Decision Making in Radiation Oncology (eBook)

Foreword 5
Contents of Volume 1 8
Contents of Volume 2 10
Contributors 13
Section VI - Tumors of the Genitalurinary System 21
18 Bladder Cancer 22
Epidemiology and Etiology 23
Anatomy 24
Pathology 26
Routes of Spread/Recurrence 27
Lymph Node Metastasis 28
Diagnosis, Staging, and Prognosis 29
Clinical Presentation 29
Diagnosis and Staging 30
Tumor, Node, and Metastasis Staging 30
Prognosis 32
Treatment 33
Principle and Practice 33
Treatment of Superficial Bladder Cancer 34
Treatment of Invasive Bladder Cancer 36
Definitive Surgical Intervention 37
Bladder Preservation 41
Treatment of Metastatic Bladder Cancer 49
Treatment of Non-urothelial Bladder Cancer 50
Treatment of Small Cell Carcinoma 50
Treatment of Squamous Cell Carcinoma 51
Treatment of Adenocarcinoma 51
Radiation Therapy Techniques 52
Simulation and Field Arrangements 52
Follow-Up 54
19 Prostate Cancer 56
Epidemiology and Etiology 57
Anatomy 58
Pathology 60
Routes of Spread 61
Lymph Node Metastasis 62
Diagnosis, Staging, and Prognosis 63
Clinical Presentation 63
Diagnosis and Staging 63
Tumor, Node, and Metastasis Staging 67
Prognoses 69
Treatment 70
Principles and Practice 70
Treatment of Localized Prostate Cancer 70
Adjuvant Radiation Therapy 85
Metastatic Prostate Cancer (T1–4, N0–1, M1) 87
Treatment of Recurrent Prostate Cancer 87
Radiation Therapy Techniques 87
External Beam Radiation Therapy for Definitive Therapy 87
Interstitial LDR Brachytherapy 91
EBRT for Adjuvant Therapy 94
Normal Tissue Tolerance 97
Follow-Up 98
20 Testicular Cancer 99
Incidence and Genetics 100
Anatomy and Routes of Spread 101
Pathology 102
Clinical Presentation 103
Diagnosis, Staging, and Prognosis 104
Staging 106
Prognostic Factors 110
Treatment 110
Principles and Practice 110
Treatment for Stages I–II Seminoma 113
Treatment for Stages II–IV Seminoma 115
Treatment for Non-seminomatous Testicular Cancer 115
Radiation Therapy Techniques 116
Preparation and Simulation 116
Target Volumes and Doses 117
Normal Tissue Tolerance 122
Follow-Up 124
Section VII - Gynecological Cancers 126
21 Endometrial Cancer 127
Epidemiology and Etiology 128
Anatomy 128
Pathology 130
Routes of Spread 131
Diagnosis, Staging, and Prognosis 131
Clinical Presentation 131
Diagnosis 132
Tumor, Node, and Metastasis/Federation of Gynecology and Obstetrics Staging 132
Prognostic Factors 134
Principles and Practice 134
Treatment of Early-Stage Endometrial Cancer 134
Locoregionally Advanced Endometrial Cancer 139
Treatment of Less Common Histologic Subtypes 140
Radiation Therapy Techniques 141
Simulation and Field Arrangements 141
Dose and Treatment Delivery 141
Three-Dimensional Conformal Radiation Therapy and Intensity-Modulated Radiation Therapy, and Target Volume Delineation 142
Brachytherapy 144
Follow-Up 146
22 Cervical Cancer 147
Epidemiology and Etiology 148
Anatomy 148
Pathology 150
Routes of Spread 150
Lymphatic Spread 151
Diagnosis, Staging, and Prognosis 152
Clinical Presentation 152
Diagnosis and Pretherapy Evaluation 153
International Federation of Gynecology and Obstetrics, and Tumor, Node, and Metastasis Staging 154
Prognosis 157
Treatment 159
Principles and Practice 159
Treatment of Stage I–IIA (Resectable) Cervical Cancer 161
Treatment of Stage IIB–IVA Cervical Cancer 164
