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PRINCIPLES AND PRACTICE OFRADIATION ONCOLOGYFOURTH EDITIONEditorsCARLOS A. PEREZ, M.D.Director, Radiation Oncology CenterMallinckrodt Institute of RadiologyRadiation Oncologist-in-Chief Barnes-Jewish HospitalProfessor, Radiation OncologyWashington University Medical CenterSt. Louis, MissouriLUTHER W. BRADY, M.D.Distinguished University ProfessorHylda CohnlAmerican Cancer Society Professor of Clinical Oncologyand Professor, Department of Radiation OncologyDrexel University College of MedicinePhiladelphia, PennsylvaniaEDWARD C. HALPERIIU, M.D.Vice Dean of the School of MedicineThe R. J. Reynolds Professor of Medical EducationProfessor, Department of Radiation OncologyProfessor, Department ofPediatricsDuke UniversityDurham, North CarolinaRUPERT K. SCHMIDT-ULLRICH, M.D.Professor and ChairmanDepartment of Radiation OncologyMedical College of VirginiaVirginia Commonwealth UniversityRichmond, VirginiaLIPPINCOTT WILLIAMS & WILKINSA Wolters Kluwer CompanyPhiladelphia Baltimore New York LondonBuenos Aires Hong Kong Sydney Tokyo
CONTENTSContributors xiPreface xixTNM Cancer Staging xxiAcknowledgments xxiiiSECTION 1: OVERVIEW AND BASIC SCIENCEOF RADIATION ONCOLOGY1The Discipline of Radiation Oncology 1Edward C. Halperin, RupertK. Schmidt-Ullrich,Carlos A. Perez, and Luther W. BradySECTION 2: TECHNIQUES, MODALITIES, ANDMODIFIERS IN RADIATION ONCOLOGY10Altered Fractionation Schedules 337K. Kian Ang and Howard D. Thames11Late Effects of Cancer Treatment on NormalTissues 357Louis S. Constine, Jacqueline P. Williams,Monica Morris, Philip Rubin, and Paul Okunieff12Methodology of Clinical Trials 391Shari B. Rudoler, Kathryn Winter, andWalter J. Curran, Jr.Part A: Cancer Biology2Biologic Basis of Radiation Therapy 96William H. McBride and H. Rodney Withers13Magna-Field Irradiation 400Hsiu-San Lin and Robert E. Drzymala3Molecular Cancer and Radiation Biology 137RupertK. Schmidt-Ullrich, Ross B. Mikkelsen,and Kristoffer Valerie14Stereotactic Irradiation 410Annie W. Chan, Robert M. Cardinale, andJay S. Loeffler4Molecular Pathophysiology of Tumors 163Rakesh K. Jain15Intraoperative Radiation Therapy 428Felipe A. Calvo, Rosa M. Meirino, Leonard L.Gunderson, and Christopher G. Willett16Particle Beam Radiotherapy: Clinical Perspective 457George E. Laramore and Mark H. Phillips17Physics and Biology of Brachytherapy 472Jeffrey Williamson and DavidJ. Brenner18Clinical Applications of Brachytherapy I. LDR andPDR 538Carlos A. Perez, Robert Zwicker,and Jeffrey Williamson19Physics and Dosimetry of High-Dose-RateBrachytherapy 604Colin G. Orton and Gary A. Ezzell20Clinical Aspects of High-Dose-RateBrachytherapy 619Subir Nag21Nonsealed Radionuclide Therapy 636Carlos A. Perez, Perry W Grigsby, and Wade ThorstadPart B: Medical Radiation Physics5Principles of Radiologic Physics, Dosimetry, andTreatment Planning 180James A. Purdy6Photon External-Beam Dosimetry and TreatmentPlanning 219James A. Purdy and Eric E. Klein7Electron-Beam Therapy: Dosimetry, Planning, andTechniques 252Kenneth R. Hogstrom8Three-Dimensional Conformal RadiationTherapy: Physics, Treatment Planning, and ClinicalAspects 283James A. Purdy9Intensity-Modulated Radiation TreatmentPlanning, Quality Assurance, Delivery, and ClinicalApplication 314Radhe Mohan, Daniel Low, K.S. Clifford Chao, QiuwenWu, and Lei Dong VII
