Gunderson & Tepper’s Clinical Radiation Oncology

Cover......Page 1
Associate Editors......Page 2
Gunderson & Tepper's Clinical Radiation Oncology......Page 3
Copyright Page......Page 4
Dedication......Page 5
Contributors......Page 6
Foreword......Page 16
Acknowledgments......Page 17
Video Contents......Page 18
The Therapeutic Ratio......Page 19
Levels of Complexity in Radiobiological Systems......Page 20
Powers of Ten......Page 21
Radiation Biology and Therapy: the First 50 Years......Page 22
The Interaction of Ionizing Radiation With Biological Materials......Page 23
Biochemical Repair of DNA Damage......Page 24
Double-Strand Break Repair......Page 25
Cytogenetic Effects of Ionizing Radiation......Page 26
What Is Meant by “Cell Death”?......Page 27
Clonogenic Assays In Vitro......Page 28
Clonogenic Assays In Vivo......Page 29
Cellular “Repair”: Sublethal and Potentially Lethal Damage Recovery......Page 30
Repair in Tissues......Page 32
Methodology......Page 33
Age Response Through the Cell Cycle......Page 34
Linear Energy Transfer......Page 35
Factors That Influence Relative Biological Effectiveness......Page 36
The Oxygen Effect......Page 37
Mechanistic Aspects of the Oxygen Effect......Page 38
Measurement of Hypoxia in Human Tumors......Page 39
Hypoxic cell radiosensitizers.......Page 40
Bioreductive drugs.......Page 41
Normal Tissue Radioprotectors......Page 42
Cell cycle and volume doubling times.......Page 43
Potential doubling time and “effective” doubling time.......Page 44
Repopulation in tumors and normal tissues.......Page 45
The hematopoietic syndrome.......Page 46
Laboratory studies.......Page 47
Cytokines, reactive oxygen species, and inflammation.......Page 48
Radiation-induced second malignancies.......Page 49
The NSD Model......Page 50
The Linear-Quadratic Isoeffect Model......Page 51
Clinical Applications of the Linear-Quadratic Isoeffect Model......Page 52
Radiation Biology in the 21st Century......Page 54
Critical References......Page 55
References......Page 56
Angiogenesis......Page 63
Metabolic Rewiring/Plasticity......Page 64
DNA Damage Response......Page 65
Cell Cycle Checkpoints......Page 66
Mechanisms of Cell Death......Page 67
Molecular Targeted Radiation Protection......Page 68
Biomarkers for Radiation Response Prediction and Personalized Oncology......Page 69
Immunotherapy......Page 70
Critical References......Page 71
References......Page 72
Importance of Oxygen......Page 75
Evidence for Hypoxia in Tumors......Page 76
High-Oxygen-Content Gas Breathing......Page 77
Hypoxic Cell Radiosensitizers......Page 78
Bioreductive Drugs......Page 80
Angiogenesis Inhibitors......Page 82
Sulfhydryl-Containing Compounds......Page 83
Modifiers of the Oxygen Supply......Page 85
Critical References......Page 86
References......Page 88
Tumor Detection......Page 93
Enhanced Tumor Response (Cytotoxic Enhancement)......Page 94
Inhibition of DNA Repair......Page 95
Mitotic Catastrophe......Page 96
Median Dose Effect Principle......Page 97
Step-by-Step Method for Constructing an Isobologram......Page 98
Deoxycytidine nucleoside analogs: gemcitabine, cytarabine.......Page 101
Estramustine.......Page 102
Anal Cancer......Page 103
Laboratory Investigations in Anal Cancer......Page 106
Gastric......Page 105
Head and Neck Cancers......Page 107
Non–Small Cell Lung Carcinoma......Page 109
Genitourinary Cancer......Page 110
Proteomics......Page 111
Critical References......Page 112
References......Page 114
Epidermal Growth Factor Receptor......Page 120
EGFR Family Inhibitors......Page 124
Clinical Studies of EGFR Family Inhibitors as Radiosensitizers......Page 125
Preclinical Studies of TGF-β Inhibitors and Radiation......Page 127
PARP and DNA Repair......Page 128
ATR Kinase, CHK1, WEE1 Inhibitors......Page 129
Clinical Studies of Angiogenesis Inhibitors as Radiosensitizers......Page 130
Cancer and the Immune System......Page 131
Designing Clinical Trials......Page 132
Critical References......Page 133
References......Page 135
Atomic and Nuclear Structure, Particles, and Nomenclature......Page 140
Nuclides and Radionuclides......Page 141
Photons and Other Definitions......Page 142
Radiation Production by Radioactive Decay......Page 143
Radiation Production by LINACs......Page 144
Attenuation and Transmission......Page 147
Beam Quality......Page 148
Attenuation Coefficients......Page 149
Photoelectric effect.......Page 150
Pair production.......Page 152
Total Absorption Coefficient......Page 153
Light Charged Particle Interactions: Electrons......Page 154
Heavy Uncharged-Particle Interactions: Neutron......Page 155
Radiation Quantities and Units......Page 156
Dose......Page 157
Kerma......Page 158
Thermoluminescent dosimeters.......Page 159
Film.......Page 160
Buildup Phenomenon......Page 161
Percent Depth Dose......Page 162
Dose Characteristics......Page 163
Effect of Energy......Page 164
Dose Characteristics......Page 167
Effect of Energy......Page 168
Effect of Field Size......Page 169
SSD Treatment......Page 170
Conventional Simulation Procedures and Immobilization......Page 171
Purpose and Procedures......Page 172
Volumes of Interest......Page 173
Beam Nomenclature......Page 174
Treatment Plan Evaluation and Optimization......Page 175
In Vivo Dosimetry......Page 176
External Beam Treatments: General Techniques......Page 177
Three-Dimensional Conformal Radiotherapy......Page 178
Imaging in Radiotherapy......Page 181
Biological Imaging......Page 182
Total-Body Procedures......Page 183
Radioactive Decay......Page 184
Secondary Decay Processes......Page 185
Properties and Applications of Isotopes......Page 186
Source Strength......Page 189
Brachytherapy Applicators and Afterloading......Page 191
Interstitial Implants......Page 192
Dose Specification......Page 193
Radiation Protection......Page 194
Critical References......Page 196
References......Page 198
Considerations in Small-Field Dosimetry......Page 201
History of Stereotactic Irradiation......Page 202
Detectors for Small-Field Measurements......Page 206
Dose Algorithms for Stereotactic Radiosurgery......Page 208
Electronic Disequilibrium Effects in Low-Density Regions......Page 210
Dosimetric Commissioning......Page 211
Critical References......Page 213
References......Page 215
Charged Particle Interactions......Page 218
Charged Particle Acceleration/Steering......Page 219
Scattered Beam......Page 220
Spot Scanning......Page 221
Beam Penumbra and Target Conformality......Page 222
Heavy Charged Particles......Page 223
Robustness Evaluation......Page 224
Interplay......Page 225
Quality Assurance......Page 226
Conclusions......Page 227
Annotated Bibliography......Page 228
Histologic Diagnosis......Page 229
Staging......Page 230
Role of Surgical Intervention......Page 231
Breast Conservation Surgery......Page 232
Multimodality Therapy for Pancreatic Adenocarcinoma......Page 233
Multimodality Therapy For Adenocarcinoma Of The Rectum......Page 234
Summary......Page 236
Critical References......Page 237
References......Page 239
A Brief History of Chemotherapy......Page 242
The Basis of Chemotherapy: Cancer Cell Biology......Page 243
Models for Chemotherapy......Page 245
Solid-Tumor Chemotherapy......Page 246
Cytotoxic Drugs: Targeting DNA Synthesis, DNA Integrity, and Mitosis......Page 247
Targeted Therapies: Signal Transduction Inhibitors......Page 248
Receptor Tyrosine Kinases as Targets......Page 249
Proteasome Inhibition......Page 250
Optimizing Clinical Chemotherapy: Pharmacokinetics and Pharmacodynamics......Page 251
