This book details the technical aspects of how to achieve requirements for clinical treatment planning aspects, including patient positioning, creation of patient specific bolus, beam angle configurations, and inverse planning optimization approaches. It is written for everyone involved in treatment planning including dosimetrists, physicists, and physicians. The book comprises of 14 chapters. The first three chapters are introductory chapters. Chapter one describes the types of treatment plans and the general process of treatment planning. The second chapter explains the principles and limitations of current inverse planning optimization algorithms, and discusses the application of auto-planning, knowledge-based planning, and multi-criteria optimization to overcome these limitations. The third chapter covers the available immobilization equipment and general principles of simulation, including patient safety procedures. Chapters four through eleven are organized by body site or system and covers central nervous system, head and neck, breast cancer, thoracic cancer, gastrointestinal radiotherapy, genitourinary cancer, gynecologic cancer, lymphoma, and soft tissue sarcoma. For each site, there is a description of patient simulation, including immobilization, setup, isocenter placement, and any special considerations such as motion management. The plan goals for each treatment site are tabulated, followed by recipes to achieve them from the simplest planning technique to the most advanced planning technique. For simple 3D conformal plans, the recipes include the field arrangement and portal shape design (both with many figures), beam weighting, and selection of dose normalization point. For advanced techniques such as intensity-modulated radiation therapy, volumetric modulated radiation therapy, and stereotactic body radiation therapy, the recipes provide details of creation of optimization structures and multiple stage optimizations. Each chapter concludes with plan evaluation, comparing achieved doses to the clinical planning goals. Chapter thirteen describes treatment planning for pediatric cancers. Chapter fourteen discusses treatment planning for palliative treatment.
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This book provides a state-of-the-art overview of the principles of cancer care and best practices for restoring function and quality of life to cancer survivors. Cancer rehabilitation interventions including physical, occupational, or speech therapy; exercise training; psychosocial and cognitive interventions; and physician-directed diagnostic imaging, injections, and pharmacologic symptom management have the potential to treat many impairments from cancer treatment, thereby improving functioning and quality of life. Multimodal rehabilitation interventions have also been shown to improve return to work compared to usual care. The chapters of the book review the latest evidence about which interventions should be used to treat specific impairments thereby constituting the most comprehensive and up-to-date reference on this topic. The book is organized into nine parts comprising 90 chapters. Part one presents history of cancer rehabilitation, cancer statistics, and principles of cancer care. Part two discusses various cancer types, which includes breast cancer, gastrointestinal malignancies, head and neck cancer, pediatric cancers, and primary bone tumors and their assessment and management. Parts three through six describe cancer pain, medical complications, neurological and neuromuscular complications, and musculoskeletal complications of cancer such as radiculopathy, plexopathy, autonomic dysfunction, and bone metastases and their management. Part seven discusses general topics related to cancer rehabilitation, which includes physical and occupational therapy, therapeutic modalities in cancer, therapeutic exercise in cancer, nutritional care of the cancer patient, sexuality issues, and distress and other psychiatric considerations in cancer rehabilitation. Part eight thoroughly explores the identification, evaluation, and treatment of specific impairments and disabilities that result from cancer and the treatment of cancer such as balance and gait dysfunction, cancer related fatigue, radiation fibrosis syndrome, and bowel dysfunction. Part nine discusses functional measurement in patients with cancer, health maintenance and screening in cancer survivors, research issues, barriers to accessing cancer rehabilitation, and building a cancer rehabilitation program.
Preparation for board examinations can be a daunting and an overwhelming process for many of us. Trainees are often busy with research projects, manuscripts, and a large clinical volume, making it difficult to find time to study for board examinations. Practicing physicians find it hard to keep up on material needed for board recertification. Questions on the board examinations are drawn from well-established, validated medical literature and widely accepted clinical guidelines. This book provides a comprehensive overview of the field of radiation oncology. The format has been designed to efficiently test and reinforce knowledge of key concepts, critical studies, and major clinical guidelines, with the most important radiation oncology citations included. From trainees preparing for their board exams to practicing physicians looking for a review or preparing for the maintenance of certification exam, whether it be a few minutes between patients or a dedicated study session, the book will an invaluable resource to the radiation oncology community. The book is organized into ten chapters. It covers oncology topics such as head and neck cancers, central nervous system cancers, breast cancer, thoracic cancers, gastrointestinal cancers, genitourinary cancers, gynecologic cancers, lymphomas, soft tissue sarcoma, and pediatric cancers. Each chapter has detailed questions covering natural history, epidemiology, diagnosis, staging, treatment options, and treatment-related side effects all in a newly configured format.
