Walter and Miller’s Textbook of Radiotherapy: Radiation Physics, Therapy and Oncology

Front Cover......Page 1
Walter and Miller\'s Textbook of Radiotherapy: Radiation Physics, Therapy and Oncology......Page 4
Copyright......Page 5
Contents......Page 6
Contributors......Page 20
International System of Units and Prefixes for Physical Quantities......Page 24
Section 1......Page 26
Particles......Page 27
The Forces......Page 28
Band Theory of Solids......Page 29
Transverse and Longitudinal Waves......Page 30
Electromagnetic Radiation......Page 31
Continuous Spectra and Characteristic Radiation......Page 32
Stable and Unstable Isotopes......Page 33
Alpha Decay......Page 34
Gamma Decay......Page 35
Radioactive Decay Series......Page 36
Further reading......Page 37
Excitation and Ionisation......Page 38
X-Ray Production......Page 39
Stopping Power and Linear Energy Transfer......Page 41
The Photoelectric Effect......Page 42
The Compton Effect......Page 43
Exponential Attenuation......Page 44
Beam Hardening......Page 46
Photon Depth Dose and the Build-Up Effect......Page 47
Absorbed Dose......Page 49
Carbon Ions and Pions......Page 50
Neutron interactions......Page 51
Further reading......Page 52
Radiation detection......Page 53
Gas Amplification Devices......Page 54
Proton Beam Detection......Page 55
Traceability of Measurement......Page 56
Standard Calorimeter......Page 57
The Free Air Chamber......Page 58
Bragg-Gray Cavity Theory......Page 59
Physical Description......Page 60
Measurement of Dose and Dose Rate......Page 61
The beam monitor chamber......Page 62
Correction for Atmospheric Conditions......Page 63
Standard Photographic Film......Page 64
Diode Detector......Page 65
Summary of Direct Reading Radiation Detectors......Page 66
Thermoluminescent Dosimetry......Page 67
Fricke Dosimetry......Page 68
Alanine-Electron Paramagnetic Resonance Dosimetry......Page 69
Area Arrays......Page 70
Alternative systems for proton beams dose measurement......Page 71
References......Page 72
Stochastic Hereditary Effects......Page 74
Effective Dose......Page 75
Background radiation......Page 77
Dose Limits......Page 78
Controlled and Supervised Radiation Areas......Page 79
Local Rules, Radiation Protection Advisers and Supervisors......Page 80
The Employer......Page 81
Administration of Radioactive Substances Advisory Committee......Page 82
Barriers......Page 83
Building Materials......Page 84
Direct Readout Dosimeters......Page 85
Transport of Radioactive Materials......Page 86
References......Page 87
Introduction......Page 89
Production of X-Rays for Imaging......Page 90
Antiscatter Grid......Page 91
Film and Screen Detection......Page 92
Fluoroscopic Imaging With Image Intensifier Chain......Page 93
X-ray Focal Point Size......Page 94
Practical Configurations......Page 95
Treatment Verification Systems......Page 96
Returning to Thermal Equilibrium......Page 97
How Positional Information Is Encoded in the Signal......Page 98
Magnetic Resonance Imaging Scanners......Page 100
Spectroscopy......Page 101
Physical Characteristics of Ultrasound Waves......Page 102
Production of Ultrasound for Imaging......Page 106
Dynamic Imaging......Page 107
Advantages and Disadvantages......Page 108
References......Page 109
Overview of the radionuclide imaging process......Page 110
Scintillation Gamma Cameras......Page 111
Image Construction......Page 112
Planar Imaging......Page 113
Gamma Camera Performance Characteristics......Page 114
Positron emission tomography scanners......Page 115
Mechanisms of Localisation......Page 117
Production and Quality Control of Radiopharmaceuticals......Page 118
MIBI......Page 119
Somatostatin Receptor Imaging......Page 120
Cardiac Imaging......Page 121
Kidney Imaging......Page 122
Infection Imaging......Page 123
Positron emission tomographic imaging......Page 124
References......Page 126
Introduction......Page 127
Thyroid Cancer......Page 128
Palliation of bone pain......Page 130
Selective internal radiation therapy......Page 131
Radioimmunotherapy......Page 132
Waste Disposal......Page 133
References......Page 134