Clinical Schedules of Drug Administration......Page 252
Drug Resistance......Page 254
Combination Therapy......Page 255
Critical References......Page 256
References......Page 258
Bibliography......Page 260
Imaging Strategies......Page 261
Tumors of the Lung......Page 263
Staging of Lung Cancer......Page 265
Esophagus......Page 266
Colon, Rectum, and Appendix......Page 268
Primary Liver Tumors......Page 272
Metastatic Liver Disease......Page 274
Adrenal......Page 275
Retroperitoneum......Page 278
Prostate......Page 279
Cervix......Page 282
Uterus......Page 284
Imaging of the Brain......Page 285
Imaging of the Head and Neck......Page 290
Imaging of the Spine......Page 292
Critical References......Page 293
References......Page 295
Basic Physics of Positron Emission Tomography......Page 298
Patient Preparation for FDG-PET......Page 300
Lung Cancer......Page 301
Head and Neck Cancers......Page 302
Lymphoma......Page 303
Breast Cancer......Page 304
Bone Imaging......Page 305
Cellular Imaging......Page 306
Critical References......Page 307
References......Page 309
Cryoablation......Page 310
Lung......Page 311
Primary Lung Cancer......Page 313
Comparison With Radiation Therapy: Bone......Page 314
Conclusion......Page 315
Critical References......Page 316
References......Page 317
Objectives......Page 320
Parameters Relevant to Sample Size Development and Inference......Page 321
Phase I......Page 322
Randomized phase II “screening” designs.......Page 324
Study Entry Features—Stratified and Blocked Randomization......Page 325
Analysis Cohort: Intent-to-Treat Analysis and Per-Protocol Analysis......Page 326
Noninferiority Trials......Page 327
Platform Trials/Master Protocols......Page 328
Response Adaptive Randomization......Page 329
Critical References......Page 330
References......Page 331
What Is the Scope of Health Services Research?......Page 333
Waiting Lists for Radiotherapy......Page 334
Measuring Waiting Times for Radiotherapy......Page 335
Measuring the direct effects of delays in radiotherapy.......Page 336
Indirect effects of waiting lists for radiotherapy on patient care.......Page 337
Societal effects of waiting lists for radiotherapy.......Page 338
A Canadian case study.......Page 339
What factors affect the rate of RT in the general cancer population?......Page 340
Evidence-based requirements analysis.......Page 341
Criterion-based benchmarking.......Page 342
Studies of the Structure of Radiotherapy Programs......Page 343
Research on Quality Assurance Processes in Radiotherapy......Page 344
Impact of program structure on the practice of radiotherapy.......Page 345
Role of Quality Indicators in the Practice of Radiotherapy......Page 346
Studies of Outcomes in Radiotherapy Programs......Page 347
Legitimate roles of outcomes research in evaluating effectiveness.......Page 349
Evaluating the adoption and generalizability of the results of clinical trials.......Page 350
Studying the Efficiency of Radiotherapy......Page 351
Critical References......Page 352
References......Page 354
Incidence and Prevalence of Cancer in the Elderly......Page 357
Comprehensive Geriatric Assessment......Page 359
Early-Stage Breast Cancer......Page 360
Glioblastoma Multiforme......Page 361
Future Directions......Page 362
Critical References......Page 363
References......Page 364
Massachusetts General Hospital Experience......Page 366
Project ENABLE (Educate, Nurture, Advise, Before Life Ends) Studies I to III......Page 367
The Oncological Management of Advanced Cancer......Page 368
Maintaining Hope......Page 369
Rapid Access Palliative Radiotherapy Program at the Cross Cancer Institute......Page 370
Prado: A Palliative Care Model for Every Radiation Oncology Practice......Page 371
Treatment of Hospice Patients......Page 372
Conventional Radiotherapy for Bone Metastases......Page 373
Retreatment......Page 374
Spinal Cord Compression......Page 375
Stereotactic Body Radiation Therapy for Bone Metastases......Page 376
Oligometastatic Disease......Page 377
Critical References......Page 378
References......Page 380
Utility and Limitations of Dose-Volume Histograms......Page 383
Defining Organ Structure......Page 384
QUANTEC......Page 386
Dose-Volume Data......Page 388
Dose-Volume Data......Page 389
Summary and Other Key Points From the QUANTEC Review......Page 390
Dose-Volume Data......Page 391
Summary and Other Key Points From QUANTEC Review......Page 392
Dose-Volume Data: Pneumonitis and Fibrosis......Page 393
Organ Function and Clinical Significance......Page 396
Dose-Volume Data......Page 397
Dose-Volume Data......Page 398
Summary and Other Key Points From the QUANTEC Review......Page 399
Dose-Volume Data......Page 400
Summary and Other Key Points From the QUANTEC Review......Page 402
Summary and Other Key Points From the QUANTEC Review......Page 403
Critical References......Page 404
References......Page 406
The Nature of Error......Page 414
Systems Engineering......Page 416
Retrospective and Prospective Error Analysis......Page 417
Engineering Summary......Page 418
Introduction to Reporting......Page 419
ASTRO’s Radiation Oncology Incident Learning System......Page 420
Effective Mitigation Strategies......Page 421
Artificial Intelligence, Machine Learning, Deep Learning......Page 422
A Call for Research......Page 423
Critical References......Page 424
References......Page 425
Real-Time/Dynamic Planning......Page 428
Cervical Cancer......Page 429
Endometrial Cancer......Page 431
Prostate......Page 432
Indications for boost.......Page 433
Urethral Cancer......Page 434
Breast Cancer......Page 435
Balloon-Based Intracavitary Technique......Page 436
Thoracic Seed Brachytherapy......Page 438
Esophageal Cancer......Page 439
Anal Cancer......Page 440
Skin/Superficial......Page 441
Central Nervous System......Page 442
Ophthalmic......Page 443
Summary and Future Possibilities......Page 444
Critical References......Page 445
References......Page 446
A Short History of Conformal and Image-Guided Therapy......Page 453
Positioning and Immobilization......Page 456
Imaging for Planning: Computed Tomography Simulation, Magnetic Resonance Imaging, and Other Cross-Sectional Imaging......Page 457
Structure Delineation and Contouring......Page 458
Target Volume Definition and Margins......Page 459
Multiple Imaging Modalities: Dataset Registration and Fusion......Page 460
Motion, Setup, and Four-Dimensional Anatomy......Page 461
Beam Technique (Energy, Direction, and Type)......Page 462
Beam Shaping With Blocks and Multileaf Collimator......Page 463
Other Beam Technique Decisions......Page 464
Dose Calculations......Page 465
Algorithms......Page 466
Dose-Volume Histograms......Page 467
Use of Equivalent Uniform Dose and “Biological Models”......Page 469
Iterative Planning......Page 470
Inverse Planning......Page 471
Plan Evaluation for Inverse Planning......Page 472
Plan Preparation......Page 473
Tools for Image Guidance......Page 474
The IGRT Process......Page 475
Electronic Medical Records, Patient Treatment Chart, and Treatment Management Systems......Page 476
Patient and Organ Motion......Page 477
Target Differential Dosing......Page 478
Potentially Negative Aspects of Intensity- Modulated Radiotherapy......Page 479
Critical References......Page 480
References......Page 481
Biology of Intraoperative Radiotherapy......Page 485
Dose Versus Complications......Page 486
Patient Selection Criteria......Page 488
Dose of Intraoperative Radiotherapy......Page 490
