Given that treatment with curative intent is possible in only one-half of cancer victims, and that such treatment frequently fails, the majority of patients with cancer will require relief of symptoms and signs caused by their disease. In this book, the specific contribution of radiation therapy to palliation is considered within the context of multidisciplinary management. Individual chapters are devoted to palliative radiation therapy for primary tumours and metastases at different sites. The management of pain is discussed, and chapters are also devoted to end of life care, the management of complications of radiation therapy, and useful medications. This book will prove useful and interesting not only to radiation oncologists but also to medical students of all ages and to doctors from all disciplines who are concerned with the relief or prevention of suffering in patients with cancer.

This volume discusses the background and various clinical applications of radiation therapy in the treatment of non-malignant diseases. It documents the radiobiological and physical principles of treatment and the rationale underlying the use of radiotherapy for various disorders of the CNS, head and neck, eye, skin and soft tissues, bone and joints, and vascular system. In so doing, it draws attention to and elucidates the scope for application of radiotherapy beyond the treatment of malignancies. Both the risks and the benefits of such treatment are fully considered, the former ranging from minor clinical problems to life-threatening diseases.

The aim of this book is to provide a uniquely comprehensive source of information on the entire field of radiation therapy physics. The very significant advances in imaging, computational, and accelerator technologies receive full consideration, as do such topics as the dosimetry of radiolabeled antibodies and dose calculation models. The scope of the book and the expertise of the authors make it essential reading for interested physicians and physicists and for radiation dosimetrists.

Increasing survival figures and the use of more intense combined treatment regimens in modern oncology have raised the problem of late therapeutic sequelae in long-term survivors after cancer. Recent scientific approaches to late sequelae concentrate on the evaluation of subclinical changes with sophisticated functional measurements and experimental investigation of the underlying pathophysiological mechanisms.
The objective of the book is to bring together these recent clinical and experimental data from different medical disciplines to give an overview of the most relevant problems of late sequelae. In clinical practice the book may help regarding estimation of risks, selection of diagnostic methods, and estimation of the prognosis of late sequelae.

Conformal radiation therapy represents a new challenge for radiation oncologists. It offers the prospect of either increasing the radiation dose to target tissues while delivering a similar dose to organs at risk, or reducing the dose to organs at risk while maintaining the dose to target tissues. First, lymph node areas at risk are established using the available data from pathological examination of surgical specimens and/or pattern of locoregional relapse. Then, based on a three-dimensional description of the anatomical regions where the areas at risk are located, guidelines for the delineation of the clinical target volumes are proposed. The data presented should enable the reader to make appropriate decisions regarding the selection and delineation of the target volumes when confronted with the most frequent tumor types and sites.The book will contribute to paving the way for more effective radiation oncology in the twenty-first century.

Given that treatment with curative intent is possible in only one-half of cancer victims, and that such treatment frequently fails, the majority of patients with cancer will require relief of symptoms and signs caused by their disease. In this book, the specific contribution of radiation therapy to palliation is considered within the context of multidisciplinary management. Individual chapters are devoted to palliative radiation therapy for primary tumours and metastases at different sites. The management of pain is discussed, and chapters are also devoted to end of life care, the management of complications of radiation therapy, and useful medications. This book will prove useful to radiation oncologists and medical students.

This volume discusses the background and various clinical applications of radiation therapy in the treatment of non-malignant diseases. It documents the radiobiological and physical principles of treatment and the rationale underlying the use of radiotherapy for various disorders of the CNS, head and neck, eye, skin and soft tissues, bone and joints, and vascular system. In so doing, it draws attention to and elucidates the scope for application of radiotherapy beyond the treatment of malignancies. Both the risks and the benefits of such treatment are fully considered, the former ranging from minor clinical problems to life-threatening diseases.

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.