VIIIContents22Radioimmunoglobulins in Cancer Therapy 653Reiner Class, Curtis T. Miyamoto,and Luther W Brady23Radiation Response Modulation 66334Nasopharynx 918K.S. Clifford Chao and Carlos A. Perez35Nasal Cavity and Paranasal Sinuses 962Jerry L. Barker, Jr., andK. KianAngPart A: Chemical Sensitizers and ProtectorsToddH. Wasserman andJ'. Donald Chapman36Salivary Glands 976Joseph R. SimpsonPart B: Biological Response ModifiersTheodore D. Chung and Rupert K Schmidt-Ullrich37Oral Cavity 997Bahman Emami24Hyperthermia 69938Ellen L. Jones, Thaddeus V. Samulski, Zeljko Vujaskovic,Leonard R. Prosnitz, and Mark W. Dewhirst25Basic Concepts of Chemotherapy and IrradiationInteraction 736Hak Choy, Rob MacRae, and Luka Milas39Hypopharynx 1071Bahman Emami and Rupert K. Schmidt- Ullrich40Larynx 1094William M. Mendenhall, Russell W. Hinerman, RoberAmdur, Anthony A. Mancuso, Douglas B. Villaret,and K. Thomas Robbins41Unusual Nonepithelial Tumors of the Head and Neck1117Carlos A. Perez and K.S. Clifford Chao42Head and Neck: Management of the Neck 1158William M. Mendenhall, Robert J. Amdur, Russell W.Hinerman, Anthony A. Mancuso, Douglas B. Villaret,and K. Thomas Robbins43Thyroid 1179Perry W. GrigsbySECTION 3: CLINICAL RADIATION ONCOLOGYPart A: Skin Cancer26Skin 757Merrill J. Solan and Luther W. BradyPart B: AIDS-Related Malignancies27Malignant Neoplasms Associated with the AcquiredImmunodeficiency Syndrome (AIDS) 776Bernadine R. Donahue andJay S. CooperPart C: Central Nervous System Tumors28Brain, Brain Stem, and Cerebellum 791Loubna T. Scally, Chi Lin, Sushil Beriwal,Luther W. Brady29Pituitary 839Volker W Stieber, Allan deGuzman,and Edward G. Shaw30Spinal Canal 860JeffM. Michalski31Eye and Orbit 876Jorge E. Freire, Luther W. Brady, Jerry A. Shields,and Carol L. ShieldsPart D: Head and Neck Tumors32Ear 897K.S. Clifford Chao and V. Rao Devineni33The Role of Combined Radiation Therapy andChemotherapy in the Management of LocallyAdvanced Squamous Carcinoma of the Head andNeck 905David M. BrizelOropharynx (Tonsillar Fossa, Faucial Arch, and Baseof Tongue) 1022Carlos A. Perez, K. S. Clifford Chao, Joseph R. SimpsoRupert K. Schmidt-UllrichPart E: Thoracic Tumors44Lung 1201Jeffrey Bradley, Ramaswamy Govinddn,and Ritsuko Komaki45Mediastinum and Trachea 1244Tony Y. Eng, ToddJ. Scarbrough,and Charles R. Thomas, Jr.46Esophagus 1282Albert S. DeNittis47Tumors of the Heart and Great Vessels 1305Mark A. Chidel and Roger M. MacklisPart F: Breast Tumors48Breast: Stage Tis 1315,David E. Wazer and Douglas W. Arthur49Breast: Stage T l and T2 Tumors 1331Carlos A. Perez, Marie E. Taylor, Jeff Bradley,David Mansur, and Maria M. Sanchez-Aragon
Contents50Breast: Locally Advanced (T3 and T4) and RecurrentTumors 1502Marie E. Taylor, Carlos A. Perez, Joanne E. Mortimer,Seymour H. Levitt, Nantakan Ieumwananonthachai,andSashaH. Wahab66Female Urethra 1994Jay Locke 67Carcinoma of the Vulva 2003Gustavo S. Montana and Song K. KangPart K: Adrenal and Retroperitoneal TumorsPart G: Gastrointestinal Tumors51Stomach 1554Christopher G. Willett and Leonard L. Gunderson52Cancer of the Pancreas 1574Felipe A. Calvo, Juan C. Viera, Leonard L. Gunderson,and Christopher G. WillettIX68Retroperitoneum 2023Imran Zoberi and Todd H. Wasserman69Adrenal Gland 2036Luther