Intraoperative Radiotherapy Dose- Limiting Structures and Tolerance......Page 491
External Beam Radiotherapy and Intraoperative Radiotherapy......Page 492
Intraoperative radiotherapy in resected disease.......Page 494
Future Possibilities......Page 495
Intraoperative Radiotherapy Plus External Beam Radiotherapy......Page 496
Massachusetts General Hospital Experience......Page 498
Cervical Cancer: Primary Locally Advanced Disease......Page 500
Endometrial Cancer: Recurrent Disease......Page 501
Primary Locally Advanced Cancers......Page 502
Locally Recurrent Colorectal Cancer......Page 503
Intraoperative Radiotherapy: Technical Considerations......Page 504
Critical References......Page 505
References......Page 508
History of Total Body Irradiation......Page 513
Radiobiology......Page 515
Immediate Toxicity and Management in Total Body Irradiation......Page 516
Oral Toxicity......Page 517
Cardiovascular Toxicity......Page 519
Renal Toxicity......Page 520
Risk of Secondary Malignant Tumors......Page 521
Physical Principles of Total Body Irradiation......Page 522
Simulation and Planning for AP/PA Total Body Irradiation......Page 523
Acute Myelogenous Leukemia......Page 524
Mixed Diseases......Page 525
Dose of Total Body Irradiation......Page 528
Boosting in Total Body Irradiation......Page 529
Total Marrow Irradiation: Systemic Targeted Radiotherapy Using IG-IMRT......Page 532
TMI Clinical Trials in Multiple Myeloma (eTable 23.6)......Page 534
Dose escalation of TMI.......Page 537
Long-term toxicities with TMI.......Page 540
Critical References......Page 542
References......Page 544
Gliomas......Page 554
Head and Neck Malignancies......Page 555
Lung Cancer......Page 558
Pancreatic Carcinoma......Page 559
Prostate Cancer......Page 561
Lymphoma......Page 562
Central Nervous System Malignancies......Page 563
Metastatic Disease......Page 564
Carbon Ion Radiotherapy......Page 565
Helium Radiotherapy......Page 566
Critical References......Page 567
References......Page 569
Antibodies......Page 573
Abbreviations......Page 574
Peptide Receptor Radionuclide Therapy in Neuroendocrine Tumors......Page 575
Peptide Receptor Radionuclide Therapy in Prostate Cancer......Page 576
Radiobiology......Page 577
Radioimmunotherapy of Solid Tumors......Page 579
Engineered Immunoconstructs......Page 587
Minimal Tumor Burden Setting (See eTable 25.1)......Page 581
Radioimmunotherapy Using Antibodies With Immunomodulatory or Biologic Activity (eTable 25.1)......Page 589
Regional Administration (eTable 25.6 and eTable 25.7)......Page 593
Radioimmunotherapy of Lymphoma and Leukemia......Page 600
Toxicities Associated With TaRT and Methods to Ameliorate These Effects......Page 605
Dosimetry......Page 613
Critical References......Page 614
References......Page 619
T-Cell Repertoire......Page 636
Cancer Immunoediting......Page 638
Immunogenic Cell Death......Page 639
Immune Checkpoint Inhibition......Page 641
Dose, Fractionation and Sequencing......Page 642
Circulating Lymphocytes as an Organ at Risk......Page 643
Critical References......Page 644
References......Page 645
Definition and Technical Principles of SRS......Page 647
The Radiobiology of SRS......Page 648
AVM......Page 650
Meningiomas and Other Central Nervous System Tumors......Page 651
Brain Metastases......Page 652
Functional Disorders......Page 653
Critical References......Page 654
References......Page 655
Safety Considerations and Technical Aspects of Stereotactic Body Radiotherapy......Page 657
SBRT Dose Versus Tumor Control......Page 658
Normal-Tissue Dose Constraints......Page 659
Gastrointestinal Cancers: Pancreatic and Hepatocellular......Page 660
Critical References......Page 661
References......Page 663
Pathophysiology......Page 665
Imaging......Page 666
Bisphosphonates and denosumab.......Page 667
Surgery......Page 668
Local-field radiotherapy.......Page 670
Hemibody irradiation.......Page 671
Stereotactic radiosurgery of the spine.......Page 672
Strontium-89.......Page 673
Treatment......Page 674
Brain Metastases......Page 675
Technique of WBRT.......Page 676
Radiosurgery......Page 677
Whole-liver irradiation.......Page 678
SBRT.......Page 679
Critical References......Page 680
References......Page 682
30 Overview......Page 688
Gliomas as a Diverse Group of Primary Brain Tumors......Page 690
Standard Computed Tomography and Magnetic Resonance Imaging Findings......Page 691
Anatomic Distributions......Page 692
Molecular Profiling......Page 693
Impact of Molecular Subtypes......Page 694
Reirradiation/Salvage......Page 695
Advanced Radiotherapy Modalities......Page 696
Prognosis and Future Directions......Page 697
Critical References......Page 698
References......Page 699
Etiology and Epidemiology......Page 702
Biological Characteristics and Molecular Biology......Page 703
Prognostic and Predictive Factors......Page 705
External Beam Radiotherapy......Page 706
Stereotactic Irradiation......Page 707
Systemic Therapy......Page 708
Immunotherapy......Page 709
Anaplastic Oligodendroglial Tumors......Page 710
Pseudoprogression......Page 711
Fractionated EBRT......Page 712
Irradiation Techniques and Toxicities......Page 713
Toxicities of Radiotherapy......Page 714
Elderly Patients......Page 715
Future Possibilities......Page 716
Critical References......Page 718
References......Page 720
Vestibular Schwannomas......Page 727
Clinical Manifestations/Patient Evaluation/Staging......Page 728
Postoperative radiotherapy.......Page 729
Definitive external beam radiation therapy.......Page 730
Stereotactic radiosurgery.......Page 731
Incidentally Detected Meningioma......Page 732
Malignant Histology (WHO Grade III)......Page 733
Dural Tail......Page 734
Contemporary Trials......Page 735
Biologic Characteristics......Page 736
Primary Therapy......Page 737
Surgery.......Page 739
Stereotactic radiosurgery.......Page 740
Fractionated stereotactic radiation therapy.......Page 741
Management of vestibular schwannoma in the patient with neurofibromatosis 2.......Page 742
Stereotactic Radiosurgery......Page 743
Fractionated Stereotactic Radiation Therapy......Page 744
Critical References......Page 745
References......Page 747
Etiology......Page 754
Pathology......Page 755
Imaging......Page 757
Surgery......Page 758
Surgery......Page 761
Radiation Therapy and Stereotactic Radiosurgery......Page 762
Surgery......Page 763
Medical Therapy......Page 764
Medical Therapy......Page 765
Radiation Therapy and Stereotactic Radiosurgery......Page 766
Medical Therapy......Page 767
Radiation Therapy and Stereotactic Radiosurgery......Page 768
Techniques of Irradiation......Page 769
Treatment Morbidity......Page 770
Biologic Characteristics and Pathology......Page 771
Treatment......Page 772
Irradiation Techniques and Tolerance......Page 773
Critical References......Page 774
References......Page 776
Epidemiology and Etiology......Page 782
Anatomy......Page 783
Pathology and Pathways of Spread......Page 784
Clinical Workup......Page 785
Staging......Page 787
General Principles of Radiotherapy......Page 788
Treatment Techniques......Page 789
Prognostic Factors......Page 792
Pathology......Page 793
Prognostic Factors......Page 794
Treatment and Outcomes......Page 795
Treatment and Outcomes......Page 796
Hemangioblastoma......Page 797
Teratoma......Page 798
Treatment Algorithm......Page 799
Critical References......Page 800
References......Page 802
Uveal Melanoma......Page 809
Uveal Melanoma......Page 812
Uveal Melanoma......Page 813
Uveal Melanoma......Page 814