Treatment of Recurrent or Metastatic Cervical Cancer 168
RT Techniques 169
Definitive RT 169
Follow-Up 182
Treatment Toxicity 183
23 Vulva Cancer 188
Epidemiology and Etiology 189
Anatomy 189
Pathology 190
Routes of Spread 190
Diagnosis, Staging, and Prognosis 192
Clinical Presentation 192
Diagnosis and Staging 192
Tumor, Node, and Metastasis, and International Federation of Gynecology and Obstetrics Staging 192
Prognosis 195
Treatment 196
Principles and Practice 196
Treatment of Early-Stage (T1N0–2) Disease 197
Treatment of Locally Advanced Diseases (Most T2–3, N2c-3) 201
Unresectable or Inoperable Diseases 202
Radiation Therapy Techniques 204
Simulation 204
Intensity-Modulated Radiation Therapy 207
Dose and Treatment Delivery 208
Normal Tissue Tolerance 208
Follow-Up 208
24 Vaginal Cancer 210
Anatomy 211
Pathology 212
Natural History 213
Diagnosis, Staging, and Prognosis 213
Clinical Presentation 213
Diagnostic Workup 214
Staging 214
Prognosis 216
Treatment 217
Treatment of VaIN 217
Treatment of Invasive SCC 218
RT Technique 222
Side Effects of Treatment 225
Follow-Up 226
Treatment of Adenocarcinoma, CCA, and Melanoma 226
Section VIII - Lymphomas 229
25 Non-Hodgkin’s Lymphoma 230
Epidemiology and Etiology 231
Classification 232
Diagnosis, Staging, and Prognosis 234
Clinical Presentation 234
Diagnostic and Staging Procedures 235
Clinical Staging of NHL 237
Prognosis 237
Treatment 239
Principles and Practice 239
Treatment of Limited-Stage Indolent NHL 239
Treatment of Advanced-Stage Indolent NHL 241
Treatment of Limited-Stage Aggressive NHL 245
Treatment of Advanced-Stage Aggressive NHL 247
Radiation Therapy Techniques 249
Follow-Up 252
26 Hodgkin’s Lymphoma 254
Epidemiology and Etiology 255
Pathology 255
Diagnosis, Staging, and Prognosis 257
Clinical Presentation 257
Diagnosis and Staging 257
Tumor, Node, and Metastasis Staging 259
Prognosis 260
Treatment 262
Principle and Practice 262
Treatment of Early Favorable Disease 263
Dose of Radiation for Favorable Early-Stage HL 264
Treatment of Early Unfavorable Disease 264
Chemotherapy as a Single Modality for Early-Stage HL 267
Treatment of NLPHL 270
Treatment of Advanced-Staged Disease 271
PET for Therapy Response Assessment 275
Treatment of Refractory and Relapsed HL 281
Radiation Incorporated into HDT plus ASCT 282
Role of Radiation as Salvage Treatment 283
Radiation Therapy Technique 283
Involved-Field RT 284
IFRT for Mediastinal Disease 285
IFRT for Cervical Disease 288
Normal Tissue Tolerance and Side Effects 290
Follow-Up 291
27 Multiple Myeloma and Plasmacytoma 293
Epidemiology and Etiology 294
MGUS 294
Smoldering MM 295
Pathology 296
Diagnosis, Staging, and Prognosis 296
Clinical Presentation 296
Diagnosis and Staging 298
Staging 301
Prognostic Factors 301
Treatment of MM 302
Principles and Practice 302
Management of Newly Diagnosed Transplant-Eligible Patients 303
Management of Newly Diagnosed Transplant-Ineligible Patients 304
Maintenance Therapy and Treatment for Recurrences 305
Supportive Treatment 305
Response to Treatment 305
Radiation Therapy for MM 307
Treatment of Solitary Plasmacytoma 309
Principles and Practice 309
Radiation Therapy Techniques 310
Simulation and Target Volume Delineation 310
Dose and Treatment Delivery 313