High-Voltage Circuits......Page 135
Superficial and deep kilovoltage machines......Page 136
Skin and Eye Shielding......Page 137
Grenz kilovoltage machine......Page 138
Brachytherapy and afterloading machines......Page 139
Implanted kilovoltage machine......Page 141
Gamma-ray machine......Page 142
Beam Collimation......Page 143
Design of Gamma-Ray Teletherapy Machines......Page 144
Conclusion......Page 145
References......Page 146
The medical linear accelerator......Page 147
Linear accelerator layout and components......Page 148
X-ray beam......Page 149
Electron beam......Page 151
Stereotactic Ablative Radiotherapy......Page 152
Patient alignment for x-ray and electron therapy......Page 153
Treatment room design for x-ray and electron protection......Page 156
Special techniques with linear accelerators......Page 157
The development of clinical proton and heavier charged particle accelerators......Page 158
Basic Theory of Classic Cyclotron Operation......Page 159
Ion Source Operation......Page 160
Azimuthal Vertical Focussing or Isochronous Cyclotrons......Page 161
Synchrotrons......Page 162
Passive-scattered beams and pencil beam scanning beams......Page 163
Gantries......Page 167
Clinical proton therapy centres......Page 168
Noncircular accelerators......Page 170
Proton Boron Capture Therapy......Page 171
Laser-Induced Proton and Particle Beams......Page 172
Nanoparticle-enhanced therapy......Page 173
Record and verify systems......Page 174
References......Page 175
Introduction......Page 177
Thermoplastic Shells......Page 178
Stereotactic Frames......Page 179
Volume definitions......Page 180
Physical simulation......Page 181
Virtual simulation......Page 182
Multimodality images for planning......Page 184
Image-Guided Radiotherapy......Page 185
References......Page 186
Introduction......Page 187
The Planning CT......Page 188
Beam modelling and dose calculations for  external MV photon beam treatment planning......Page 189
Modelling of the Source of Radiation......Page 190
Explicit Dose Modelling......Page 191
Point Kernel Models......Page 192
Factor-Based Approaches......Page 194
Isodose Distributions......Page 195
Dose Volume Histograms......Page 196
Clinical Use and Limitations of Dose Volume Histograms......Page 197
Other Tools......Page 198
Forward Planning With Standard Beam Arrangements......Page 199
Beams Weighted in 2:1 Ratio......Page 200
Pelvis Plans......Page 201
Thorax Plans......Page 202
Phased Treatments......Page 203
Forward-Planned Intensity-Modulated Radiotherapy......Page 205
Intensity-Modulated Radiotherapy With Fixed Beam Configurations......Page 206
Tomotherapy......Page 207
Total-Body Irradiation......Page 208
Stereotactic treatment planning......Page 209
Energy and Depth-Dose Characteristics......Page 210
Patient Contour Effects......Page 211
Arcing Electron Treatment......Page 212
Proton and heavy-ion therapy......Page 213
Treatment Planning System Commissioning and Performance Testing......Page 214
Plan-Specific Quality Assurance......Page 215
References......Page 216
Benefits and Hazards of Computerisation......Page 218
Network Layer: Addressing......Page 219
DICOM......Page 220
DICOM Data Objects......Page 221
Curves, Annotations and Overlays......Page 222
Archive......Page 223
References......Page 224
The quality control required......Page 225
Measurement and uncertainty......Page 226
Performance improvement......Page 227
The radiotherapy process......Page 228
Virtual Simulation......Page 229
Measurement Equipment......Page 230
Gamma Index......Page 231
Quality control scheduling for megavoltage machines......Page 232
References......Page 233
Introduction: what is quality?......Page 234
1. Customer Focus......Page 235
7. Relationship Management......Page 236
Clause 4 Context of the Organisation......Page 237
Clause 8 Operation......Page 238
Risk Management......Page 239
Clinical Incidents......Page 241
Audit......Page 242
Patient-Focussed Care......Page 245
Implementation of new technology and new techniques......Page 246
References......Page 247
Section 2......Page 250
Cancer in the United States......Page 251