Choroidal Metastasis......Page 815
Optic Nerve Sheath Meningioma......Page 817
Periocular Skin Cancers......Page 818
Radiation Therapy Options......Page 819
Primary Intraocular Lymphoma......Page 823
Orbital Pseudotumor......Page 824
Pterygium......Page 825
Episcleral Brachytherapy......Page 826
Intensity-Modulated Radiation Therapy......Page 829
Tolerance Issues......Page 834
Critical References......Page 836
References......Page 839
Molecular Biology and Ecogenetics......Page 846
Viral Causes—Human Papillomavirus......Page 847
Accelerated Fractionation......Page 848
Sequential Versus Concurrent Radiotherapy and Chemotherapy......Page 849
High-Precision Radiotherapy......Page 850
Biomarkers and Molecular Targeting......Page 851
Prevention of Head and Neck Cancers......Page 852
Critical References......Page 853
References......Page 855
Etiology and Epidemiology......Page 860
Anatomy......Page 861
Management of the Neck......Page 862
EBRT or surgery.......Page 863
T3 and T4......Page 864
Pathology and Patterns of Spread......Page 865
Clinical Manifestations, Patient Evaluation, and Staging......Page 866
Moderately Advanced Lesions (Large T2 and Exophytic T3 Lesions)......Page 867
Techniques of Irradiation......Page 868
T1 and T2 Cancers......Page 869
Complications......Page 870
Anatomy......Page 871
Results......Page 872
T1 and T2 Cancers......Page 874
Complications......Page 875
Results......Page 876
T1 and T2 Lesions......Page 877
Pathology and Patterns of Spread......Page 878
Results......Page 879
Complications......Page 880
Results......Page 881
Complications......Page 882
Results......Page 883
T1 and T2 Lesions......Page 884
Complications......Page 885
Critical References......Page 886
References......Page 887
Key Points......Page 891
Tobacco and Alcohol Use......Page 892
Human Papillomavirus Infection......Page 893
Biologic Characteristics and Molecular Biology......Page 894
Pathways of Spread......Page 896
Oropharyngeal Wall......Page 898
Tongue Base......Page 899
Patient Evaluation......Page 900
Selection of Imaging Studies......Page 902
p16-Positive Oropharyngeal Cancers......Page 904
General Principles of Treatment......Page 906
Surgery......Page 907
Tonsillar Cancers......Page 908
Unilateral radiation.......Page 910
Soft Palate Carcinomas......Page 911
Induction or Adjuvant Chemotherapy......Page 913
Concurrent Chemoradiation......Page 914
Treatment Deescalation......Page 915
Postradiation Neck Dissection......Page 917
Salvage Surgery......Page 918
Immunotherapy......Page 919
Radiation Treatment Planning......Page 921
Hyperfractionation......Page 922
Acceleration with Dose Reduction......Page 923
Conventional Radiation......Page 924
IMRT Planning......Page 926
IMRT Constraints......Page 928
Acute Toxicities......Page 929
Dysphagia.......Page 932
Treatment Algorithm, Challenges, and Future Possibilities......Page 933
Critical References......Page 934
References......Page 935
Etiology and Epidemiology......Page 943
Prevention and Early Detection......Page 944
Anatomy and Pathways of Spread......Page 945
Biological Characteristics and Molecular Biology......Page 947
Staging......Page 948
Irradiation Plus Chemotherapy......Page 950
Intensity-Modulated Radiotherapy With or Without Chemotherapy......Page 952
Epstein-Barr Virus Biology-Driven Personalized Adjuvant Chemotherapy......Page 953
Concurrent Chemoradiation......Page 954
Treatment Fields......Page 955
Intensity-Modulated Radiation Therapy......Page 956
Simulation and Treatment Planning......Page 957
Treatment Planning and Delivery......Page 958
Normal Tissue Tolerance and Complications......Page 959
Critical References......Page 962
References......Page 964
Key Points......Page 969
Early Detection......Page 970
Supraglottis.......Page 971
Postcricoid tumors.......Page 972
Clinical Manifestations......Page 973
Larynx......Page 974
Hypopharynx.......Page 976
T1 and T2 Glottic Tumors......Page 977
T1, T2, and Selected T3 Supraglottic Tumors......Page 980
T1 and T2 Hypopharyngeal Tumors......Page 981
Locally Advanced Carcinomas......Page 982
Bulky Supraglottic Cancer......Page 983
Locally Advanced Hypopharynx Cancer......Page 984
T1-2N0 Glottic Carcinomas......Page 985
T3N0 Glottic, T1-3 Supraglottic, T Any N Glottic, or Hypopharyngeal Carcinomas......Page 987
Postoperative Radiotherapy......Page 988
Treatment Algorithm......Page 989
Controversies, Challenges, and Future Possibilities......Page 990
Critical References......Page 992
References......Page 994
Key Points......Page 999
Etiology and Epidemiology......Page 1002
Nasal Vestibule......Page 1003
Nasal Cavity and Ethmoid Air Cells......Page 1005
Maxillary Sinus......Page 1007
Carcinoma......Page 1012
Nasal Vestibule......Page 1013
Nasal Cavity—Comparative Outcome by Series (H4)......Page 1015
Nasal Cavity—Comparative Outcome by Histology, Stage, and Pathologic Features......Page 1016
Esthesioneuroblastoma......Page 1017
Maxillary Sinus......Page 1019
Target Volume......Page 1021
Target Volume......Page 1023
Target Volume, Field Arrangement, and Dose Fractionation Schedule......Page 1028
Proton Radiotherapy......Page 1030
Acknowledgments......Page 1033
Critical References......Page 1034
References......Page 1035
Etiology and Epidemiology......Page 1038
Prevention and Early Detection......Page 1039
Adenoid Cystic Carcinoma......Page 1040
Mutation Analysis: Dysregulation in Growth Factor Receptors......Page 1041
Pathology......Page 1042
Pathways of Spread......Page 1043
Patient Evaluation......Page 1044
Primary Therapy......Page 1045
Postoperative Radiotherapy......Page 1048
Neutrons and Heavy Charged Particle Therapy......Page 1051
Palliation: Role of Chemotherapy......Page 1052
Minor Salivary Glands......Page 1053
Simulation and Field Arrangements......Page 1055
Treatment Algorithm, Conclusions, Controversies, and Future Possibilities......Page 1056
Critical References......Page 1057
References......Page 1058
Key Points......Page 1062
Etiology and Epidemiology......Page 1063
Pathology and Pathways of Spread......Page 1064
Clinical Manifestations/Patient Evaluation/Staging......Page 1065
Staging......Page 1066
Papillary Thyroid Carcinoma......Page 1067
Follicular Thyroid Carcinoma and Hürthle Cell Carcinoma......Page 1068
Medullary Thyroid Carcinoma......Page 1069
Surgery......Page 1070
Radioactive Iodine Therapy......Page 1071
External Beam Radiation Therapy......Page 1072
Targeted Therapy for Advanced Thyroid Cancer......Page 1073
Thyroid Lymphoma and Anaplastic Thyroid Carcinoma......Page 1074
Anaplastic Thyroid Carcinoma......Page 1075
Treatment Algorithm......Page 1076
Papillary Thyroid Carcinoma, Follicular Thyroid Carcinoma, and Hürthle Cell Carcinoma......Page 1077
Critical References......Page 1078
References......Page 1080
Diagnostic Evaluation......Page 1085
Results......Page 1087
Complications......Page 1090
Critical References......Page 1091
References......Page 1092
Anatomy of the Lymphatic System of the Neck......Page 1094
Imaging of the Neck......Page 1097
Clinical and Radiologic Assessment......Page 1098
Pathologic Lymph Node Metastases......Page 1100
Incidence of Skip Metastases in the Neck......Page 1102
Recommendations for Selection of Target Volumes in the Neck......Page 1103
Neck Node Dissection Procedures and Sentinel Node Biopsy......Page 1105
Delineation of the Clinical Target Volume......Page 1107
Irradiation Techniques......Page 1110
Control of the N0 Neck......Page 1111
Neck Control After Radiotherapy......Page 1112