This second edition of Pocket Guide to Radiation Oncology provides an updated and rapid review of the existing standard of care and the most relevant literature. Like the first edition, this quick pocket-sized reference can be carried for a quick review instead of heavy textbooks often filled with esoteric topics and lengthy minutiae. The book has new chapters on the growing areas of oligometastatic disease, benign indications, and proton therapy. The book comprises 55 chapters organized by site-specific diseases: central nervous system neoplasms, head and neck cancers, thoracic cancers, breast cancer, gastrointestinal cancers, gynecologic cancers, genitourinary cancers, lymphoma, sarcoma, skin cancers, pediatric malignancies, metastatic disease, and benign indications. The chapters present must-know key points, including treatment options by stage, technical considerations, and important items for follow-up. Clinical pearls and tables covering treatment options, dose constraints, side effects, target delineations, and treatment planning complete each chapter. The chapters conclude with a list of selected, summarized studies relevant to the disease. The book takes an efficient and no-frills approach to fundamental topics in the field, making it the perfect reference for a quick review for the board exam or
MOCand even serving as a handy reference during a case review at a tumor board. The book provides essential, quick reference appendices on radiation therapy symptom management, normal tissue tolerance constraints, and radiation therapy and new systemic agents.
This book is a comprehensive guide for the practicing physician and medical physicist in the management of complex intracranial and extracranial disease. It presents the scientific principles, clinical background and procedures, treatment planning, and treatment delivery of stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) for the treatment of tumors throughout the body. The book is organized into two parts comprising twenty chapters. Beginning with an overview of SRS and SBRT, Part one provides insightful coverage on topics such as the evolving radiobiological principles of radiosurgery and SBRT, SRS and SBRT process, patient immobilization, imaging, treatment planning process, and technologies and equipment used for SRS and SBRT. It also contains focused chapters on quality assurance, quality management, and patient safety. Part Two describes the clinical application of SRS and SBRT for tumors throughout the body. The body regions covered includes brain, head and neck, lung, pancreas, adrenal glands, liver, prostate, cervix, and spine. It also has a chapter on oligometastatic disease. Each clinical chapter includes an introduction to the disease site, followed by a thorough review of all indications and exclusion criteria, in addition to the important considerations for patient selection, treatment planning and delivery, and outcome evaluation. These chapters conclude with a detailed and site-specific dose constraints table for critical structures and their suggested dose limits. The final chapter discusses immunoradiosurgery. The book is enhanced with supplemental video tutorials and is a must-have book for clinicians, physicists, and other radiation therapy practitioners.
Revised and updated, this third edition continues its tradition of providing evidence-based approaches to the specific technical aspects of delivering radiation treatment. Easy to read and relevant to general practice, this popular pocket-sized manual leads radiation oncology trainees and clinicians through the basics of radiotherapy planning and delivery for all major malignancies in a step-by-step manner. Organized by body site or system, each chapter provides technical details and clinical updates to planning as a result of practice-changing paradigms as well as new and updated equipment and techniques. Specialized topics such as palliative radiotherapy and pediatric radiotherapy round out the final chapters. With over 40 new images in addition to detailed accounts of advances in the field, this highly anticipated third edition provides important updates while retaining the valued, practical features of the previous editions. Written by members of staff in the Department of Radiation Oncology at the Cleveland Clinic, this edition continues to be a valuable resource for training as well as a reliable quick reference for professionals in the field such as radiation therapists and technologists, radiation nurses, dosimetrists, physicists, and practicing physicians. It presents concise summaries including target definitions and dose constraints for planning all major disease sites, provides updated coverage of planning associated with stereotactic body radiation therapy for prostate, pancreas, and liver cancers, and includes over 190 full color images. It also outlines new practice standards for hypofractionated radiation therapy in breast and prostate cancers and explains specific technical aspects important for the appropriate clinical delivery of radiation treatment.
