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."

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.

The book is divided into two parts: Part I deals with the relevant physics and planning algorithms of protons (H Breuer) and Part II with the radiobiology, radiopathology and clinical outcomes of proton therapy and a comparison of proton therapy versus photon therapy (BJ Smit). Protons can be used for radiosurgery and general radio therapy. Since proton therapy was first proposed in 1946 by Wilson, about sixteen facilities have been built globally. Only a very few of these have isocentric beam delivery systems so that proton therapy is really only now in a position to be compared directly by means of randomised clinical trials, with modern photon radiotherapy therapy sys tems, both for radiosurgery and for general fractionated radiotherapy. Three-dimensional proton planning computer systems with image fusion (image of computerised tomography (CT), magnetic resonance registration) capabilities imaging (MRI), stereotactic angiograms and perhaps positron emission tomography (PET) are essential for accurate proton therapy planning. New planning systems for spot scanning are under development. Many of the older comparisons of the advantageous dose distributions for protons were made with parallel opposing or multiple co-planar field arrangements, which are now largely obsolete. New comparative plans are necessary once more because of the very rapid progress in 3-D conformal planning with photons. New cost-benefit analy ses may be needed. Low energy (about 70 MeV) proton therapy is eminently suitable for the treatment of eye tumours and has firmly established itself as very useful in this regard."

Computers have had and will continue to have a tremendous impact on professional activity in almost all areas. This applies to radiological medicine and in particular to radiation therapy. This book compiles the most recent developments and results of the application of computers and computer science as presented at the XIIIth International Conference on the Use of Computers in Radiation Therapy in Heidelberg, Germany. The text of both oral presentations and posters is included. The book is intended for computer sientists, medical physicists, engineers and physicians in the field of radiation therapy and provides a comprehensive survey of the entire field.

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.

A comprehensive description of the current treatment modalities, and while special attention is paid to the role of radiotherapy, established alternative radical surgical procedures and the newer chemotherapeutic regimens are also considered in detail. Devoted entirely to female genital cancers, the book is written by internationally recognised experts from Europe, the United States, and Japan, who all have extensive experience of the special entities involved. Close to 200 tables present the impressive amount of data contributed by the authors in a clear manner and no attempt is made to avoid controversies concerning adequate treatment.

This volume is based on the LENT V NCI-sponsored meeting held in May 2004 and the CURED I Conference in 2006. Written by experts in the field, it addresses a critical topics relating to late effects, such as mechanisms of injury, the role of screening, options for interventions, second malignancies, and prevention. It is hoped that these findings will help readers to prevent and treat the long-term side-effects of irradiation.

Imaging is a critical component in the delivery of radiotherapy to patients with malignancy, and this book teaches the principles and practice of imaging specific to radiotherapy. Introductory chapters outline the basic principles of the available imaging modalities including x-rays, CT, ultrasound, MRI, nuclear medicine, and PET. Site specific chapters then cover the main tumour sites, reviewing optimal imaging techniques for diagnosis, staging, radiotherapy planning, and follow-up for each site. The important areas of radiation protection, exposure justification, and risks are also covered, exploring issues such as balancing radiation exposure with long-term risks of radiation effects, such as second cancer induction. This second edition has been fully revised and updated to reflect current techniques, and includes two brand new chapters on imaging for radiotherapy treatment verification, and the role of specialist MRI techniques and functional imaging for radiotherapy planning. With insights from experts in each field and over 200 illustrations, this comprehensive and easy-to-read guide will be an invaluable resource for radiation oncologists, clinical oncologists, and radiotherapists, both qualified and in training. ABOUT THE SERIES Radiotherapy remains the major non-surgical treatment modality for the management of malignant disease. It is based on the application of the principles of applied physics, radiobiology, and tumour biology to clinical practice. Each volume in the series takes the reader through the basic principles of the use of ionizing radiation and then develops this by individual sites. This series of practical handbooks is aimed at physicians both training and practising in radiotherapy, as well as medical physics, dosimetrists, radiographers, and senior nurses.