Survival and cure in cancer......Page 252
Tobacco......Page 253
Radon......Page 254
Breast......Page 255
Screening......Page 256
Cervix......Page 257
Head and Neck......Page 258
Leukaemia......Page 259
Reducing Tobacco Smoking......Page 260
Occupational Exposure......Page 261
Chemoprevention......Page 262
Further reading......Page 263
Growth Disorders......Page 264
Progression......Page 265
Blood Vessels......Page 266
Asbestos......Page 267
Precancerous lesions......Page 268
Functional Effects......Page 269
Across Cavities (Transcoelomic)......Page 270
TNM Classification......Page 271
Histological grading: differentiation......Page 272
Classification of neoplasms......Page 273
Undifferentiated Tumours......Page 274
Current advances in pathology guiding patient management......Page 276
Further reading......Page 277
Ionising radiation, free radical generation, subcellular radiogenic damage......Page 278
Epigenetic Radiation Signalling Mechanisms......Page 280
Tumour Hypoxia, Oxygen Effect and Reoxygenation......Page 282
Patterns of Cell Death After Irradiation......Page 284
Models of Radiation Cell Survival......Page 285
The Tolerance of Normal Tissues......Page 286
Heavy Particle Radiotherapy......Page 287
Molecular Studies......Page 288
Further reading......Page 289
Introduction......Page 290
Operability......Page 291
Palliative Surgery......Page 292
Radiotherapy Methods......Page 293
Support Services......Page 294
Pain Control......Page 295
Further reading......Page 296
Development and Testing of Anticancer Agents......Page 297
Principles of cytotoxic therapy......Page 298
Route of administration......Page 299
Folate Antagonists......Page 300
Pyrimidine Antagonists......Page 302
Mitotic Inhibitors......Page 303
Platinum Analogues......Page 304
Aromatase Inhibitors......Page 305
Targeted Therapies......Page 306
Poly(ADP-Ribose) Polymerase Inhibitors......Page 307
Immune Checkpoint Inhibitors......Page 308
Further reading......Page 309
Ultraviolet Radiation......Page 310
Basal Cell Naevus Syndrome (Gorlin Syndrome)......Page 311
Basal Cell Carcinoma......Page 312
Keratoacanthoma......Page 314
Medical Treatment of Basal Cell Carcinomas......Page 315
Radiotherapy for Keratinocyte Skin Cancers......Page 317
Superficial X-Ray Treatment......Page 318
Lentigo Maligna Melanoma......Page 321
Stage and Prognosis......Page 322
Management of Melanoma......Page 325
Management of recurrent or metastatic melanoma......Page 326
Role of radiotherapy in malignant melanoma......Page 327
Skin sarcoma......Page 328
Skin appendage tumours......Page 330
Further reading......Page 331
Aetiology......Page 333
Investigation......Page 335
Palliative Radiotherapy......Page 336
Definitive Radiotherapy......Page 337
What Is Intensity Modulated Radiotherapy?......Page 338
Treatment Planning in Intensity Modulated Radiotherapy......Page 339
The Scope of Intensity Modulated Radiotherapy in Head and Neck Tumours......Page 340
Definitive Radiotherapy......Page 342
Chemotherapy in the palliative setting......Page 343
Acute Toxicity......Page 344
Further reading......Page 345
Chapter 22: Sino-Nasal, Oral, Larynx and Pharynx Cancers......Page 347
Incidence of Nasopharyngeal Tumours......Page 348
Treatment......Page 349
Follow-up......Page 350
Anatomy......Page 351
Radiotherapy Technique......Page 353
Staging System for Paranasal Sinus Tumours......Page 355
Signs and Symptoms......Page 356
Complications......Page 357
Staging System for Oral Cavity and Lip Carcinoma (TNM, 8th Edition)......Page 358
Signs and Symptoms......Page 359
Diagnosis and Staging......Page 360
Treatment Lip Cancers......Page 361
Cancers of Oral Cavity......Page 362
Inferior Wall......Page 363
Signs and Symptoms......Page 364
Tonsillar Tumours......Page 365
Large Tonsillar Tumours and Other Oropharyngeal Tumours......Page 366
Anatomy......Page 367
Staging System for Laryngeal Cancer (TNM, 8th Edition)......Page 368
Diagnosis and Staging......Page 369
Bulky T2 and T3 Glottic and Supraglottic Tumours  (Fig 22.64)......Page 370
Postoperative Radiotherapy......Page 371
