulmonary Fibrosis
Smoking Cessation
Breast
Abscess/Infection
Costochondritis
Lymphedema
Hot Flashes
Gastrointestinal Tract
Antacids/Hypersecretion Medications
Esophagitis
Nausea/Vomiting
Hiccups
Diarrhea
Antiflatulents
Acute Proctitis/Tenesmus
Chronic Radiation Enteritis, Proctitis, or Rectal Bleeding
Anorexia/Appetite Stimulant
Enteral/Oral Nutritional Supplements
General Guidelines for Calculating Basic Nutritional Needs
Oral Intake/Supplements
General Guidelines for Tube Feedings
Feedings may be:
Motility Agents
Constipation
Genitourinary
Analgesics/Antispasmodics/Incontinence
Antibiotics
Erectile Dysfunction Therapy
Male Hot Flashes
Hematuria and Chronic Radiation Cystitis
Urinary Obstruction Modifiers
Gynecological
Perineal Reaction
Acute Vaginitis
Vaginal Late Toxicity
Nervous System
Neurocognition Management
Edema Management
Vertigo
Seizure
Pain Management
NonOpioid Analgesics
Opioid Analgesics for Mild to Moderate Pain
Opioid Analgesics for Severe Pain (Class II Narcotics)
Coanalgesics
Narcotic Antagonist
Psychotropic Medications
Somnolence and Fatigue
Antianxiety
Antidepressants
Antipsychotics
Hypnotics/Sleep Aids
Sedatives
Benzodiazepine Receptor Antagonist
Radiation Fibrosis and Muscle Relaxants
Acronyms and abbreviations
Index

Life Sciences

Physical Sciences & Engineering

Social Sciences & Humanities

Health

Fundamentals of Radiation Oncology

Physical, Biological, and Clinical Aspects

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Hasan Murshed