Principles and Practice of Radiotherapy Techniques in Thoracic Malignancies

 

Description:

This evidence-based guide on the use of radiotherapy in patients with common malignancies of the lung, esophagus, and thymus will help radiation oncologists to deliver optimal care within a multidisciplinary setting. Detailed information is provided on all aspects, from delineation of tumor volumes and organs at risk based on four-dimensional CT simulation through to the various advanced radiotherapy techniques, including stereotactic ablative radiotherapy (SABR), intensity-modulated radiation therapy (IMRT), tomotherapy, volumetric modulated arc therapy (VMAT), and proton therapy. Contouring, treatment planning, and treatment delivery are documented in a range of everyday cases, with illustrations of slice-by-slice delineations on planning CT images and finalized treatment plans based on detailed acceptance criteria. Numerous practical tips are highlighted, and relevant information is included on surgical techniques and systemic therapies. The book will facilitate decision making in the management of patients with common thoracic malignancies and assist in overcoming the challenges encountered in daily clinical practice.

 

 

Table of Contents:

 

1: Selection Criteria for Definitive Treatment Approach in Thoracic Malignancies: Radiation Oncolo

Introduction

Evaluation of Dosimetric Values in Planning

Baseline Pulmonary Function

Three-Dimensional Conformal Radiotherapy (3DCRT) and Intensity-Modulated Radiotherapy (IMRT)

Chemotherapy

Cardiopulmonary Relationship

Functional Imaging, Assessment, and Prediction

Immune Parameters

Conclusion

References

2: Modern Radiotherapy Techniques in Lung Cancer

Introduction

Radiation Treatment Planning

Positron Emission Tomography (PET-CT) Simulation

Motion Management

Four-Dimensional CT Simulation (4D-CT)

Breathing Control: Breath-Hold Technique

Active Breathing Control

Gating

Abdominal Compression

Image Guidance Technology

Real-Time Tracking

Treatment Delivery

Intensity-Modulated Radiotherapy (IMRT)

Volumetric Arc Therapy

Image-Guided Adaptive Radiation Therapy

Proton Therapy

Stereotactic Body Radiotherapy

Conclusion

References

3: Guidelines for the Delineation of Primary Tumor Target Volume in Lung Cancer

Introduction

Target Volume Delineation

Tracking Tumor Mobility

Gross Tumor Volume (GTV)

Clinical Target Volume (CTV)

Internal Target Volume (ITV)

Planning Target Volume (PTV)

Conclusion

References

4: Guidelines for the Delineation of Lymphatic Target Volumes in Lung Cancer

Introduction

Treatment Strategies in Non-small Cell Lung Cancer

Treatment Strategies in Small Cell Lung Cancer

Target Volume Delineation

Level 1 (Low Cervical/Supraclavicular LNs)

Level 2 (Upper Paratracheal LNs)

Level 3A (Prevascular LNs)

Level 3P (Retrotracheal LNs)

Level 4 (Lower Paratracheal LNs)

Level 5 (Subaortic/AP Window LNs)

Level 6 (Para-aortic LNs)

Level 7 (Subcarinal LNs)

Level 8 (Paraesophageal LNs)

Level 9 (Pulmonary Ligament LNs)

Level 10–14 LNs

Clinical Target Volume and Planning Target Volume

Conclusion

References

5: Stereotactic Ablative Radiotherapy for Lung Cancers

Introduction

SABR in Inoperable Early-Stage Non-small Cell Lung Cancer

Patient Preparation, Simulation, and Treatment for CyberKnife™

Treatment According to Tumor Localization

Treatment of Larger Tumors with SABR

SABR in Operable Lung Cancer Patients

Is There Any Contraindication for Lung SABR?