Normal Tissue Tolerance 314
Follow-Up 314
28 Cutaneous T-Cell Lymphoma 315
Epidemiology and Etiology 316
Anatomy and Pathology 316
Histopathology 317
Routes of Spread 318
Diagnosis, Staging, and Prognosis 318
Clinical Presentation 318
Diagnosis and Staging 319
Prognostic Factors 322
Treatment 323
Principles and Practice 323
Radiation Therapy for CTCL 329
Radiation Therapy Techniques 329
Target Volumes 329
Radiation Doses 331
Limited Superficial RT 331
TSEBT 331
Toxicity 334
Follow-Up 334
29 Primary Central Nervous System Lymphoma 335
Epidemiology and Etiology 336
Anatomy 337
Pathology 337
Pattern of Spread 338
Clinical Presentation 339
Diagnosis 339
Staging 341
Prognosis 341
Response Criteria 342
Treatment 342
Salvage Treatment 349
Radiation Therapy Technique 351
Radiation Therapy for Definitive and Salvage Treatment 351
Dose and Treatment Delivery 351
Normal Tissue Tolerance 352
Follow-Up 352
Section IX - Tumors of the Central Nervous System 353
30 Meningioma 354
Epidemiology and Etiology 355
Anatomy 355
Pathology 356
Routes of Spread 357
Diagnosis, Staging, and Prognosis 357
Clinical Presentation 357
Prognosis 358
Treatment 359
Treatment of Benign Meningioma 362
Treatment of Atypical and Malignant Meningiomas 364
Treatment of Unresectable or Recurrent Meningioma 366
RT Techniques 368
Simulation and Target Volume Delineation 368
Treatment Planning Technique 370
Dose and Treatment Delivery 371
Normal Tissue Tolerance 373
Toxicities 373
Follow-Up 374
31 Adult Gliomas 375
Epidemiology and Etiology 375
Pathology 376
Diagnosis, Staging, and Prognosis 377
Clinical Presentation 377
Diagnosis 378
Staging 381
Prognosis 381
Treatment 383
Principles and Practice 383
Treatment of High-Grade Gliomas 384
Treatment of Low-Grade Gliomas 391
Radiation Therapy Techniques 397
Definitive Radiation Therapy 397
Normal Tissue Tolerance 400
Follow-Up 402
32 Pituitary Tumors 403
Epidemiology and Etiology 404
Anatomy 404
Pathology 405
Routes of Spread 407
Diagnosis, Staging, and Prognosis 407
Clinical Presentation 407
Diagnosis and Staging 408
Staging 409
Prognosis 411
Treatment 412
Principles and Practice 412
Radiation Therapy Techniques 414
Simulation and Target Volume Delineation 414
Field Arrangement and Treatment Techniques 416
Dose and Treatment Delivery 418
Normal Tissue Tolerance 419
Follow-Up 419
Toxicities 420
Section X - Skin Cancers and Soft Tissue Sarcoma 421
33 Soft Tissue Sarcoma 422
Epidemiology and Etiology 423
Anatomy 423
Pathology 424
Routes of Spread 426
Diagnosis, Staging, and Prognosis 427
Clinical Presentation 427
Tumor, Node, and Metastasis Staging 429
Prognosis 430
Treatment 431
Principles and Practice 431
Treatment of Localized Superficial Small (< 5 cm) STS (T1a, N0, M0)
Treatment of Localized Deep and/or Large (> 5 cm) STS (T1b–2b, N0, M0)
Surgery 433
Radiotherapy Treatment 436
Brachytherapy 436
Treatment with Chemotherapy 439
Locally Recurrent STS 441
Advanced STS (Unresectable T1–2/N1/M1) 441
Retroperitoneal STS 441
Gastrointestinal Stromal Tumors 446
RT Techniques 448
RT for Adjuvant Therapy 448
Normal Tissue Tolerance 454
Follow-Up 454
34 Cutaneous Malignant Melanoma 456
Epidemiology and Etiology 457
Anatomy 457
Pathology 457
Routes of Spread 459
Local Extension 459
Lymph Node Metastasis 460
Distant Metastasis 460