This new volume in the Radiotherapy in Practice series provides a comprehensive and evidence-based guide to radiotherapy in the management of children and young people with cancer. It explains the roles of the various modalities of treatment available, including image-guided and intensity modulated radiotherapy, brachytherapy, proton beam therapy, and molecular radiotherapy, and aids selection of the most appropriate technique in different situations. Each cancer type in children is explored, including diagnostic investigations, risk stratification, multi-modality approaches to treatment, and decision making with regard to radiotherapy. Specific guidance is given for the planning and prescription of radiotherapy for infants, children, and teenagers. The authors also identify the need for specialist paediatric radiotherapy service provision, and the wider requirements for radiotherapy in children, including consent, immobilisation, anaesthesia, multi-professional team working, and play specialist support. With over 75 colour illustrations, case histories to demonstrate the various approaches, and a carefully selected guide to further reading on each topic, this practical volume will be a valuable resource for physicians and trainees in radiotherapy and clinical oncology, and to nurses, radiographers and other allied health professionals who come into contact with young patients receiving radiotherapy. ABOUT THE SERIES Radiotherapy remains the major non-surgical treatment modality for the management of malignant disease. It is based on the application of the principles of applied physics, radiobiology, and tumour biology to clinical practice. Each volume in the series takes the reader through the basic principles of the use of ionizing radiation and then develops this by individual sites. This series of practical handbooks is aimed at physicians both training and practising in radiotherapy, as well as medical physics, dosimetrists, radiographers, and senior nurses.

External beam therapy is the most common form of radiotherapy, delivering ionizing radiation such as high-energy x-rays, gamma rays, or electron beams directly into the location of the patient's tumour. Now in its third edition, this book is an essential, practical guide to external beam radiotherapy planning and delivery, covering the rapid technological advances made in recent years. The initial chapters give a detailed insight into the fundamentals of clinical radiotherapy. This is followed by systematic details for each tumour site commonly treated with radiotherapy, covering indications, treatment, and planning. The final chapter covers the all important aspect of quality assurance in radiotherapy delivery. This third edition has been fully updated and revised to reflect new techniques, including details of intensity modulated radiotherapy (IMRT), image guided radiotherapy (IGRT), stereotactic body radiotherapy (SBRT), and proton therapy. Written by experts in each field, External Beam Therapy is an invaluable companion to professionals and trainees in medical physics, therapeutic radiology, and clinical or radiation oncology. ABOUT THE SERIES Radiotherapy remains the major non-surgical treatment modality for the management of malignant disease. It is based on the application of the principles of applied physics, radiobiology, and tumour biology to clinical practice. Each volume in the series takes the reader through the basic principles of the use of ionizing radiation and then develops this by individual sites. This series of practical handbooks is aimed at physicians both training and practising in radiotherapy, as well as medical physics, dosimetrists, radiographers, and senior nurses.

Sonography has emerged as a substantial diagnostic tool today. This handbook aims to cover ultrasound physics, abdominal and obstetric sonography, color Doppler, high resolution sonography and USG guided interventions with multiple choice questions and case reports for practical orientation.

Brachytherapy remains an important component of radical radiation therapy in the modern management of cancer. Widespread adoption of remote afterloading now enables brachytherapy to be delivered with minimum exposure to staff and other patients. Technical advances in imaging and computing power have improved the precision of implantation and complex dosimetry can now be achieved in routine practice. The advantages of direct placement of the radiation source into the area to be treated, overcoming the problems of patient and organ movement, together with the dosimetric advantages inherent in brachytherapy, will ensure that modern brachytheraoy continues to provide the optimal means of delivering accurate high does radiation therapy for many patients.
Fully updated for the second edition, this book provides practical guidance on the use of brachytherapy. Each chapter gives the reader a solid background in the physics and dosimetry of the technique, followed by practical information on its use in common disease sites. Whilst low, medium, and high dose rate techniques are covered, emphasis is placed on high dose rate afterloading techniques which are likely to replace most other forms of brachytherapy in the future.
ABOUT THE SERIES:
Radiotherapy remains the major non-surgical treatment modality for the management of malignant disease. It is based on the application of the principles of applied physics, radiobiology, and tumour biology to clinical practice. Each volume in this series takes the reader through the basic principles of the use of ionising radiation and then develops this by individual sites. This series of practical handbooks are aimed at physicians both training and practising in radiotherapy, as well as medical physicists, dosimetrists, radiographers and senior nurses.