W Brady and Patrizia GuerrieriPart L: Lymphoma and Hematologic Malignancies53Liver and Hepatobiliary Tract 1589Skye H. Cheng and Andrew T. Huang70Hodgkin's Disease 2043Richard T. Hoppe54Colon and Rectum 1607Robert J. Myerson71Non-Hodgkin's Lymphoma 2064Leonard R. Prosnitz and Peter M. Mauch72Cutaneous T-Cell Lymphoma 2112Sushil Beriwal, Luther W. Brady, and Eric C. Vonderhe73Leukemia 2125Christopher Coughlin, Rose Papac, and Kenneth B.Roberts74Myeloma and Plasmacytomas 2157Todd H. Wasserman55 Anal Canal 1630Bernard J. Cummings and James D. BrierleyPart H: Urinary Tract Tumors56Kidney, Renal Pelvis, and Ureter 1649JeffM. Michalski57Bladder 1664Zbigniew Petrovich, John P. Stein, Gabor Jozsefiand Silvia C. Formenti58Part M: Sarcomas of Bone and Soft TissuePart I: Male Genitourinary Tumors75Prostate Cancer 1692Michael J. Zelefsky, Richard K. Valicenti,Karyn Goodman, and Carlos A. PerezBone 2168 Paolo Montemaggi, Luther W. Brady,and Stephen M. Horowitz76Soft Tissue Sarcomas (Excluding Retroperitoneum)2185Cornelius J. McGinn59Testis 1763Gerard C. Morton and Gillian M. Thomas60Penis and Male Urethra 1785DavidB. Mansur andK.S. Clifford ChaoPart N: Pediatric Tumors77Central Nervous System Tumors in Children 2206Carolyn R. Freeman, Jean-Pierre Farmer,and Roger E. TaylorPart J: Gynecologic Tumors61Uterine Cervix 1800Carlos A. Perez and Brian D. Kavanagh78Wilms' Tumor 2238John A. Kalapurakal and Patrick R. M. Thomas62Endometrium 1916John R. Glassburn, Luther W. Brady,and Perry W Grigsby79Neuroblastoma 2247JeffM. Michalski8063Ovary 1934Michael D. StambaughRhabdomyosarcoma 2261John C. Breneman and Sarah S. Donaldson8164Fallopian Tube 1958Patrizia Guerrieri and Luther W. BradyEwing's Sarcoma 2277Robert B. Marcus, Jr.8265Vagina 1967Carlos A. PerezLymphomas in Children 2285Melissa Hudson, Barbara L. Asselin, Lynda R. Mandell,and Louis S. Constine
Contents83Unusual Tumors in Childhood 2308Christian Carrie and Abraham Kuten89Pain Management 2412Nora A. JanjanPart O: Benign Diseases90Supportive Care and Quality of Life in RadiationOncology 2426Marvin Rotman, Darlene J. Johnson,and Todd H. Wasserman84Radiation Treatment of Benign Disease 2332William Serber, Luther W. Brady, Mei Zhang,and Richard T. Hoppe85Endovascular Brachytherapy 2352Prabhakar Tripuraneni and Ian CrockerSECTION 4: PALLIATIVE AND SUPPORTIVECARE86Palliation of Brain and Spinal-Cord Metastases 2373A. Robert Kagan87Palliation of Bone Metastases 2385Vaneerat Ratanatharathorn, William E. Powers,and H. Thomas Temple88Palliation of Visceral Recurrencesand Metastases 2405A. Robert KaganSECTION 5: ECONOMICS, ETHICS, ANDTECHNOLOGY ASSESSMENT91Technology Assessment, Cost Benefit, OutcomeResearch, and Evidence-Based Medicine 2443Carlos A. Perez, Ernest Franklin, Beverly Kobeissi,Edward C. Halperin, and Rupert K.Schmidt- Ullrich92Ethics, Professional Values, and Legal Considerationsin Radiation Oncology 2461Brian D. Kavanagh, Laurie Lyckholm,and Jeremy SugarmanIndex 2471
Jerry L. Barker, Jr., andK. KianAng 36 Salivary Glands 976 Joseph R. Simpson 37 Oral Cavity 997 Bahman Emami 38 Oropharynx (Tonsillar Fossa, Faucial Arch, and Base of Tongue) 1022 Carlos A. Perez, K. S. Clifford Chao, Joseph R. Simpson, Rupert K. Schmidt-Ullrich 39 Hypopharynx 1071 Bahman Emami and Rupert K. Schmidt- Ullrich 40 Larynx 1094