Following Tumor Response After Lung SABR

Conclusion

References

6: Radiochemotherapy and Fractionation in Locally Advanced Non-small-cell Lung Cancer

Introduction

Lung Cancer Screening

Biology of Lung Cancer

Staging of NSCLC

Prognostic Factors

Treatment of LA-NSCLC

Radiotherapy Alone

Induction (Neoadjuvant) Chemotherapy Followed by TRT

Concurrent Chemoradiotherapy

Preoperative Chemoradiotherapy for Stage IIIA-N2 Patients

Management of Elderly LA-NSCLC Patients

Radiotherapy Techniques in NSCLCs

Radiotherapy Planning (RTP)

Three-Dimensional Conformal Radiotherapy (3D-CRT)

Immobilization

Imaging

Target Volume Definition

GTV Delineation

CTV Delineation

PTV Delineation

Internal Target Volume (ITV) Delineation

Delineation of OAR Volumes

Role of Elective Nodal Irradiation

Thoracic Radiotherapy Doses

Altered Fractionation and Isotoxic TRT

IMRT in LA-NSCLC

Treatment Plan Evaluation

Radiotherapy Dose, Target Volume Coverage, and Organ at Risk Dose Limits

Treatment for Intrathoracic Recurrences

Recommended Treatment Algorithm for LA-NSCLC

Conclusion

References

7: Stereotactic Cranial Radiosurgery for Metastatic Non-small-cell Lung Carcinoma

Introduction

Biology of Brain Metastasis

Prognostic Factors

Treatment

Stereotactic Radiosurgery

Radiobiology of SRS

Comparative Clinical Outcomes of SRS

SRS for Multiple BM

SRS for Large BM

SRS for Tumor Bed

SRS for Recurrent Lesions

Complications of SRS

Acute Complications

Late Complications

Quality of Life

SRS Techniques

Patient Immobilization and Setup

Imaging

Delineation of Target Volume

Delineation of OAR Volumes

Target Dose Selection

Defining the Dose Prescription Isodose Lines

The Assessment of Treatment Plan

RTOG Indices

Alternative Conformity Indices

Recommended Treatment Algorithms for SRS

Conclusion

References

8: Modern Radiotherapy in Limited and Extensive Stage Small-Cell Lung Cancer

Introduction

Staging

Histologic and Immunohistochemical Markers

Prognostic Factors

Treatment of LS-SCLC

Surgery

Chemotherapy

Thoracic Radiotherapy (TRT)

Early Versus Delayed Thoracic Radiotherapy

Dose and Fractionation

Extensive Stage SCLC

Radiotherapy Techniques

3D-Conformal Radiotherapy (3D-CRT)/

Immobilization

Target Volume Definition

GTV Delineation

CTV Delineation

PTV Delineation

Internal Target Volume (ITV) Delineation

Delineation of OAR Volumes

TRT Portal Size Without Elective Nodal Irradiation in SCLC

TRT Portal Size After Induction Chemotherapy

Management of Poor Performance Status and Elderly SCLC Patients

Plan Evaluation

Prophylactic Cranial Irradiation

Recommended Treatment Algorithm for SCLC

Conclusion

References

9: Prophylactic Cranial Irradiation in Small- and Non-small-Cell Lung Carcinoma

PCI in Small-Cell Lung Carcinoma

PCI for Geriatric SCLC Patients

PCI in Locally Advanced Non-small-Cell Lung Carcinoma

Patients at Higher Risk of BM Development

Rationale of PCI in NSCLC

Efficacy of PCI in High-Risk NSCLC Patients

Nonrandomized Studies

Randomized Studies

Treatment Techniques

Standard PCI Technique and Doses

Novel Cranial Irradiation Techniques to Avoid Neurocognitive and Scalp Toxicity

Hippocampal Avoidance PCI

Scalp-Sparing PCI

Key Points on PCI-Related Toxicity Assessment

Conclusion

References

10: Systemic Therapy for Lung Cancer

Non-small Cell Lung Cancer (NSCLC)

Early Stage Non-small Cell Lung Cancer

Adjuvant Therapy for Resected NSCLC

Neoadjuvant Chemotherapy

Advanced Stage Non-Small Cell Lung Cancer

Initial Systemic Treatment for Advanced NSCLC

Maintenance Therapy

Second-Line Treatment

Targeted Therapies

Antiangiogenic Therapies

Immunotherapy for Non-small Cell Lung Cancer Progressing After Platinum-Based Chemotherapy

Systemic Treatment for Small Cell Lung Cancer (SCLC)