Radioisotope therapy is an internal form of radiation used to treat cancer; it may be administered orally or intravenously and represents the nearest treatment option to the 'magic bullet', specifically targeting sites of disease whilst sparing surrounding normal tissues. Radioisotope therapy has an important role to play in modern medicine, particularly in the treatment of thyroid disease, neuroendocrine tumours, bone metastasis and non-Hodgkin's lymphoma. It is found in both the diagnostic setting and in therapy, but recently there has been a renaissance in the application of radioisotope unsealed sources in therapeutic indications. It is an active area of research, with the quest for new compounds that will be specific for therapeutic targets. This book is an essential, practical guide to the use of radioisotope therapy, and also includes the background and developmental biology which underpins its use. Individual tumours and diseases are explored, with specific focus given to radioisotope treatment options. The barriers to radioisotope therapy, such as ease of access, acquisition of radioisotopes, radiation protection regulations, and cost are also discussed. ABOUT THE SERIES Radiotherapy remains the major non-surgical treatment modality for the management of malignant disease, with over 50% of patients receiving treatment at some time during the management of their malignant disease. It is based on the application of the principles of applied physics, radiobiology, and tumour biology to clinical practice. Each volume in this series takes the reader through the basic principles of different types of radiotherapy, and then develops these by individual sites. This series of practical handbooks are aimed at physicians both training and practising in radiotherapy, as well as medical physicists, dosimetrists, radiographers and senior nurses.

The quest for therapeutic specificity is implicit in all branches of medicine. In cancer treatment, where the therapeutic modality is a cytotoxic agent such as radiotherapy or chemotherapy, such specificity is of paramount importance. The growing realisation that current therapeutic options are likely to yield no more than incremental improvements in outcome has fuelled the search for more active targeted approaches.

This book discusses the more archetypal systemic targeted therapies, such as those employing monoclonal antibodies or liposomes, but also includes strategies, such as photodynamic therapy and boron neutron capture therapy, that rely on direct physical targeting of disease. The explosion in our understanding of the molecular biology of cancer in recent years has led to the identification of a number of new potential therapeutic targets.

These factors, combined with the likelihood that yet more valuable information will be gleaned from the Human Genome Project, mean that inevitably, significant clinical activity in this arena is anticipated in the coming years with the very real prospect that gene therapy approaches may find an established role in the standard treatment of some of the common cancers.

This book brings together the very latest research in this field from an international group of experts and will prove invaluable for molecular oncologists, cancer researchers and those involved with clinical trials as well as providing a reference for oncologists who are beginning to use some of these therapies in everyday clinical practice.

ALSO PUBLISHED BY OXFORD UNIVERSITY PRESS

Oncology - an Oxford Core Text Edited by RAJ Spence OBE & P Johnston

Oxford Handbook of Oncology Edited by J Cassidy, D Bissett & RAJ Spence OBE

Collecting the key information in this burgeoning field into a single volume, this handbook for clinical oncology trainees and consultants covers all of the basic aspects of stereotactic radiotherapy systems and treatment and includes plenty of case studies.

Radiotherapy has been one of the principal modalities for the treatment of malignant disease for more than 50 years. From the outset, its advancement has depended on the work of physicists and engineers, in particular for the development of high-energy accelerators for X-ray and electron beams, and in the production of radioactive sources. In addition, the clinical application of ionizing radiations for therapy is based on the foundation of dosimetric concepts and instrumentation. Medical physics plays a pivotal role in many areas, including treatment equipment, dosimetry, treatment planning, and radiation protection.

Radiotherapy physics, second edition is a comprehensive, practical introduction to radiotherapy physics. It provides detailed descriptions of current techniques, written by experienced practitioners who review current methods and give specific guidance in their own areas of expertise. This new edition reflects the significant changes that have occurred in radiotherapy equipment and techniques - the routine use of MLCs, the delivery of IMRT, advances in imaging technology for planning (eg MRI, CT-simulator) and for treatment verification (EPIDs). There have also been significant changes in dosimetry, which have resulted in new dosimetry protocols. Trainee and qualified medical physicists, radiographers, radiation oncologists, and other personnel involved in radiotherapy will find this book to be an excellent guide to this important specialty.