Radiotherapy Technique......Page 373
Follow-up......Page 376
Further Reading......Page 377
Aetiological factors......Page 378
Presentation, diagnosis and patient pathway......Page 379
Differentiated thyroid cancer......Page 380
Surgery......Page 381
Radioiodine Ablation......Page 382
Medullary thyroid cancer......Page 383
As Adjuvant Treatment......Page 384
Low Dose Palliation......Page 385
Radiotherapy for Thyroid Lymphoma......Page 387
Further Reading......Page 388
Epidemiology......Page 389
Diagnostic Evaluation......Page 390
Neoadjuvant Chemoradiation......Page 391
External Beam Radiation......Page 392
Pathology......Page 394
Perioperative (Neoadjuvant and Adjuvant) Chemotherapy......Page 395
Anatomy......Page 396
Surgery......Page 397
Management of Locally Advanced Pancreatic Cancer......Page 398
Supportive Care for Symptom Palliation......Page 399
Locoregional Treatments......Page 400
Principles of Radiation Delivery......Page 401
Future perspectives......Page 402
Aetiology......Page 403
Staging Systems......Page 404
Radiotherapy and Colon Cancer......Page 405
Organs at Risk......Page 406
Diagnostic Work-Up and Staging......Page 407
Target definition......Page 408
Palliative Treatment......Page 409
Gastrointestinal Stromal Tumours......Page 410
References (hepato-biliary,  colo-rectal  and anal cancer)......Page 411
Paraneoplastic Syndromes......Page 413
Diagnosis and Staging......Page 414
Screening......Page 415
Technique......Page 416
Combined treatment chemoradiation......Page 417
Acute reactions......Page 418
Chemotherapy......Page 419
Prophylactic cranial irradiation......Page 420
Natural History......Page 421
Management......Page 422
Further Reading......Page 423
Chapter 26: Breast Cancer......Page 424
High-risk mutations......Page 425
Ionising radiation......Page 426
Multidisciplinary management of breast cancer......Page 427
Breast Ultrasound......Page 428
Staging......Page 429
Staging Investigations......Page 430
Management of ductal carcinoma in situ......Page 431
Role of postoperative radiotherapy for ductal carcinoma in situ......Page 432
Axillary Node Status......Page 433
Endocrine Therapy......Page 434
Lobular Cancer......Page 435
Regional nodal irradiation......Page 436
After Breast-Conserving Surgery......Page 438
Following Mastectomy......Page 439
Indications for postmastectomy radiotherapy......Page 440
Respiratory gated radiotherapy......Page 441
Chest wall and breast......Page 442
The chest wall......Page 443
Dosimetry......Page 444
Boost to the primary tumour volume after whole breast irradiation......Page 445
Partial Breast Irradiation......Page 446
Intraoperative Radiotherapy......Page 447
Brachial Plexopathy......Page 449
Rationale......Page 450
Adjuvant Endocrine Therapy......Page 451
Aromatase Inhibitors......Page 452
Adjuvant Hormonal Therapy After 5 Years of Tamoxifen......Page 453
Neoadjuvant Chemotherapy......Page 454
HER2 Positive Breast Cancer......Page 455
Choice of Systemic Therapy......Page 459
Bone metastases: prevention and treatment......Page 460
Menopausal Status and Hormone Receptor Status......Page 461
Cytotoxic Therapy......Page 462
Combination Chemotherapy and Anti-HER2 Therapy......Page 464
Bone Marrow Involvement......Page 465
Follow-up......Page 466
Breast cancer in pregnancy......Page 467
Further Reading......Page 468
Pathology of Cervical Cancer......Page 469
Symptoms and Investigations of Cervical Cancer......Page 470
Treatment of Stage I Disease......Page 473
External Beam Radiotherapy......Page 474
Brachytherapy......Page 475
Future Trends......Page 476
Carcinoma of endometrium......Page 477
Other Treatment Modalities......Page 478
Investigations and Staging......Page 479
Radiotherapy......Page 480
Tumours of the vagina and vulva......Page 481
Further Reading......Page 482
Spread......Page 483
Investigation and Staging......Page 484
Tyrosine Kinase Inhibitors......Page 485
Microscopic Appearance......Page 486
Superficial Tumours Ta, Tis and T1......Page 487
Concurrent Chemotherapy and Radiotherapy......Page 488
Pathology......Page 490
Diagnosis and Staging......Page 491
