The first text to focus solely on quality and safety in radiotherapy, this work encompasses not only traditional, more technically oriented, quality assurance activities, but also general approaches of quality and safety. It includes contributions from experts both inside and outside the field to present a global view. The task of assuring quality is no longer viewed solely as a technical, equipment-dependent endeavor. Instead, it is now recognized as depending on both the processes and the people delivering the service. Divided into seven broad categories, the text covers:

• Quality Management and Improvement includes discussions about lean thinking, process control, and access to services.
• Patient Safety and Managing Error looks at reactive and prospective error management techniques.
• Methods to Assure and Improve Quality deals broadly with techniques to monitor, assure, and improve quality.
• People and Quality focuses on human factors, changing roles, staffing, and training.
• Quality Assurance in Radiotherapy addresses the general issues of quality assurance with descriptions of the key systems used to plan and treat patients and includes specific recommendations on the types and frequencies of certain tests.
• Quality Control: Equipment and Quality Control: Patient-Specific provides explicit details of quality control relating to equipment and patient-specific issues.

Recently, a transformation of quality and safety in radiotherapy has begun to take place. Among the key drivers of this transformation have been new industrial and systems engineering approaches that have come to the forefront in recent years following revelations of system failures. This book provides an approach to quality that is long needed, one that deals with both human and technical aspects that must be the part of any overall quality improvement program.

This book concisely reviews important advances in radiation oncology, providing practicing radiation oncologists with a fundamental understanding of each topic and an appreciation of its significance for the future of radiation oncology. It explores in detail the impact of newer imaging modalities, such as multiparametric magnetic resonance imaging (MRI) and positron emission tomography (PET) using fluorodeoxyglucose (FDG) and other novel agents, which deliver improved visualization of the physiologic and phenotypic features of a given cancer, helping oncologists to provide more targeted radiotherapy and assess the response. Due consideration is also given to how advanced technologies for radiation therapy delivery have created new treatment options for patients with localized and metastatic disease, highlighting the increasingly important role of image-guided radiotherapy in treating systemic and oligometastatic disease. Further topics include the potential value of radiotherapy in enhancing immunotherapy thanks to the broader immune-stimulatory effects, how cancer stem cells and the tumor microenvironment influence response, and the application of mathematical and systems biology methods to radiotherapy.

Current cancer therapies are focused on three general strategies: modifying intrinsic radiosensitivity via molecular targeting, manipulating microenvironmental factors to enhance tumor susceptibility to radiation, and improving delivery of radiation to critical tumor locations while sparing normal tissues. The goal of this volume is to describe a number of promising approaches corresponding to each strategy. In general, research in radiation oncology tends to be siloed into fundamental biology, physics or treatment delivery. The strategies for improving therapeutic ratio encompassed in this book will involve each of these components of radiation oncology. Thus, they will illustrate the variety of disparate approaches available for potentially improving the efficacy of radiotherapy, which may then stimulate discussion across disciplines and foster further translational investigations. Although a goal of each chapter will be to highlight advances within an approach, of equal importance will be the delineation of barriers to successful clinical application and how to overcome or minimize such impediments. Along these lines, because therapeutic ratio incorporates both tumor and normal tissue radio response, a point of emphasis will be the mechanistic rationale for selectively modifying tumor (sensitization) or normal cells (protection). Finally, whereas the literature is replete with studies describing potential targets/strategies for increasing the therapeutic ratio for radiotherapy, this book will focus on those supported by in vivo data consistent with impending translational application along with those that are already being evaluated in the clinic.

This book provides a comprehensive overview of the approach to retroperitoneal sarcomas, rare and challenging tumors requiring highly specialized, multidisciplinary management. Based on an updated review of the literature and drawing on the expertise of respected authors, it analyzes key topics - such as pre-operative work-up and staging, multimodal therapy, multi-organ resection, surgical complications and management of local recurrence and advanced disease - as well as several other debated issues. Presenting surgery as the cornerstone in the treatment of this disease, the book serves both as a guide for non-expert physicians wishing to understand the best management of RPS patients, including the need to refer them to specialized centers, and as a state-of-the-art overview for surgeons with interest in sarcoma surgery.