Neck Control After Surgery Alone......Page 1113
Neck Control After Primary Radiotherapy......Page 1114
Indications for Postoperative Irradiation or Chemoradiation......Page 1115
Indications for Postradiotherapy Neck Node Dissection......Page 1116
Complications of Neck Irradiation......Page 1117
Management of Recurrent Neck Disease......Page 1119
Critical References......Page 1120
References......Page 1121
Etiology and Epidemiology......Page 1126
Biology and Pattern of Spread......Page 1127
Clinical Presentation and Pathology......Page 1128
Clinical Presentation and Pathology......Page 1129
Clinical presentation and pathology.......Page 1130
Staging of Basal and Squamous Cell Carcinoma......Page 1131
Primary Tumor......Page 1132
Regional Nodes......Page 1133
Adnexal Carcinoma......Page 1134
Basal and Squamous Cell Carcinoma......Page 1135
Setup, Field Arrangement, and Dose Fractionation Schedule......Page 1136
Basal Cell Carcinoma and Squamous Cell Carcinoma......Page 1137
Critical References......Page 1138
References......Page 1140
Key Points......Page 1142
Biology and Patterns of Spread......Page 1143
Patient Evaluation and Staging......Page 1145
Primary Tumor......Page 1146
Elective Nodal Treatment......Page 1147
Distant Disease and Adjuvant Systemic Therapy......Page 1148
Locally Advanced Disease and Palliation......Page 1149
Setup, Field Arrangement, and Dose-Fractionation Schedule......Page 1150
Acknowledgments......Page 1151
Critical References......Page 1152
References......Page 1153
Lung Cancer......Page 1156
Thymic Tumors......Page 1157
Normal-Tissue Toxicity Considerations......Page 1158
Non–Small Cell Lung Cancer......Page 1159
Immune Checkpoint Inhibitors......Page 1160
Prophylactic Cranial Irradiation......Page 1161
Mesothelioma......Page 1162
Critical References......Page 1163
References......Page 1164
Etiology and Epidemiology......Page 1169
Clinical Manifestations, Patient Evaluation, and Staging......Page 1170
Surgery for Small Cell Lung Cancer......Page 1171
Dose and Fractionation in Limited Stage Small Cell Lung Cancer......Page 1172
Timing and Sequencing of Radiotherapy in Limited-Stage Small Cell Lung Cancer......Page 1173
Definitive Treatment in the Elderly......Page 1175
Optimal Systemic Therapy......Page 1176
Treatment Algorithm(S), Controversies, Problems, Challenges, Future Possibilities, and Clinical Trials......Page 1177
Critical References......Page 1179
References......Page 1180
Introduction......Page 1184
Early Detection and Prevention......Page 1185
Pathology and Molecular Biology of Lung Cancer......Page 1186
ROS1......Page 1188
Carcinogenesis and Pathways of Spread......Page 1189
Patient/Staging Evaluation......Page 1191
Tumor-Node-Metastasis Stage Grouping......Page 1193
Medically Operable Patients......Page 1194
Medically Inoperable......Page 1196
Adjuvant Chemotherapy......Page 1199
Preoperative Treatment for Patients With Resectable Non–Small Cell Lung Cancer......Page 1200
Postoperative Radiotherapy......Page 1202
Definitive Radiotherapy for Stage IIIA/IIIB Disease......Page 1203
Definition of Target Volumes......Page 1206
Treatment Planning Techniques......Page 1208
Toxicity of Thoracic Radiotherapy......Page 1209
Systemic Therapy......Page 1210
Palliative Radiotherapy......Page 1212
Conclusions......Page 1214
Critical References......Page 1215
References......Page 1216
Thymic Tumors......Page 1226
Biologic Characteristics and Molecular Biology......Page 1227
Clinical Features......Page 1228
Diagnostic Work-Up for Thymic Tumors......Page 1229
Surgery for Thymoma......Page 1233
Chemotherapy for Thymoma......Page 1234
Techniques of Irradiation......Page 1235
Pulmonary Carcinoid Tumors......Page 1237
Biologic Characteristics and Molecular Biology......Page 1238
Clinical Manifestations, Patient Evaluation, and Staging......Page 1239
Radiation Therapy......Page 1240
Irradiation Techniques......Page 1241
Clinicopathologic Features and Prognostic Factors......Page 1243
Invasive Staging......Page 1244
Extrapleural pneumonectomy.......Page 1245
Radiation Therapy After Extrapleural Pneumonectomy......Page 1246
Target volume delineation.......Page 1249
Three-Dimensional Conformal Radiation Therapy......Page 1250
Intensity-Modulated Radiation Therapy......Page 1252
Acknowledgments......Page 1253
Critical References......Page 1254
References......Page 1256
Epidemiology and Prevention......Page 1268
Biology of Gastrointestinal Cancers......Page 1269
Anatomy and Pathways of Tumor Spread......Page 1270
Adjuvant Colorectal Cancer......Page 1271
Chemoradiation: 5-Fluorouracil–Based......Page 1272
Chemoradiation: New Chemotherapy Drugs......Page 1273
Upper Gastrointestinal and Extrapelvic Colon Cancers......Page 1274
Pelvic Gastrointestinal Cancers......Page 1275
Critical References......Page 1276
References......Page 1278
Key Points......Page 1280
Etiology......Page 1281
Molecular Characteristics of Gastric Cancer......Page 1284
Molecular Features of Esophageal Squamous Cell Carcinoma......Page 1285
Summary......Page 1286
Clinical Manifestations......Page 1287
Esophagus......Page 1289
Gastric......Page 1291
Gastric Cancer......Page 1294
Relapse Patterns After “Curative Resection”......Page 1296
Postoperative Chemotherapy Alone......Page 1299
Postoperative Chemoradiotherapy......Page 1301
Preoperative (Neoadjuvant) Therapy Before Surgery......Page 1302
Preoperative/Perioperative Chemotherapy Alone......Page 1303
Preoperative Radiotherapy and Chemotherapy......Page 1304
Induction Chemotherapy Before Preoperative Radiotherapy and Chemotherapy......Page 1306
Concurrent Radiotherapy and Chemotherapy vs Radiotherapy or Chemotherapy Alone......Page 1308
Role of Surgery After Concurrent Radiotherapy and Chemotherapy......Page 1311
Addition of Targeted Agents to Combined-Modality Therapy......Page 1312
Chemotherapy......Page 1313
Target Volumes and Normal Structures......Page 1314
Treatment Technique......Page 1316
Toxicity From Radiotherapy......Page 1320
Primary and Adjuvant Therapy......Page 1322
Critical References......Page 1324
References......Page 1326
Key Points......Page 1337
Etiology......Page 1338
Biologic Characteristics and Molecular Biology......Page 1339
Cystic neoplasms.......Page 1341
Pathways of Spread......Page 1342
Patient Evaluation......Page 1343
Surgery......Page 1345
Selection of Surgical Candidates......Page 1347
Adjuvant Chemoradiation......Page 1348
Gemcitabine-Based Chemoradiation......Page 1350
Novel Combination Chemotherapy......Page 1351
Neoadjuvant Therapy in Resectable Disease......Page 1352
Borderline Resectable Disease......Page 1353
Chemoradiation and/or Chemotherapy......Page 1356
Stereotactic Body Radiation Therapy......Page 1360
Neoadjuvant CRT Plus IOERT......Page 1362
Irreversible Electroporation......Page 1366
Palliative Surgery and Stenting......Page 1365
Motion Management......Page 1367
Proton beam radiation therapy.......Page 1369
Stereotactic Body Radiotherapy......Page 1371
Treatment Algorithm, Challenges, and Future Directions......Page 1372
Critical References......Page 1375
References......Page 1377
Introduction......Page 1385
Biological Characteristics and Molecular Biology......Page 1386
Diagnosis......Page 1387
Primary Therapy......Page 1388
Intermediate-Stage Hepatocellular Carcinoma......Page 1390
Surgical Resection......Page 1391
Radiotherapy for Hepatocellular Carcinoma......Page 1392
Radiotherapy as Definitive Therapy......Page 1393
Radiation Combined With Other Local Therapies......Page 1394