Dose escalation and intensity-modulated radiotherapy......Page 492
Prostate brachytherapy - low-dose rate seeds......Page 493
Pelvic Lymph Node Irradiation......Page 494
Salvage Radiotherapy......Page 495
Anatomy......Page 496
Clinical Features......Page 497
Diagnosis and Staging......Page 498
Late reactions......Page 499
Toxicity......Page 500
Staging......Page 501
Management of regional nodes......Page 502
Further Reading......Page 503
Aetiology and Epidemiology......Page 504
Extranodal non-Hodgkin´s lymphoma......Page 505
Initial Management......Page 506
Indolent non-Hodgkin´s lymphoma......Page 507
Clinical Features......Page 508
Acute Leukaemia......Page 509
Myeloproliferative Disorders......Page 510
Indolent Lymphoma: Follicular and Marginal Zone......Page 511
Extra-Nodal Sites......Page 512
Waldeyer\'s ring.......Page 513
Bone......Page 514
Thyroid......Page 515
Rib deposits......Page 516
Chemotherapy Regimens and Toxicities......Page 517
CTD......Page 518
Further Reading......Page 519
Chapter 30: Tumours of the Central Nervous System......Page 520
Tissues of the Brain......Page 521
Anatomy of the Cerebrospinal Fluid Pathways and Hydrocephalus......Page 522
Anatomy of the Skull and Meninges......Page 523
Principles of Neurosurgery......Page 524
Principles of Radiotherapy Planning for Central Nervous System Tumours......Page 525
Normal Tissue Tolerance to Radiotherapy......Page 526
Pathology and Clinical Features......Page 527
Treatment......Page 528
Late......Page 529
Elderly Patients......Page 530
Pathology and Clinical Features......Page 531
Pathology and Clinical Features......Page 532
Pathology and Clinical Features......Page 533
Clinical Features and Management Principles......Page 534
Treatment......Page 535
Side Effects......Page 536
Target Volume......Page 537
Target Volume......Page 538
Pathology and Clinical Features......Page 539
Side Effects......Page 540
Results of Treatment......Page 541
Results of Treatment......Page 542
Patients With One to Three Brain Metastasis......Page 543
Management Principles......Page 544
Further Reading......Page 545
Principles of radiotherapy to the eye......Page 549
The Cornea and Lacrimal Apparatus......Page 550
Thyroid Eye Disease......Page 551
Skin Cancers Involving the Eyelid......Page 552
Lymphoma......Page 553
Ocular Melanoma......Page 554
Retinoblastoma......Page 555
Further reading......Page 556
Pathology......Page 557
Triple Assessment......Page 558
Staging Investigations......Page 559
Surgery......Page 560
Retroperitoneal Sarcomas......Page 561
Gross tumour volume......Page 562
Proton Therapy......Page 563
Clinical Features......Page 564
Chemotherapy......Page 565
Treatment......Page 566
Dose and energy......Page 567
Undifferentiated pleomorphic sarcoma of bone......Page 568
Treatment......Page 569
Further reading......Page 570
Introduction......Page 571
Central Nervous System......Page 572
Leukaemia......Page 573
Total Body Irradiation......Page 574
Neuroblastoma......Page 575
Rhabdomyosarcoma......Page 576
Osteosarcoma......Page 579
Low-Grade Astrocytoma......Page 580
Brainstem Glioma......Page 582
Embryonal Tumours......Page 583
Management of Germinoma......Page 584
Craniopharyngioma......Page 589
Further reading......Page 590
Assessment of individual patient and carer needs......Page 591
Skin reactions......Page 592
Nutrition......Page 593
Psychosocial issues......Page 594
Communication......Page 595
Information......Page 596
Complementary therapies......Page 597
Further reading......Page 598
Pleural Effusions......Page 600
Venous Thrombosis......Page 601
Infection......Page 602
Further reading......Page 603
Physical Characteristics of Proton Beams......Page 604
Passively Scattered Proton Beams......Page 605
Sources of Physical and Biological Uncertainties......Page 606
Proton beam therapy in children, teenagers and young adults......Page 607
Retinoblastoma......Page 608
Proton beam therapy for adult cancers......Page 609
Paraspinal Tumours and Sarcomas......Page 610
Conclusions and future directions......Page 611
Further reading......Page 612
Index......Page 614