This well-received book, now in its fifth edition, is unique in providing a detailed examination of the technological basis of radiation therapy. Another unique feature is that the chapters are jointly written by North American and European authors. This considerably broadens the book's contents and increases its applicability in daily practice throughout the world. The book is divided into two sections. The first section covers basic concepts in treatment planning and explains the various approaches to radiation therapy, such as intensity-modulated radiation therapy, tomotherapy, stereotactic radiotherapy, and high and low dose rate brachytherapy. The second discusses in depth the practical clinical applications of the different radiation therapy techniques in a wide range of cancer sites. All chapters have been written by leaders in the field. This book will serve to instruct and acquaint teachers, students, and practitioners with the basic technological factors and approaches in radiation therapy.

The average physician and even cancer care-givers are not knowledgeable about the effects of cancer treatment on sex and reproductive life. They are even less aware of the options available for treatment of such patients. Cancer and Sexual Health fills a great need for a reference work devoted to the link between cancer and human sexuality. The volume is designed to give a comprehensive and state-of-the-art review of the sexual and reproductive consequences of cancer diagnosis and treatment. It will prove an invaluable resource for those clinicians caring for cancer patients as well as acting as a reference text for the sexual medicine clinician who may not see a large number of cancer patients.

Recent advances in the treatment of gynecologic malignancies led to a new worldwide consensus to introduce image guidance to gynecologic radiation therapy, particularly to brachytherapy. The book summarizes the changed practice of management: treatment planning for cervical cancer, not modified for over 60 years, has been shifted to an image-based approach, endometrial cancer management with an increase in the use of chemotherapy and vaginal brachytherapy, and vaginal cancer therapy including image guidance and high-dose delivery with IMRT.

Tailoring treatment for individual breast cancers is no longer a dream and is now the main goal for current research. This book gives an overview of the most recent techniques, agents and approaches for breast cancer and the individualization of treatment. Particular attention is given to organ-specific tailored approaches, specific populations, patients' preferences and rehabilitation. Contributions from experts focus on the biomedical research behind the transfer of molecular biology knowledge into the clinical management of patients. This has led to increased survival as well as improved quality of life. The book gives an overview of the latest achievements in breast cancer and their use in clinical practice.

Anemia, a frequent complication of cancer and its treatments, produces unwanted symptoms and significantly impairs metabolic and physiologic functions, as well as patients' activity, quality of life and even life expectancy. In its new Second Edition, this book presents current knowledge on anemia in cancer and its treatment with Recombinant Human Erythropoietin (rhEPO). Expanded, updated and newly added chapters describe scientific and clinical aspects of anemia, and give diagnostic and therapeutic recommendations on use of rhEPO. This is an essential source of information for radiotherapists, medical oncologists, hematologists, internists, pediatricians, surgeons, specialists in transfusion and laboratory medicine, and pharmacologists.