Der unterschiedliche nat}rliche Verlauf des lokal begrenzten und des fortgeschrittenen Prostatakarzinoms machen eine in- dividuelle Therapie dringend erforderlich. Ausf}hrlich wer- den herk-mmliche und neue Therapiemethoden geschildert - ein ausgezeichneter Wegweiser zu einer verbesserten patienten- orientierten Behandlungen.

Das schnell wachsende und sich auch schnell vedindernde Wissen in der modernen Onko- logie hat bei vielen Krankheitsgruppen dazu gefiihrt, daB zusammenfassende Darstellungen im Sinne eines Handbuchs rasch wieder iiberholt waren. Dies gilt insbesondere fiir einige ganz im Brennpunkt der heutigen onkologischen Diskussion stehende Problemkreise. Der klinisch Hitige Onkologe, speziell Radioonkologe, wird aber auch Higlich mit einer Vielzahl von Fragen aus dem Gesamtbereich der Onkologie konfrontiert, die nicht so im Brennpunkt des 6ffentlichen Interesses stehen, bei denen die Entwicklung - aus welchen Griinden auch immer - wesentlich langsamer verHiuft und auf die er kompetente Antworten geben muB bzw. bei denen er arztlich handeln muB. Zu dies en Entitaten geh6ren sowohl die Tumoren des Nervensystems als auch die Tumo- ren der Nebenniere, die Tumoren des sympathischen Nervensystems, die Glomustumoren, Chemodektome und innersekretorischen Tumoren des Pankreas und der Nebenschilddriise. Fiir diese Tumoren ist daher eine umfassende zusammenhangende Darstellung in Form eines Handbuchs noch immer eine sehr aktuelle und fUr jeden Onkologen hilfreiche MaB- nahme, da ein solcher Band fUr lange Zeit seinen Wert behalten wird. Auch das Kapitel iiber die Larynxtumoren gewinnt seinen bleibenden Wert nicht nur aus der kompetenten Darstellung der derzeitigen Therapieregime, sondern aus der gleichzeiti- gen Wiedergabe der geschichtlichen Entwicklung aus der Feder eines Altmeisters der Ra- dioonkologie. Der vorliegende Band aus der Reihe "Spezielle Strahlentherapie maligner Tumoren" wird deshalb sicher zu einem besonders wertvollen Baustein jeder radioonkologischen Biblio- thek werden.

Unter den unerwtinschten Folgen einer Strahlentherapie bei bosarti- gen Tumoren nimmt die Strahlenmyelopathie einen besonders wich- tigen Platz ein, weil sie den Tumorkranken fUr den Rest seines Lebens zum Invaliden macht oder gar tiber Komplikationen den Tod des Pa- tienten bedingt. Wie bei allen iatrogenen Erkrankungen muB es das oberste Ziel sein, solche ernsten Nebenwirkungen arztlichen thera- peutischen Eingreifens zu verhindern. Wenn das vorliegende Buch hierzu fUr die Zukunft einen Beitrag zu leisten vermag, so ist seine Aufgabe erfUllt. Mein Dank gilt an dieser Stelle all jenen Patienten, die in den letzten 7 lahren immer wieder geduldig zu langen Gesprachen und Untersuchungen zu mir kamen, ohne daB ich ihnen zu einer wesentli- chen Befundbesserung verhelfen konnte. P. Berlit v Danksagung Fur seine wertvolle Unterstiitzung bei der Ermittlung der Rucken- marksstrahlendosen danke ich Herrn Prof. Dr. H. Kuttig, Universi- tats-Strahlenklinik Heidelberg. Herrn Prof. Dr. K. zum Winkel, Uni- versitats-Strahlenklinik Heidelberg, mochte ich fUr wertvolle Anre- gungen und sachkundige Hinweise danken. Die neuropathologi- schen Befunde verdanke ich Prof. Dr. G. Ule und Prof. Dr. H. P. Schmitt, Pathologisches Institut Heidelberg. Fur seine stete Forde- rung und sein aktives Interesse an der Studie danke ich meinem neu- rologischen Lehrer, Herrn Prof. Dr. H. Ganshirt, Neurologische Kli- nik Heidelberg, herzlich. Frau M. Deiseroth, Neurologische Universitatsklinik Heidelberg, und das Ehepaar Bontzol, Fotoabteilung der Strahlenklinik Heidel- berg, haben wie immer in vorzuglicher Weise die Abbildungen ange- fertigt. Frau A. Kohm in Heidelberg und Frau Egidi-Mulder in Mannheim danke ich fur die sorgfiiltigen und gewissenhaften Schreibarbeiten.