An understanding of biostatistics is necessary for reading and comprehending published literature, for performing retrospective research, and for designing and analyzing prospective clinical trials. Biostatistical concepts are also tested on oncology board exams. This book is organized into four sections covering 13 chapters. Section I begins with the basic foundations of biostatistics that are tested on board exams such as summarizing and graphing data, sampling, and statistical estimation. In Section II, these basics are then expanded on to include the concepts used in retrospective study design, analysis, and interpretation. It discusses hypothesis testing, correlation, regression, categorical data analysis, survival analysis methods, and noninferiority analysis. Section III focuses on prospective clinical trials, guiding readers in their understanding of published clinical trials and in the design and analysis of novel clinical trials. It describes cohort studies, case-control studies, cross-sectional studies, matched studies, analysis of studies, and sample size. The final section presents self-study multiple choice questions with answers and rationales.
Cancer patients frequently present with scenarios for which level I evidence is not available and a more individualized approach to each patient is warranted. This book analyzes common difficult clinical situations from various vantage points. It presents case examples which were developed to guide discussions on treatment recommendations, with a review of current issues, and any potential data utilized to drive treatment decisions. The cases are organized into sections corresponding to the major treatment areas of radiation oncology: Breast, Gastrointestinal, Gynecology, Genitourinary, Head and Neck, Thorax, and Central Nervous System. Radiation oncological apsects are discussed for several difficult cases of breast cancer, pancreatic cancer, rectal cancer, anal cancer, endometrial cancer, prostate cancer, laryngeal carcinoma, oral tongue cancer, small-cell lung cancer, non-small cell lung cancer, anaplastic oligodendroglioma and glioblastoma. The book provides residents, fellows, and clinicians with a practical, evidence-based guide to the current management of difficult cases in radiation oncology. Emphasis is on the management of those clinical challenges commonly seen in practice that the community practitioner would normally handle without outside referral.
Quality and Safety in Radiation Oncology:Implementing Tools and Best Practices for Patients, Providers, and Payers
This book provides an authoritative and evidence-based guide to the understanding and implementation of quality and safety procedures in radiation oncology practice. Chapter topics range from fundamental concepts of value and quality to commissioning technology and the use of metrics. They include perspectives on quality and safety from the patient, third-party payers, as well as from the federal government. Other chapters cover prospective testing of quality, training and education, error identification and analysis, incidence reporting, as well as special technology and procedures, including MRI-guided radiation therapy, proton therapy and stereotactic body radiation therapy (SBRT), quality and safety procedures in resource-limited environments, and more. The book is divided into three parts. Part I presents the basic concepts in quality, value and safety includes descriptions of value in the American and European health care systems, and error prevention and risk management. Part II is devoted to quality considerations in radiation physics. Chapters cover equipment, software and techniques that are used, and the quality considerations that need to be kept in mind during external beam radiotherapy, brachytherapy, and proton and particle therapy. The third part discusses quality considerations in clinical practice settings. Discussions range from creation of a quality culture, testing of quality and safety measures, and training in graduate medical education to patient’s perspectives, reporting and investigation of incidents, error disclosures and error identifications, and the role of dosimetrist and therapist in radiation oncology.
This book provides a concise and practical resource to assist in real-time, clinical decision making for managing lung cancer. The first two chapters deal with epidemiology and etiology of lung cancer, lung carcinogenesis, lung cancer genetics, epigenetics, and tumor microenvironment. Environmental Tobacco Smoke (ETS) is associated with a 20% to 40% increase in lung cancer risk. The third chapter provides an overview of several of the driver oncogenes that are important in the pathogenesis of non–small-cell lung carcinoma (NSCLC) and have emerged as targets for therapeutic approaches. The advent of molecular profiling and targeted therapy renewed interest in the distinguishing between the major subtypes of NSCLC: adenocarcinoma (ADC), squamous cell carcinoma (SqCC) and large cell lung carcinoma (LCLC). The fourth and fifth chapters deal with screening and diagonosis of lung cancer. This is followed by four chapters which describe the management of early stage, locally advanced stage, advanced stage, and recurrent NSCLC, and their respective treatment therapies such as video-assisted thoracic surgery, robotic-assisted thoracic surgery, sequential induction chemotherapy, necitumumab, maintenance therapy, and sequential single-agent therapy. Chapters 10 and 11 discuss the management of limited-stage and extensive-stage small-cell lung carcinoma (SCLC) and the treatment therapies. Lung cancer is a disease of the elderly, and accordingly chapter 13 covers the management of elderly and high-risk patients suffering from this disease. This is followed by a focus on the management of neuroendocrine tumors (NET), pleural mesothelioma, and thymic tumors. The book ends with a discussion on palliative care in thoracic oncology.