Authors and Co-Authors of Volume 4 Preface Contents of Volume 1, 2, and 3 PART I. COLORECTAL CANCER 1. INTRODUCTION: COLORECTAL CANCER M.A. Hayat INTRODUCTION Screening for Colorectal Cancer Treatment Rectal Cancer REFERENCES A. Diagnosis 2. POORLY DIFFERENTIATED COLORECTAL ADENOCARCINOMA: (METHODOLOGY) Seiichi Shinji, Zenya Naito, Toshiyuki Ishiwata, Yoko Matsuda, Tomoko Seya, and Takashi Tajiri INTRODUCTION HISTOPATHOLOGY IMMUNOHISTOCHEMISTRY FOR DIFFERENTIAL DIAGNOSIS IMMUNOHISTOCHEMISTRY FOR MALIGNANT CHARACATERISTICS OF POORLY DIFFERENTIATED ADENOCARCINOMA IN SITU HYBRIDIZATION FOR MALIGNANT CHARACTERISTICS OF POORLY DIFFERENTIATED ADENOCARCINOMA THERAPY REFERENCES 3. COLORECTAL CANCER: IMMUNOHISTOCHEMICAL; DIAGNOSIS WITH HETEROGENEOUS NUCLEAR RIBONUCLEOPROTEIN K Ayham Alnabulsi, Brian Carpenter, Colin Telfer, and Graeme I. Murray INTRODUCTION BIOMARKERS Approved Biomarkers - Problems Biomarkers of Colorectal Cancer Demand for Colorectal Biomarkers COLORECTAL BIOMARKER HETEROGENEOUS NUCLEAR RIBONUCLEOPROTEIN K Methodology 2D Gel Electrophoresis (2DGE) Semiquantitative Reverse Transcription-Polymerase Chain Reaction Monoclonal Antibody to Heterogeneous Nuclear Ribonucleoprotein K Immunohistochemistry (IHC) RESULTS DISCUSSION FUTURE DIRECTION REFERENCES 4. METASTASES AND RECURRENCE OF COLORECTAL CANCER: DIAGNOSTIC ROLE OF IMMUNOSCINTIGRAPHY Vladimir Obradovic and Vera Artiko INTRODUCTION GENERAL CONSIDERATIONS Radiopharmaceuticals Imaging Systems and Techniques IMMUNOSCINTIGRAPHIC METHODS USED FOR DIAGNOSTICS OF COLORECTAL CANCER Immunoscintigraphy Based onRadiopharmaceuticals Labeled with Radioiodines Immunoscintigraphy Based on Radiopharmaceuticals Labeled with 111In Immunoscintigraphy Based on Radiopharmaceuticals Labeled with 99mTc Comparison of Diagnostic Values of Different Radiopharmaceuticals Immunoscintigraphy and Positron Emission Tomography Radioimmunoguided Surgery CONCLUSION REFERENCES 5. COLORECTAL CANCER DIAGNOSIS USING DNA LEVELS IN BLOOD AND STOOL Emanuela Flamini, Daniele Calistri, Laura Mercatali, Claudia Rengucci and Dino Amadori INTRODUCTION AVAILABLE TESTS AND THEIR COST BENEFITS Fecal Occult Blood Test Flexible Sigmoidoscopy Colonoscopy Barium Enema with Air Contrast Virtual Colonoscopy MOLECULAR MARKERS AND THEIR COST BENEFITS FREE CIRCULATING DNA IN BLOOD Biological Mechanisms of Free Circulating DNA Release Methodological Aspects of Free Circulating DNA Sources and Influence of Pre-Analytical Factors Isolation and Quantification Free Circulating DNA Levels in Colorectal Cancer Diagnosis INTEGRITY OF GENOMIC EXTRACTED DNA FROM STOOL Analysis of Long Fragment DNA in Stool Advantages and Technical Problems CONCLUSIONS REFERENCES 6. COLORECTAL CARCINOMA: IDENTIFICATION OF microRNAs USING REAL-TIME POLYMERASE CHAIN REACTION Eva Bandres, Nerea Bitarte, Natalia Ramirez, Ruth Zarate, and Jesus Garcia-Foncillas INTRODUCTION GENOMICS OF microRNA microRNA BIOGENESIS AND FUNCTION EVIDENCE FOR THE INVOLVEMENT OF microRNA IN CANCER REGULATION OF microRNA EXPRESSION IDENTIFICATION OF microRNA TARGETS: BIOINFORMATIC AND FUNCTIONAL TOOLS TECHNOLOGY TO QUANTIFY microRNAs EXPERIMENTAL WORKFLOW FOR microRNA EXPRESSION BY REAL- TIME POLYMERASE CHAIN REACTION IDENTIFICATION OF DIFFERENTIALLY EXPRESSED microRNA IN COLORECTAL CANCER USING REAL-TIME POLYMERASE CHAIN REACTION Q