Biological Characteristics and Molecular Biology......Page 1395
Locally Advanced Disease and Palliation......Page 1396
Epidemiology, Etiology, and Prevention—Gallbladder Cancer/Extrahepatic Cholangiocarcinoma......Page 1397
Diagnosis, Staging, and Follow-Up......Page 1398
Adjuvant Therapy—Gallbladder Cancer......Page 1399
Neoadjuvant Chemoradiotherapy Plus Transplantation—Extrahepatic Cholangiocarcinoma......Page 1400
Dose-Limiting Organs......Page 1403
Stereotactic Body Radiotherapy Technique......Page 1404
Hepatobiliary Cancer Treatment Algorithm and Future Directions......Page 1405
Critical References......Page 1407
References......Page 1408
Introduction......Page 1414
Biological Characteristics and Molecular Biology......Page 1415
Clinical Manifestation, Patient Evaluation, and Staging......Page 1416
Surgery......Page 1417
Fluoropyrimidine Therapy......Page 1418
Oxaliplatin......Page 1419
Rationale: Patterns of Relapse and Surgery Alone......Page 1420
Adjuvant Irradiation, Single Institution......Page 1421
Phase III Intergroup Trial......Page 1423
Targeted Agents......Page 1424
Treatment Algorithm, Conclusions, and Future Possibilities......Page 1425
Critical References......Page 1428
References......Page 1430
Etiology and Epidemiology......Page 1432
Biological Characteristics and Molecular Biology......Page 1433
Anatomy and Pathways of Spread......Page 1434
Patient Evaluation......Page 1435
Imaging After Chemoradiation......Page 1436
TNM Staging......Page 1437
Short-Course Preoperative Irradiation......Page 1438
The role of concurrent and postoperative chemotherapy.......Page 1440
Positive radial (circumferential) margins.......Page 1441
Clinical experience with sphincter preservation.......Page 1442
Prospective series.......Page 1443
Phase III trials.......Page 1444
Phases I/II trials.......Page 1445
Sequential Chemotherapy......Page 1446
Polish trial 1.......Page 1447
Local excision alone.......Page 1448
Standard Treatment (Preoperative Chemoradiation/Resection)......Page 1449
Primary Unresectable Disease......Page 1450
Locally Recurrent Disease......Page 1451
Irradiation Alone for Locally Unresectable or Recurrent Disease......Page 1453
Irradiation Fractionation, Modality, and Dose......Page 1454
Methods to Reduce Acute and Chronic Toxicity......Page 1455
Critical References......Page 1456
References......Page 1458
Etiology and Epidemiology......Page 1466
Chronic Immunosuppression......Page 1467
Biologic Characteristics......Page 1468
Patient Evaluation......Page 1469
Radiation Alone or Plus Chemotherapy......Page 1470
Radiation Alone or Plus 5-FU and Mitomycin C......Page 1471
Radiation Plus 5-FU and MMC Versus 5-FU and Cisplatin......Page 1472
Locally Advanced Disease and Palliation......Page 1473
Intensity-Modulated Radiotherapy......Page 1474
Radiation Dose and Fractionation......Page 1476
Treatment Tolerance......Page 1477
Treatment Algorithm and Future Directions......Page 1478
Critical References......Page 1479
References......Page 1480
Prostate Cancer......Page 1484
Testicular Cancer......Page 1485
Critical References......Page 1486
References......Page 1487
Epidemiology......Page 1488
Body Habitus......Page 1489
Vasectomy......Page 1492
Early Detection......Page 1491
Screening Recommendations......Page 1493
Histologic Appearance......Page 1495
Grading......Page 1496
Clinical and Pathologic Stage Grouping......Page 1497
Molecular Biology......Page 1498
Nodal Involvement......Page 1499
Nodal Involvement......Page 1500
Prostate-Specific Antigen......Page 1502
PSA Failure Definitions After Local Therapy......Page 1503
Clinical Symptoms and Signs......Page 1504
Staging......Page 1507
Magnetic Resonance Imaging......Page 1508
Bone scans.......Page 1510
Expectant Management......Page 1512
Acid Phosphatase......Page 1513
Local Therapy......Page 1514
Biochemical relapse.......Page 1518
Dose escalation.......Page 1519
Hypofractionation.......Page 1521
Complications.......Page 1524
Clinical outcomes.......Page 1528
Carbon Ion Therapy......Page 1531
Patient Selection......Page 1530
Postimplant dosimetry.......Page 1534
High-dose rate brachytherapy.......Page 1535
Brachytherapy outcomes.......Page 1537
Lower gastrointestinal morbidity and management.......Page 1539
HDR-Brachy Outcomes......Page 1541
Organ-Confined Disease......Page 1543
Quality of Life......Page 1545
Androgen Deprivation Plus Radiation......Page 1548
Scope of Radiation Therapy......Page 1551
Regional Lymph Node Positive Disease (pN+)......Page 1552
Adjuvant Radiotherapy......Page 1553
Biochemical Recurrence......Page 1554
Adverse Events......Page 1558
Hormonal Therapy......Page 1559
Bone-Directed Therapies......Page 1561
Clinical Target Volumes......Page 1563
Planning Target Volumes......Page 1564
Treatment Planning and Delivery......Page 1566
HDR Brachytherapy......Page 1568
Techniques of Radiotherapy......Page 1570
Treatment Algorithm and Future Directions......Page 1573
Future Directions......Page 1574
Critical References......Page 1575
References......Page 1576
Key Points......Page 1598
Biological Characteristics and Molecular Biology......Page 1599
Clinical Manifestations, Patient Evaluation, and Staging......Page 1600
Non-Muscle-Invasive (Superficial) Bladder Cancer......Page 1601
Radical Cystectomy......Page 1604
Cystectomy plus radiation.......Page 1605
Bladder-Preserving Selective Trimodality Therapy......Page 1606
Cooperative group trials.......Page 1607
Quality of Life......Page 1608
Simulation.......Page 1609
Adjuvant.......Page 1610
Dose-Fractionation Schemes......Page 1612
Critical References......Page 1613
References......Page 1615
Etiology and Epidemiology......Page 1623
Pathology......Page 1624
Seminomas......Page 1627
Patient Evaluation......Page 1628
Tumor Markers......Page 1629
Surveillance.......Page 1631
Overview of management of stage I seminoma.......Page 1633
Residual Retroperitoneal Mass......Page 1634
Chemotherapy with or without retroperitoneal node dissection.......Page 1635
Chemotherapy Complications......Page 1637
Testicular Tumors Developing in Patients Who Are Immunosuppressed......Page 1639
Irradiation Techniques and Dose......Page 1640
Stage II Seminoma......Page 1641
Treatment Algorithms, Conclusions, and Future Possibilities......Page 1642
Critical References......Page 1643
References......Page 1645
Key Points......Page 1650
Etiology......Page 1651
Renal Pelvis and Ureter......Page 1652
Pathways of Spread......Page 1653
Patient Evaluation......Page 1654
Staging......Page 1655
Primary Irradiation......Page 1656
Adjuvant Irradiation......Page 1658
Surgery......Page 1660
Adjuvant Chemotherapy......Page 1661
Adjuvant Topical Therapy......Page 1662
Palliation and Metastatic Disease......Page 1663
Brain Metastases......Page 1665
Renal Pelvis and Ureter......Page 1667
Treatment-Related Toxicity......Page 1668
Kidney......Page 1675
Critical References......Page 1678
References......Page 1679
Etiology and Epidemiology......Page 1687
Lymph Node Assessment: The N0 Patient......Page 1689
Surgery......Page 1691
Node-Positive Disease......Page 1693
Molds......Page 1695
Interstitial Brachytherapy......Page 1696
Urethral stenosis.......Page 1697
Treatment Algorithm, Controversies, and Challenges......Page 1698
Critical References......Page 1699
References......Page 1700
Cervical Cancer......Page 1702
Ovarian Cancer......Page 1703
References......Page 1704
Key Points......Page 1705
Prevention and Early Detection......Page 1706
Pathology and Pathways of Spread......Page 1707