H: SACK Lungentumoren sind die haufigste Krebstodesursache bei Mannern tiber 35 Jahren, die epidemiologischen Daten der letzten Jahre lassen erkennen, daB dies bald auch auf Frauen zutreffen wird. Zum Zeitpunkt der Diagnose hat das Bronchialkarzinom bei 70% der Patienten bereits Metastasen abgesiedelt, bei 22% in die regionalen Lymphknoten und bei 48% hamatogen. Das erkHirt, warum viele Patienten innerhalb des ersten Jahres nach Diagnosestellung versterben. Aber auch bei den Kranken mit einer klinisch lokalisierten Erkran- kung (17%) ist eine Oberlebenserwartun von 5 Jahren eher die Ausnahme als die Regel. Viele Hoffnungen wurden bei diesen Gegebenheiten auf die Friihdiagnose ge- setzt, urn den Tumor im loko-regional begrenzten Stadium der Operation zu- fUhren zu konnen, die fast allein als kurative BehandlungsmaBnahme anzuse- hen ist. Die Friihdiagnostik hat jedoch die in sie gesetzten Erwartungen nicht erftillen konnen. Feldstudien in den USA und der DDR haben eine Verbesse- rung der Oberlebensraten nicht erreichen konnen. Die Moglichkeiten der Friihdiagnose sind weiterhin beschrankt, Vorsorgeuntersuchungen fUr die Ge- samtbevolken, mg sind deshalb nicht empfehlenswert. Die folgenden Beitrage namhafter Forscher und Kliniker sollen den Stand des heute Moglichen in der Behandlung von Kranken mit Lungenkrebs diskutieren und Wege zur Verbesserung der Ergebnisse aufzeigen. Auch von den in kurati- ver Absicht radikal Operierten leben nach 5 Jahren nur rund 30%, nach 10 Jah- ren 15%. Die Operationsletalitat betragt je nach der GroBe des Eingriffs 4-11 %.

Die Strahlentherapie der otorhinolaryngologischen Tumoren sowie der Tumoren des Re- spirationstraktes stellt eine der wichtigsten Aufgaben des Radioonkologen dar. Er ist hier wesentlicher Partner im Rahmen der interdisziplinaren Onkologie und betreut gemeinsam mit dem Otorhinolaryngologen, dem Chirurgen oder Pulmologen die Patienten. In einzelnen Bereichen, so beim kleinzelligen Bronchus-Karzinom, ist eine enge Koopera- tion zwischen medizinischer Onkologie und Radioonkologie Voraussetzung einer sinnvollen Behandlung. Eine umfassende Darstellung der strahlentherapeutischen Moglichkeiten im Rahmen des Gesamtbildes der Erkrankungen der HNO-Tumoren-und der Tumoren des Respirationstrak- tes bildet damit ein wertvolles Hilfsmittel flir jeden Arzt, der mit der Behandlung dieser Tumoren befaBt ist. Die radiologischen Moglichkeiten in der Behandlung der malignen Schilddriisentumoren stellen ein Thema dar, bei dem besonders dringend eine fachkundige zusammenfassende Darstellung erforderlich wurde. Auch dieses Kapitel wird nicht nur dem Radioonkologen, sondern anderen, mit den Erkrankungen der Schilddriise befaBten Arzten eine wertvolle Hilfe sein. Hamburg H.-P. HElLMANN Preface Radiotherapy of otorhinolaryngolic tumors and tumors of the respiratory tract is one of the most important responsibilities of radio-oncologists. They are major partners in inter- disziplinary oncology and treat patients together with otorhinolaryngologists, surgeons, and pulmologists. In special problems, such as small-cell bronchial carcinoma, close cooperation between radio-oncologists and medical-oncologists is a precondition of meaningful treatment. The possible applications of radiology in treating malignant thyroid tumors also require a compre- hensive expert discussion.

The American Cancer Society anticipates that 16,500 patients will be diagnosed with primary malignant tumors of the central nervous system in 2000, with about 200,000 individuals presenting with brain metastases. The advances in the treatment of solid tumors have contributed significantly to the major increase in metastatic cancers to the brain. Of the primary malignant tumors of the brain, more than 50% are high-grade gliomas; the incidence has been increasing among older patients over the past decade. Major developments in new technologies in the treatment of primary brain tumors as well as metastatic disease are covered in depth. Even though management is difficult, advances are being made. This book is a concerted effort to present data regarding basic science research efforts alongside their translation into clinical practice using combined, integrated multimodal programs of treatment. Progress has been made, but innovatice approaches need to be pursued.