This volume presents a detailed survey of cancers. This volume was written by of various methodologies related to diag- 94 oncologists representing 13 countries. nosis, therapy, and prognosis of ovar- Their practical experience highlights their ian cancer, renal cancer, urinary bladder writings, which should build and further cancer, and cervical uterine cancer, while the endeavors of the readers in this imp- the already published Volumes 1-5 detail tant area of disease. The text of each c- similar aspects of breast, lung, prostate, cer type is divided into subheadings for liver, gastrointestinal, colorectal, and bil- the convenience of the readers. It is my iary tract carcinomas. hope that the current volume will join the It is well established that cancer is the preceding volumes of this series for assi- deadliest of human diseases. The follow- ing in the more complete understanding ing estimated global incidence of seven of globally relevant cancer syndromes. types of cancers discussed in this volume There exists a tremendous, urgent demand indicated the seriousness of this malig- by the public on the scientific community nancy. to address cancer prevention, diagnosis, treatment, and hopefully cures. Cervical uterine cancer 493,342 I am grateful to the contributors for their Urinary bladder cancer 357,000 promptness accepting my suggestions. I respect their dedication and diligent work Leukemia 300,522 in sharing their invaluable knowledge with Renal cancer 208,480 the public through this series.

Nuclear Medicine Therapy presents the state of the art in targeted radionuclide therapy, both in clinical practice and contemporary clinical investigation and trials. With contributions from an internationally-distinguished group of physicians and scientists, the book is devoted entirely to the use of nuclear medicine techniques and technology for therapy of malignant and benign diseases. Individual chapters cover the scientific principles and clinical applications of radionuclide therapy and the state of clinical trials of agents currently under investigation in the therapy of tumors involving virtually every organ system. Due to overlapping interest in techniques, indications, and clinical use, the development of radionuclide therapy attracts considerable input from other medical specialists whose collaboration is essential, including radiation and medical oncologists, hematologists, diagnostic radiologists, hepatologists, endocrinologists, and rheumatologists. And because radionuclide therapy is a rapidly evolving field of nuclear medicine, it is the aim of this volume to appeal to all specialists involved in targeted radionuclide therapy and to contribute to the standardization of the practice globally.

Oncological imaging has thoroughly changed in the past decade, especially due to the introduction of PET and 18FDG. In Positron Emission Tomography, expert referring specialists and professional imagers seek to help bridge some of the knowledge gaps in several oncological domains. The book's goal is to aid in the improvement of communicative competences: to communicate scan findings so that the referring specialist receives proper advice from the imager, and that, alternatively, the referring one provides the imager with appropriate clinical details to allow for a proper interpretation, and that the referring specialist is aware of the possibilities and limitations of the requested technology. While it focuses on FDG PET, other radiopharmaceuticals are covered as well, where appropriate. Written for the highly respected Methods in Molecular Biology (TM) series, this volume provides the kind of detailed description and implementation advice that is crucial for getting optimal results. Authoritative and convenient, Positron Emission Tomography serves as an excellent reference for oncologists, surgeons, radiotherapists, radiologists, nuclear medicine physicians, and pathologists desiring a stronger synergy within their vital efforts.

This comprehensive text focuses exclusively on the management of metastatic spinal disease, evaluating the most recent literature and providing patient-centered treatment algorithms. Beginning with initial imaging, classification and clinical decision-making, the spine is approached anatomically from the upper cervical to the sacrum, describing the unique considerations and approaches appropriate to each region, such as laminectomy and stabilization, en bloc spondylectomy and resection and reconstruction. Less invasive and minimally invasive approaches are discussed throughout the text. Radiation therapy modalities and other adjuvant treatments are also discussed, as well as reconstructive flap coverage and the management of complications. The spinal column is the most common site of metastatic cancer, and a multidisciplinary approach is required to provide patients with reasonable management options to prevent and treat the disabling symptoms caused by this debilitating condition. This compendium of experience from thought leaders in the treatment of metastatic spine disease will provide spine surgeons, oncologists, radiation oncologists, physiatrists and palliative care specialists with up-to-date information to guide their patients through the multidisciplinary management of metastatic spinal disease.

