Radiation Therapy for Skin Cancer

Preface......Page 8
Contents......Page 10
Contributors......Page 12
History of Radiation Therapy in Dermatology......Page 14
References......Page 19
 Interaction of Radiation with Matter......Page 21
 Interaction Types......Page 22
 Linear Energy Transfer......Page 23
 Relative Biological Effectiveness......Page 24
 Cell Survival Curves......Page 25
 Oxygen Effect......Page 26
 Fractionation......Page 27
References......Page 28
Electromagnetic Spectrum......Page 29
 Nonionizing vs. Ionizing in Electromagnetic Spectrum......Page 30
 X-ray Production......Page 31
 Bremsstrahlung X-rays......Page 33
 X-ray Beam Quality and Filtration......Page 35
 Kilovolt Peak......Page 36
 Milliamperage (MA)......Page 37
 Percentage Depth Dose (Depth Dose)......Page 38
 D ½ vs. D90 Philosophy......Page 40
 Radiation Exposure......Page 42
 Electronic Equilibrium (Dmax)......Page 43
 Superficial Therapy......Page 44
 Brachytherapy......Page 45
 Electron Beams......Page 46
References......Page 47
Radiation Protection......Page 48
Calibration......Page 53
 Record Keeping......Page 54
References......Page 55
Introduction......Page 56
 Squamous Cell Carcinoma and Basal Cell Carcinoma of the Skin......Page 57
 Staging for Squamous Cell Carcinoma Treated by Dermatologists Utilizing Radiotherapy......Page 60
 Clinical Examples for Staging SCC and BCC in Dermatologic Radiotherapy......Page 61
 Half-Value Depth (D ½ Philosophy) and Depth Assessment......Page 62
References......Page 64
Introduction......Page 66
 Risk Factors......Page 67
 Pathophysiology......Page 68
 Assessment of Radiodermatitis......Page 69
 Management of Acute Radiodermatitis......Page 71
 Topical Corticosteroids......Page 72
 Other Topical Products......Page 73
Pentoxifylline......Page 74
 Conclusion......Page 75
References......Page 76
Efficacy for Primary BCC and SCC......Page 81
 Cosmesis......Page 83
 Comparison to Electron Beam Radiotherapy......Page 85
 Conclusion......Page 87
References......Page 88
Introduction......Page 90
 Overview of Superficial Radiotherapy......Page 91
 General Indications for Superficial Radiotherapy of BCC/SCC......Page 92
 Considerations for Surgery of BCC/SCC......Page 94
References......Page 95
Therapeutic Index......Page 98
 Time, Dose, and Fractionation......Page 99
 The Effect of Dose......Page 100
 The Nominal Standard Dose......Page 101
 The Time Dose Fractionation Factor......Page 102
Tumor Depth......Page 108
 Half-Value Depth (D ½)......Page 109
 Umbra Selection......Page 110
 Dose and Fractionation Schemes......Page 111
 Patient Evaluation for Superficial Radiation Therapy......Page 112
 Indications......Page 113
Radiation Positioning and Shielding......Page 114
 Shielding......Page 115
 Select Depth of Penetration......Page 124
 Select Umbra, Shields, and Cone Size......Page 125
 Patient Eligibility......Page 126
 Prescription and Fractionation Log......Page 128
 Accounting for Treatment Interruptions......Page 129
 Example of a Decay Event......Page 131
 Example of a Second Check Calculation......Page 132
 Weekly Management of Patient’s Dose Response......Page 133
References......Page 135
Introduction......Page 136
 Safety Issues/Radiogenic Carcinomas......Page 138
 Licensing Regulations and Maintenance......Page 139
 Start-up Costs......Page 140
 Lack of Teaching on the Practical Application and Use of Superficial Radiotherapy......Page 141
 Cost Analysis of RT in Dermatology Setting Versus Radiation Oncology Setting and Mohs Surgery......Page 142
References......Page 144
 Physical Characteristics of Grenz Ray......Page 146
 Other Physical Properties......Page 147
 Calibration......Page 148
 Physical Effects of Grenz Ray......Page 149
Grenz Ray for Lentigo Maligna......Page 150
 Grenz Ray for Bowen’s Disease......Page 153
 Grenz Ray for Actinic Keratosis......Page 155
 Grenz Ray for Inflammatory Skin Diseases......Page 156
References......Page 160
Staging......Page 163
 Radiotherapy Alone......Page 165
 Management of Regional Lymph Node Metastases......Page 166
 Treatment Techniques......Page 167
 Results......Page 169
Regional Nodes......Page 172
References......Page 173
Introduction......Page 175
 Historical Use in Dermatology......Page 176
 Technical Aspects......Page 179
 Radiation Source and Dose Delivery......Page 180
Surface-Mold Brachytherapy......Page 181
 Interstitial Brachytherapy......Page 185
 Efficacy and Indications......Page 186
 Tolerability, Cosmesis, and Adverse Events......Page 187
References......Page 189
Introduction......Page 191
 Treatment Outcomes......Page 192
References......Page 195
Introduction......Page 197
 Histopathology......Page 198
 Staging......Page 199
 Outcomes......Page 200
 Chemotherapy......Page 201
References......Page 202
Introduction......Page 204
 Diagnostic Evaluation......Page 205
 Outcomes......Page 206
References......Page 209
Introduction......Page 212
Primary Cutaneous Follicular Center Lymphoma......Page 213
 Primary Cutaneous Diffuse Large B-Cell Lymphoma-Leg Types......Page 214
 Primary Cutaneous T-Cell Lymphoma......Page 215
 Total Skin Electron Beam Treatment......Page 218
References......Page 219
Introduction......Page 221
 Treatment......Page 222
 Outcomes......Page 224
References......Page 227
Introduction......Page 230
 Incidence of Positive Sentinel Lymph Node Biopsy......Page 231
 Incidence of Residual Positive Nodes in a Completion Node Dissection After a Positive SLNB......Page 232
 Adjuvant Radiotherapy......Page 233
References......Page 237
Introduction......Page 240
 Planning......Page 241
 Implementation......Page 244
Index......Page 246