Wenn auch die Fortschritte der Onkologie langsam, viel zu langsam er- kennbar sind, so mussen doch neue Entwicklungen - und mogen sie noch so sehr erwartet werden - kritisch vor dem Hintergrund wissenschaftlich fundierter langer Erfahrungen gesehen werden. So war es ein besonderes Anliegen dieses Buches, die weltweiten Erfahrun- gen klinischer Radio-Onkologie ihrer aktuellen Wertigkeit entsprechend zu- sammenzutragen, als Basis heutiger Onkologie zu sehen und im interdiszipli- naren Behandlungskonzept darzustellen. Fur den Auftrag, die Anregungen und die Initiative zu diesem Buch mochte ich meinem Lehrer, Herrn Prof. DIETHELM noch einmal sehr danken. Dusseldorf HORST DIETER PIROTH Preface Advances in oncology may be slow - far too slow - but new developments must, however keenly they are anticipated, be scanned critically against the background of long years of scientific experience. Thus in compiling this volume I was particularly concerned to show the importance of worldwide experiences in clinical radio-oncology as the basis of modern oncology and in the context of multidisciplinary treatment. I would like to take this opportunity to express my lasting gratitude to my teacher, Professor DIETHELM, for entrusting this volume to me and for his advice and encouragement. Dusseldorf HORST DIETER PIROTH Inhaltsverzeichnis - Contents Bindegewebstumoren A. Primare Sarkome des Skelettsystems. Von H.D. PIROTH und H. HOFFMANNS 1 I. Osteosarkom . . . . .

Es wird die Therapie des Zervixkarzinoms in grossen Kliniken der Bundesrepublik Deutschland und einigen europaischen Nachbarlandern dargestellt. Indikation und Grenzen von Radikaloperationen, paraaortaler Lymphono dektomie, Skalenusbiopsie und Staginglaparotomie werden ebenso aufgezeigt, wie die Moglichkeiten einer modernen Strahlentherapie unter Einsatz der Afterloadingverfahren und neue Ansatze einer Chemotherapie. Dabei macht die Auseinandersetzung zwischen operativen, radiologischen und chemotherapeutischen Behandlungskonzepten die vielschichtige Problematik einer adaquaten Therapie und die Notwendigkeit einer interdisziplinaren Zusammenarbeit deutlich. Dem mit der Therapieplanung im Einzelfall konfrontierten Arzt werden die hier zusammengetragenen, ungeschonten Erfahrungen eine Entscheidungshilfe geben und Wege zu neuen Behandlungskonzepten eroffnen.

Mit Beitragen zahlreicher Fachwissenschaftler

Das Buch behandelt die Diagnostik und Therapie der Erkrankungen der grossen Kopfspeicheldrusen. Die modernen bildgebenden Verfahren und neuartigen immunhistologischen Untersuchungstechniken werden ausfuhrlich dargestellt. Neue Aspekte der konservativen und chirurgischen Therapie einschliesslich der Strahlentherapie werden abgehandelt. Der neueste Stand der TNM-Klassifikation von Speicheldrusenmalignomen wurde berucksichtigt. Ein umfangreiches Bildmaterial uber Kernspintomographie, Ultraschall, Szintigraphie und Immunhistologie illustriert den Einsatz dieser Methoden in der Diagnostik. Den mit der Erkennung und Behandlung von Speicheldrusenerkrankungen beschaftigten Arzten vermittelt das Buch einen breiten Uberblick uber die moderne Diagnostik und Therapie von Speicheldrusenerkrankungen.

Dem interessierten Leser wird der neueste Wissensstand }ber die Erkrankung des Prostatakarzinoms vermittelt, die die zweith{ufigste Krebstodesursache des Mannes in der Bundesre- publik Deutschland ist. Aktuelle Probleme der Diagnostik und Ttherapie werden aufgegriffen und Wege zur L-sung disku- tiert. Die Beitr{ge sind straff gegliedert und mit hervorra- gendem Bildmaterial ausgestattet.