This book is a comprehensive review and study aid for radiation therapists. Organized in a question-and-answer format, it present clinical features and principles of treatment. Topics include radiation therapy physics, radiobiology, treatment and simulation equipment, principles of patient care, clinical components of cancer care, and cancers of the brain, head and neck region, and respiratory, digestive, urinary, and male and female reproductive systems. It offers over 500 multiple-choice questions with detailed answers and rationales. Radiation Therapy Study Guide is a valuable resource for radiation therapists preparing for certification examinations as well as for practicing therapists in need of a review.

Patient Surveillance After Cancer Treatment covers the history of cancer patient surveillance after curative-intent treatment, the rationale, the methodologies used in the past and at present, the methodologies that will probably emerge in the future, the costs of surveillance, the definitions of various terms used in the field, and how those who are interested in the topic can get more information about it from the internet. The secondary focus of the book is to publicize the need for well-designed, adequately powered randomized clinical trials comparing two (or more) surveillance strategies for each type of cancer. The audience includes all oncologists, cancer researchers, medical economists and policy makers in government and insurance companies, and finally, interested patients. This book is part of the Current Clinical Oncology series, which provides cutting-edge knowledge of cancer diagnosis, management, and treatment. World renowned experts share their insights in all the major fields of clinical oncology. From the fundamentals of pathophysiology to the latest developments in experimental and novel therapies, Current Clinical Oncology is an indispensable resource for today's practicing oncologist.

-Richly illustrated; 109 illustrations, 57 in color -Cover a wide range of diagnostic and theraputic techniques, i.e. MRI, PET, surgical treatment, radiation therapy

Because of the current progress in molecular medicine (genomics, proteomics), a plethora of new and often human-specific targets are being identified. These targets often play a significant role in the pathogenesis of diseases, and identifying them offers the potential for early diagnosis and intervention. An early in vivo validation of specific ligands binding to these targets in humans is needed to as- sess their potential for targeted imaging and radiotherapy. Further- VI Preface more, such validation studies may allow for a better understanding of the molecular processes underlying phannacologic activity and therefore for a more successful development of phannaceuticals in general. The purpose of the Ernst Schering Research Foundation (ESRF) Workshop 48 was to provide a forum for an open exchange on the state of the art in the early development of such radiophanna- ceuticals. Experts from academia, industry, and regulatory authori- ties were invited to give presentations on aspects covering the identi- fication of targets, preclinical studies on the safety of ligands, as well as their validation in human clinical trials. It was our intention to cover both the opportunities and the challenges that scientists in this field are facing. Radiopharmaceuticals are uniquely suitable for the above-men- tioned target validation studies.

Since the incidence of skin neoplasms is constantly increasing as the population ages, there is a need for a monograph about radiation treatment of skin neoplasms and diseases. Excellent cosmetic and functional results can be shown with this treatment modality. This book comprehensively examines the indications for radiation therapy of cutaneous cancers, pre-cancerous lesions and benign dermatological disorders. The monograph provides concise introduction to physical and radiobiological principles, selection of radiation factors, dose definitions, as well as radiation reactions and risk assessments. Specific indications for radiotherapy of cutaneous neoplasms and radiation protection measures are discussed. Topics include radiation therapy of basal cell carcinoma, squamous cell carcinoma, lymphomas, Kaposi's sarcoma, Lentigo maligna melanoma, and Merkel cell tumor. A separate chapter discusses the skin reactions after nuclear accidents. Major scientific publications of the past 10 years are reviewed.

