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The vast majority of cervical cancer cases are human papillomavirus -mediated. Incidence and mortality significantly declined with introduction of screening with Pap smears. Adenocarcinoma often presents with larger tumors (“barrel cervix”) with higher risk of local failure. Cervical cancers are often asymptomatic and detected on screening, or can present with abnormal vaginal discharge, post-coital bleeding, dyspareunia, or pelvic pain. Three Food and Drug Administration approved vaccines are available that prevent the development of cervical cancer. Imaging includes positron emission tomography/computed tomography (nodal staging), pelvic magnetic resonance imaging (to delineate local disease extent and guide decisions on fertility vs. non-fertility sparing approaches). Treatment at early stages is often surgical, while Radiation therapy (
RT)+/− Chemotherapy ( CHT) is employed in later stages. When treating definitively, External beam radiation therapy is followed by an intracavitary or interstitial brachytherapy boost. Post-operative RT+/− CHTis occasionally indicated for adverse pathologic features.
World Health Organization grade III gliomas are referred to as anaplastic gliomas. The general treatment paradigm includes maximal safe surgical resection followed by adjuvant radiation therapy and chemotherapy (
CHT). The randomized trials that established a survival benefit from chemotherapy used Procarbazine, Lomustine, and Vincristine ( PCV). Concurrent and adjuvant temozolomide ( TMZ) is given more often and is still subject to ongoing study. An improved understanding of genomics is rapidly informing the clinical behavior and treatment. Histologic subtypes of anaplastic gliomas include anaplastic astrocytoma and anaplastic oligodendroglioma ( AO). Headache and seizures are the most common symptoms of anaplastic gliomas. Adjuvant radiation improves overall survival after surgery compared to observation or CHTalone and is indicated for all high-grade gliomas. Despite the survival advantage demonstrated with PCVin patients with AOsand AOs, many substitute TMZas it is easier to administer and generally better tolerated.
The chapter discusses strategies for radiation therapy treatment planning for lymphoma. It explains clinical application, patient setup and immobilization. Treatment planning describes dose specification, extended field radiation therapy, involved/regional field radiation therapy, and involved site radiation therapy. Radiation therapy is used as monotherapy, or as an adjunct to chemotherapy to treat Hodgkin’s and Non-Hodgkin’s lymphoma. The chapter provides clinical application, patient setup, and treatment planning with dose specification, and treatment techniques for total skin electron irradiation. The clinical application for total skin electron irradiation is definitive treatment of cutaneous T-cell lymphoma, also called mycosis fungoides. The chapter also presents clinical application, patient setup, and treatment planning for total body irradiation. Total body irradiation is used on its own, or as an adjunct to chemotherapy as part of a myeloablative regimen, to condition the host prior to receiving a hematopoietic transplantation.
This chapter addresses the treatment of the obese pediatric patient. Treatment can include medical therapy, pharmacotherapy, or even surgical therapy. Medical treatment is slightly different for a growing child in comparison to an adult, especially if the child is overweight or even mildly obese. If no other health concerns exist, the goal may not be weight loss, but rather weight maintenance. Pediatric patients should be screened for depression as well as sleep apnea, and referrals initiated for further counseling or testing, as needed. Prescription weight-loss medications are not often recommended for children or adolescents, as long-term side effects of many prescription medications are unknown. Patients and families should be reminded that medications do not replace healthy eating or physical activity; these should be encouraged in addition to prescription medication. Surgery is also not recommended for those who have an untreated psychiatric disorder, including an eating disorder.