Molecular Biology......Page 1708
Staging and Patient Evaluation......Page 1709
Primary Therapy......Page 1711
Chemoradiation......Page 1712
Brachytherapy Plus External-Beam Radiotherapy......Page 1715
Role of Extended Field Irradiation......Page 1716
The Role of Neoadjuvant Chemotherapy......Page 1717
Microinvasive Disease (FIGO Stage IA Disease)......Page 1718
FIGO Stages IB and IIA Disease......Page 1719
Sentinel lymph nodes assessment.......Page 1720
Adjuvant postoperative irradiation.......Page 1721
Locally Advanced Disease and Palliation......Page 1722
Chemotherapy and Biological Therapy......Page 1723
External-Beam Treatment Techniques......Page 1725
Low-Dose-Rate Intracavitary Therapy......Page 1728
High-Dose-Rate Brachytherapy......Page 1731
Treatment Algorithm, Conclusions, and FUTURE Possibilities......Page 1735
Critical References......Page 1736
References......Page 1738
Key Points......Page 1747
Etiology......Page 1748
Biological Characteristics......Page 1749
Prognostic Factors......Page 1750
Pathways of Spread......Page 1751
Staging......Page 1753
Primary Therapy (Including Adjuvant Therapy) Surgery......Page 1754
Primary Radiotherapy: Indications and Results......Page 1756
Adjuvant Therapy: Stages I and II......Page 1757
FIGO 2009 Stage IB, Grade 3 Disease (High Risk, Early Stage)......Page 1759
Unfavorable Histological Types......Page 1760
Adjuvant Chemotherapy for Stage I to II and Postsurgical Stage III Disease......Page 1761
Stage IIIA Disease......Page 1764
Stage IV Disease......Page 1765
Hormonal Therapy......Page 1766
Targeted Therapy......Page 1767
Treatment of Uterine Sarcomas......Page 1768
Intensity-Modulated Radiotherapy......Page 1769
Complications of Pelvic Irradiation......Page 1771
Vaginal Brachytherapy......Page 1774
Treatment Algorithm, Conclusions, and Challenges......Page 1775
Critical References......Page 1777
References......Page 1778
Key Points—Vulvar Cancer......Page 1787
Key Points—Vaginal Cancer......Page 1788
Early Detection, Treatment and Prevention......Page 1789
Pathways of Spread......Page 1790
Biology and Prognostic Factors......Page 1793
Staging......Page 1794
Surgical Trends Including Sentinel Node Studies......Page 1797
Adjuvant Postoperative Radiation......Page 1802
Preoperative/Neoadjuvant Chemoradiation......Page 1803
Treatment of primary lesions.......Page 1806
Treatment of inguinal nodes.......Page 1807
Early, Favorable, or Low-Risk Disease......Page 1808
Locally Advanced Disease and Palliation......Page 1809
Locally Recurrent or Metastatic Cancer......Page 1811
Target Volume Delineation and Treatment Planning......Page 1813
Adjuvant Postoperative Irradiation of the Vulva......Page 1815
Radiation Tolerance and Treatment Sequelae......Page 1817
Melanoma of the Vulva......Page 1819
Vaginal Cancer......Page 1821
Clinical Manifestations, Patient Evaluation, and Staging......Page 1825
Vaginal Intraepithelial Neoplasia......Page 1826
Treatment Rationale, General Principles and Outcomes......Page 1827
Brachytherapy......Page 1828
External Beam Radiotherapy......Page 1831
Vaginal Melanoma......Page 1832
Critical References......Page 1834
References......Page 1835
Key Points......Page 1843
Genetic Factors......Page 1844
Biological Characteristics and Prognostic Factors......Page 1845
Histological Classification......Page 1846
Patient Evaluation and Diagnosis......Page 1847
Surgical Staging......Page 1848
Radiotherapy......Page 1849
Advanced-Stage Disease......Page 1851
Role of Chemotherapy......Page 1853
Molecular Targeting Agents......Page 1855
Recurrent Ovarian Cancer......Page 1856
Definitive Radiotherapy for Locoregional Relapse......Page 1858
Dysgerminoma......Page 1859
Granulosa Cell Tumors......Page 1861
Treatment Algorithm......Page 1862
Critical References......Page 1864
References......Page 1865
Anatomy......Page 1873
Risk Factors......Page 1876
Genetics Factors and Breast Cancer Etiology......Page 1878
Breast Cancer Screening......Page 1880
Risk-Reduction Agents......Page 1881
Staging......Page 1883
Predictive Markers and Selection of Therapy......Page 1884
Axillary Management......Page 1890
Radiation......Page 1891
Selection of Therapy......Page 1892
Cytotoxic Therapies......Page 1893
Endocrine Therapies......Page 1895
HER2 Targeting......Page 1896
Male Breast Cancer......Page 1897
Critical References......Page 1898
References......Page 1900
Lobular Carcinoma in Situ......Page 1906
Paget Disease......Page 1907
Pathology......Page 1908
Total Mastectomy......Page 1909
Breast-Conserving Therapy......Page 1910
Radiotherapy Technique......Page 1911
Future Directions......Page 1912
Summary......Page 1913
Critical References......Page 1914
References......Page 1915
Imaging......Page 1919
Genetic Factors......Page 1921
Margin Status......Page 1923
Correlates of Local Recurrence in Patients Treated with Conservative Surgery and Endocrine Therapy Without Radiotherapy......Page 1924
Supraclavicular Nodal Irradiation......Page 1926
Patient Position and Immobilization......Page 1927
Breast Boost Volume and Techniques......Page 1929
Supraclavicular and Axillary Nodal Irradiation......Page 1935
Interval Between Surgery and the Start of Radiotherapy......Page 1939
Introduction......Page 1941
Acute Reactions and Their Management......Page 1942
Arm Edema and Shoulder and Arm Function......Page 1946
Carcinogenesis......Page 1947
Presentation of Local Recurrence......Page 1948
Critical References......Page 1950
References......Page 1953
Introduction......Page 1975
Clinical Manifestations, Patient Evaluations, and Staging......Page 1976
Treatment Overview......Page 1978
Mastectomy and Postmastectomy Radiotherapy......Page 1979
Inflammatory Breast Cancer......Page 1981
Techniques of Irradiation......Page 1982
Integration of Postmastectomy Radiation and Breast Reconstruction......Page 1985
Therapeutic Challenges and New Approaches......Page 1986
Conclusions......Page 1989
Critical References......Page 1991
References......Page 1992
Key Points......Page 1994
Biologic Characteristics and Molecular Biology......Page 1995
Liposarcoma......Page 1996
Epithelioid Sarcoma......Page 1999
Clinical Manifestations......Page 2000
Establishing the Diagnosis......Page 2001
Exclusion of Metastasis......Page 2002
Role of Adjuvant Radiation......Page 2003
Timing of Adjuvant RT......Page 2004
Intensity-Modulated RT......Page 2005
RT Target Volume......Page 2006
Radiation Doses......Page 2008
Morbidity of Radiation......Page 2010
Neoadjuvant (Preoperative) Chemotherapy......Page 2011
Surgery for Retroperitoneal Sarcoma......Page 2012
Adjuvant RT......Page 2013
Head and Neck STS......Page 2015
Dermatofibrosarcoma Protuberans......Page 2016
Chemotherapy for Metastases......Page 2017
Critical References......Page 2020
References......Page 2021
Reactions in the Vascular System......Page 2026
Definition and Clinical Features......Page 2027
Surgical Treatment......Page 2028
Definition and Clinical Features......Page 2029
Irradiation Options......Page 2030
Definition and Clinical Features......Page 2031
Dupuytren Contracture (Morbus Dupuytren) and Morbus Ledderhose......Page 2032
Irradiation Options......Page 2033
Definition and Clinical Features......Page 2034
Medical therapy.......Page 2035
Irradiation Technique and Procedures......Page 2036
Critical References......Page 2037
References......Page 2038
Cancer in Children......Page 2046
Critical References......Page 2049
References......Page 2051
WNT Tumors......Page 2053