Rectal Cancer: International Perspectives on Multimodality Management is a timely analysis of the diagnosis, staging, pathology, and therapy of cancer of the rectum. This book is intended as a useful resource for physicians, scientists, medical students, and allied health personnel in the disciplines of radiology, gastroenterology, surgical oncology, medical onc- ogy, radiation oncology, and pathology. Renowned contributors from different medical d- ciplines have written their chapters in a thoughtful, provocative, and visual fashion. Importantly, these chapters highlight the controversies in the diagnostic, staging, and the- peutic management of patients with rectal cancer while providing practical management recommendations. This book is divided into 18 chapters. Early chapters address the diagnosis and staging of rectal cancer, highlighting the critical role of contemporary imaging in guiding treatment. The remaining chapters focus on the multimodality management of rectal cancer from the vantage points of surgery, pathology, chemotherapy, and radiation therapy. The major dev- opments in surgery are reviewed first, including contemporary roles of local excision, total mesorectal excision, lateral pelvic lymph node dissection, organ preservation approaches, as well as the management of advanced, recurrent, and metastatic disease. Following is a ch- ter describing the pathologic evaluation of rectal cancer specimens, with emphasis on proper methodology and its clinical relevance to overall disease management. The final chapters review the contemporary roles of chemotherapy (including with radiation therapy, adjuvant and neoadjuvant settings without radiation therapy, as well as in metastatic disease) as well as radiation therapy (including adjuvant and neoadjuvant approaches, short vs.

Multiple myeloma is the second most common hematologic malignancy and c- rently affects approximately 50,000 people in the United States. Each year about 20,000 people are diagnosed with myeloma. Although new treatments have been developed, which signi?cantly prolong the survival of patients, myeloma bone d- ease still remains a major cause of severe morbidity and increased mortality in patients with myeloma. Myeloma bone disease is characterized by "punched out" lytic lesions caused by increased osteoclastic bone destruction accompanied by suppressed or even absent osteoblast activity. Advances in our understanding of both the pathophysiology of myeloma bone disease and the development of novel agents that target speci?c pathways involved in both the increased osteoclast f- mation and the suppressed osteoblast activity in myeloma provide new hope for these patients. The treatment of myeloma bone disease was revolutionized by cl- ical trials that demonstrated the signi?cant bene?t of intravenous bisphosphonate therapy in patients with myeloma bone disease. With the identi?cation of many of the cytokines and chemokines involved in myeloma bone disease, novel th- apies such as denosumab that blocks RANKL activity, anti-DKK1, which targets the inhibition of osteoblast activity by blocking Wnt signaling inhibition, and the potential anabolic effects of agents such as bortezomib and activin have greatly improved our potential to block the progression or reverse myeloma bone disease.

The scientific and clinical foundations of Radiation Therapy are cross-disciplinary. This book endeavours to bring together the physics, the radiobiology, the main clinical aspects as well as available clinical evidence behind Radiation Therapy, presenting mutual relationships between these disciplines and their role in the advancements of radiation oncology.

by Professor J. H. Middlemiss, Department of Radiodiagnosis, The Medical School, University of Bristol This book, for so long and so deservedly, has been a favourite and reliable guide for any person undergoing training in diagnostic radiology whether that person be doctor or technician. This new, largely re-written edition is even more comprehen sive. And yet throughout the book simplicity of presentation is maintained. Professor G. J. van der Plaats has been well known to radiologists in the English speaking world for more than three decades. He has been, and still is, respected by them for his vision, his thoroughness, determination and meticulous attention to detail and for his unremitting enthusiasm. The standard of radiography in the Netherlands throughout this period has been recognised as being of the highest quality, and this has, in no small measure, been due to the pattern set by Professor van der Plaats and his colleagues."

In this issue of Neuroimaging Clinics, guest editors Drs. Pejman Jabehdar Maralani and Sean Symons bring their considerable expertise to the topic of Neurotrauma. Top experts in the field cover key topics such as conventional MRI in trauma management in adults and children; imaging approach to concussion; clinical updates on concussion; the current state of DWI/DTI for trauma prognostication; the current state of fMRI/rs-fMRI for trauma prognostication; and more. Contains 13 relevant, practice-oriented topics including MRI perfusion in traumatic brain injury; traumatic brain injury and vision; traumatic brain injury and cerebrovascular reactivity; SWI / qSM in traumatic brain injury; imaging of non-accidental trauma in children; advances in MRI related to TBI management; and more. Provides in-depth clinical reviews on neurotrauma, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.