Diagnosis, Staging, and Prognosis 460
Clinical Presentation 460
Diagnosis and Staging 460
Tumor, Node, and Metastasis Staging 461
Prognosis 465
Treatment 465
Principles and Practice 467
Surgery for Definitive Treatment 468
Adjuvant Systemic Therapy 470
Treatment of Metastatic Melanoma 471
Radiation Therapy Technique 472
Simulation and Field Arrangement 472
Dose Fractionation 472
Follow-Up 472
35 Basal and Squamous Cell Carcinoma of the Skin 474
Epidemiology and Etiology 475
Anatomy 476
Pathology 476
BCC 476
SCC 477
Routes of Spread 477
Lymph Node Metastasis 477
Diagnosis, Staging, and Prognosis 477
Clinical Presentation 477
Diagnosis and Staging 477
Tumor, Node, and Metastasis Staging 478
Prognosis 480
Treatment 481
Principles and Practice 481
Radiation Therapy Techniques 485
Follow-Up 487
Section XI - Pediatric Tumors 488
36 Pediatric Brain Tumors 489
Epidemiology and Etiology 490
Brain Development During Childhood and Adulthood 492
Pathology 493
Routes of Spread 494
Clinical Presentation, Diagnosis and Staging, and Prognosis 496
Clinical Presentation 496
Diagnosis and Staging 496
Staging for Medulloblastoma and Supratentorial Primitive Neuroectodermal Tumor 500
Prognosis 500
Treatment 502
Treatment of Low-Grade Astrocytoma 502
Treatment of Brainstem Glioma 503
Treatment of Medulloblastoma 503
Treatment of Supratentorial PNET 505
Treatment of Ependymoma 505
Treatment of Germ Cell Tumors 506
Treatment for Craniopharyngioma 507
CSI Techniques for Medulloblastoma 509
Follow-Up 513
37 Retinoblastoma 514
Epidemiology and Risk Factors 515
Anatomy 516
Patterns of Spread 517
Clinical Presentation 517
Staging 517
Prognosis 518
Treatment 520
Radiation Therapy Techniques 524
External-Beam Radiation Therapy 524
Brachytherapy 526
Protons 526
Treatment-Induced Complications and Second Cancer Risk 527
38 Neuroblastoma 530
Epidemiology and Etiology 531
Anatomy 531
Routes of Spread 532
Pathology 532
Diagnosis, Staging, and Prognosis 533
Screening 533
Clinical Presentation 533
Diagnosis 534
Staging 535
Prognosis and Risk Stratification 538
Treatment 541
Principle and Practice 541
The Low-Risk Group 542
The Intermediate-Risk Group 543
The High-Risk Group 545
Radiation Therapy 545
Treatment of Spinal Cord Compression 548
Follow-Up 549
Disease Surveillance 549
Late Effects 549
39 Ewing Sarcoma 550
Epidemiology and Etiology 550
Anatomy 550
Pathology and Cytogenetics 551
Routes of Spread 551
Diagnosis, Staging, and Prognosis 552
Prognosis of Ewing Sarcoma of the Bone 552
Treatment 553
Radiation Therapy Techniques 557
Imaging for Planning/Simulation 557
Special Sites 559
Radiation Dose 560
Radiation Modality 562
Normal Tissue Tolerance Guidelines 562
Follow-Up of Radiation Therapy 563
40 Wilms’ Tumor and Other Childhood Renal Tumors 566
Epidemiology and Etiology 567
Pathology 568
Clinical Presentation, Diagnosis, and Staging 569
Clinical Presentation 569
Diagnosis and Staging 569
Staging 571
Prognostic Factors and Survival 573
Treatment 574
Principle and Practice 574
FH Wilms’ Tumor 574
Anaplastic Wilms’ Tumor 576
Clear Cell Sarcoma 577
Rhabdoid Tumor 577
Renal Cell Carcinoma 578
Mesoblastic Nephroma 578
Radiation Therapy Techniques 578
Radiation Therapy for FH Wilms’ Tumor 578
Pulmonary Radiation Therapy 580
Follow-Up 581
Index of Volumes 1 and 2 582