Posterior Fossa Tumors......Page 2054
Childhood Central Nervous System (CNS) Tumors......Page 2056
Stereotactic Radiosurgery/Stereotactic Radiation Therapy......Page 2057
Medulloblastoma......Page 2058
CNS Embryonal Tumor, Not Otherwise Specified (Formerly Supratentorial Primitive Neuroectodermal Tumors)......Page 2060
Embryonal Tumor With Multilayered Rosettes (ETMR)......Page 2061
Ependymoma......Page 2062
Low-Grade Astrocytoma......Page 2063
Diffuse Pontine Glioma......Page 2064
Germ Cell Tumors......Page 2065
Craniopharyngioma......Page 2066
Choroid Plexus Tumors......Page 2067
Neuroendocrine Toxicity......Page 2068
Critical References......Page 2069
References......Page 2071
Epidemiology......Page 2075
Nonrhabdomyosarcoma Soft-Tissue Sarcoma......Page 2076
Rhabdomyosarcoma......Page 2077
Rhabdomyosarcoma......Page 2078
Rhabdomyosarcoma......Page 2079
Techniques......Page 2081
Rhabdomyosarcoma......Page 2082
Critical References......Page 2083
References......Page 2085
Biologic Characteristics and Molecular Biology......Page 2087
Clinical Manifestations, Patient Evaluation, and Staging......Page 2088
Primary Therapy......Page 2089
Advanced Disease and Palliation......Page 2090
Definitive Radiotherapy......Page 2092
Target Volume......Page 2093
Radiation Therapy of Bone Metastases......Page 2094
Primary Therapy......Page 2095
Critical References......Page 2096
References......Page 2098
Prevention and Early Detection......Page 2100
Loss of Heterozygosity at 1p and 16q......Page 2101
Clinical Manifestations, Patient Evaluations, and Staging......Page 2102
Staging......Page 2104
Whole-Lung Irradiation......Page 2105
Favorable Histology Wilms Tumor......Page 2106
Anaplastic Histology......Page 2107
Irradiation Techniques......Page 2108
Late Effects......Page 2109
Critical References......Page 2110
References......Page 2111
Biologic Characteristics/Molecular Biology......Page 2114
Clinical Manifestations, Patient Evaluation, and Staging......Page 2115
Unilateral Retinoblastoma......Page 2117
External Beam Radiotherapy......Page 2119
Long-term Effects of Treatment for Retinoblastoma......Page 2120
Additional Information on Late Effects of Radiotherapy......Page 2123
Critical References......Page 2124
References......Page 2125
Prevention and Early Detection......Page 2127
Clinical Manifestations, Patient Evaluation, and Staging......Page 2128
Very-Low-Risk Neuroblastoma......Page 2129
High-Risk Neuroblastoma......Page 2130
Recurrent Disease and Palliation......Page 2131
Irradiation Techniques......Page 2132
Critical References......Page 2133
References......Page 2135
Etiology......Page 2137
Cytogenetics......Page 2138
Prognostic Factors......Page 2139
Treatment......Page 2140
Technique......Page 2141
Acute Myeloid Leukemia......Page 2142
Non-Hodgkin Lymphoma......Page 2143
Critical References......Page 2145
References......Page 2146
Key Points......Page 2150
Etiology and Epidemiology......Page 2151
Staging......Page 2152
Clinical Manifestations......Page 2153
Prognostic Factors......Page 2154
Response-Based Therapy......Page 2156
ABVD and Derivative Chemotherapy......Page 2159
Immunotherapy......Page 2160
Volume......Page 2161
Proton Radiotherapy......Page 2162
Favorable-Risk Disease......Page 2164
Risk-Adapted Therapy—Unfavorable Risk Disease......Page 2166
Treatment of Relapsed and Refractory Disease......Page 2167
Treatment Algorithms......Page 2168
Critical References......Page 2169
References......Page 2170
Key Points......Page 2177
Primary and Adjuvant Therapy and Results......Page 2178
Treatment Algorithms, Controversies, Challenges, and Future Possibilities......Page 2179
Primary and Adjuvant Therapy and Results......Page 2180
Pathology and Pathways of Spread......Page 2181
Pathology and Pathways of Spread......Page 2182
Etiology and Epidemiology......Page 2183
Etiology and Epidemiology......Page 2184
Primary and Adjuvant Therapy and Results......Page 2185
Pathology and Pathways of Spread......Page 2186
Primary and Adjuvant Therapy and Results......Page 2187
Treatment Algorithms, Controversies, Challenges, and Future Possibilities......Page 2188
Locally Advanced Disease and Palliation......Page 2189
Critical References......Page 2190
References......Page 2191
Staging......Page 2197
Stages III-IV......Page 2198
Follicular Lymphoma......Page 2199
Critical References......Page 2200
References......Page 2202
Etiology and Epidemiology......Page 2206
Biological Characteristics/ Molecular Biology......Page 2207
Clinical Presentation......Page 2208
Prognostic Factors......Page 2209
Optimal Combination Chemotherapy Regimen......Page 2210
Modern Radiation Fields: Involved-Site/ Involved-Node Radiotherapy......Page 2211
Optimal Radiation Dose......Page 2213
Recommendation on Treatment for Early-Stage Hodgkin Lymphoma......Page 2214
Adding Brentuximab......Page 2215
Optimal Radiation Dose and Volume......Page 2217
Role of Radiotherapy Before or After High-Dose Therapy......Page 2218
Respiratory Motion Adaptation Techniques......Page 2219
Critical References......Page 2220
References......Page 2222
Etiology and Epidemiology......Page 2227
Prevention and Early Detection......Page 2228
Follicular Lymphoma and BCL-2......Page 2229
Diffuse Large B-Cell Lymphoma......Page 2230
Extranodal Marginal Zone Lymphoma, MALT Type......Page 2231
Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type......Page 2232
History and Physical Examination......Page 2233
Staging Classification......Page 2234
Principles of Management......Page 2235
Surgery......Page 2236
Localized (Stages I and II) Follicular Lymphoma......Page 2237
Orbital Mucosa-Associated Lymphoid Tissue Lymphoma......Page 2239
Localized (Stages I and II) Diffuse Large B-Cell Lymphoma......Page 2240
Advanced (Stages III and IV) Diffuse Large B-Cell Lymphomas......Page 2241
Primary central nervous system lymphoma.......Page 2242
Testicular diffuse large B-cell lymphoma.......Page 2243
NK/T-Cell Lymphoma......Page 2244
Cutaneous Lymphomas......Page 2245
Radiotherapy for Palliation......Page 2246
Thyroid Lymphoma......Page 2247
Gastric Lymphoma and Issues Relating to Abdominal Irradiation......Page 2248
Critical References......Page 2249
References......Page 2251
Epidemiology and Etiology......Page 2260
Multiple Myeloma and Monoclonal Gammopathy of Undetermined Significance......Page 2261
Therapy for Multiple Myeloma......Page 2263
Treatment and Emerging Novel Therapies......Page 2264
Stem-Cell Transplantation......Page 2265
Solitary Plasmacytoma......Page 2266
Future Directions......Page 2267
Critical References......Page 2268
References......Page 2269
Key Points......Page 2272
Biologic Characteristics and Molecular Biology......Page 2273
Histopathology......Page 2274
Premycotic Phase......Page 2275
Internal Organs......Page 2277
Primary Cutaneous Anaplastic Large Cell Lymphoma/CD30+ Large Cell CTCL......Page 2278
Adult T-Cell Lymphoma/Leukemia......Page 2279
Prognosis and Staging......Page 2280
Patient Evaluation......Page 2281
Primary Therapy......Page 2282
PUVA and UVB......Page 2283
Extracorporeal Photochemotherapy......Page 2284
Dose......Page 2285
Limited patches or plaques: T1 N0 M0 (IA) and T1 N1 M0 (IIA).......Page 2286
Palliation......Page 2287
Historical Development......Page 2288
Modern TSEBT......Page 2289
Other Radiation Management Issues......Page 2290
Treatment Controversies, Problems, Challenges, and Future Possibilities......Page 2291
Critical References......Page 2293
References......Page 2295