Limited Disease

Extensive Disease

Second-Line Treatment

References

11: Surgical Staging and Advanced Surgical Techniques in Early Stage Non-small Cell Lung Cancers

Case Presentation

Case 1

Case 2

Evidence-Based Surgical Approaches

Surgical Staging

References

12: Translational Research and Immunotherapy in Lung Cancer

Overview: Targeted Therapy for Lung Cancer

Alternatives to Tumor Sampling: “Liquid Tumor Biopsies”

Biomarkers of Toxicity: Single Nucleotide Polymorphisms and Radiation Pneumonitis

Biomarkers of Response to Therapy: MicroRNAs

Immunotherapy for Lung Cancer

How Tumors Evade the Immune System

Targeting PD1/PDL1

Targeting TGFβ

TGFβ and the Immune System

TGFβ, Lung Cancer, and Radiation Therapy

Immunotherapy and the Abscopal Effect

Evading Immune Surveillance

Radiation and the Immune System

Enhancing the Abscopal Effect by Combining Radiation with Immunotherapy

Three Phases of Immune Activation for an Abscopal Effect

Abscopal Effects in NSCLC

Radiation Therapy and the Tumor Microenvironment

Regulatory T-Cell Radioresistance

Recruitment of MDSCs After Radiation Therapy

Recruitment of Tumor-Associated Macrophages and M2 Polarization of Macrophages After Radiation

Upregulation of Hypoxia-Inducing Factors After Radiation Therapy

Clinical Relevance: Non-Small Cell Lung Cancer

Targeted Therapies

EGFR Inhibitors

ALK Translocations

KRAS Mutations

Clinical Studies of Immunotherapy

Stage I NSCLC

Stage II NSCLC

Stage III NSCLC

Stage IV NSCLC

Clinical Relevance: Small Cell Lung Cancer

Clinical Relevance: Mesothelioma

Future Directions

Chimeric Antigen Receptor T-Cell Therapy

NK-Cell Therapy

Tumor Vaccines and Other Immune Agents

Cancer Vaccines

Immune Agents Targeting the TNF Receptor Superfamily

References

13: Esophageal Cancer

Epidemiology

Pathological and Biological Features

Staging

Evidence-Based Treatment Approaches

Superficial Tumors

Locoregional Cancer (Stages I–III)

Should Every Patient Undergo Esophagectomy? Selecting Patients Best Suited for Chemoradiotherapy A

Surveillance Salvage

Recommended Algorithm for Treatment of Esophageal Cancer

Target Volume Determination and Delineation Guidelines

Simulation

Contouring: A Case Example

Treatment Planning

Treatment Planning Assessment

Recommended Algorithm for Follow-Up Surveillance of Esophageal Cancer

References

14: Systemic Treatment of Esophageal Cancer

Introduction

Chemotherapy in Metastatic Esophageal Cancer

Second-Line Chemotherapy in Esophageal Cancer

Chemotherapy in Localized/Locally Advanced Esophageal Cancer

Chemotherapy for Esophageal Adenocarcinoma

Second-Line Chemotherapy

Molecular Biology of Esophageal SCC and Adenocarcinoma

Targeted Therapies in Esophageal SCC and Adenocarcinoma

EGFR

HER-2

Targeting Angiogenesis

Immune Checkpoint Inhibition

MET and Hepatocyte Growth Factor

Fibroblast Growth Factor Receptor

Conclusion

References

15: Advanced Surgical Approaches for the Management of Esophageal Carcinoma

One Hundred Years of Esophagectomy

Multimodality Therapy for Esophageal Cancer

Principles of Surgery for Esophageal Carcinoma

Timing of Esophagectomy

Salvage and Selective Esophagectomy

Esophageal Replacement Conduits

Stomach

Jejunum

Colon

Anastomoses: Locations, Types, and Complications

Extent of Lymphadenectomy

Postoperative Care and Surveillance

Conclusion

References

16: Radiotherapy in Thymic Tumors

Pathological and Biological Features

Pathology

Staging

Evidence-Based Treatment Approaches

Stage I

Stage II

Stage III–IV

Thymic Carcinoma

Target Volume Determination and Delineation Guidelines

Simulation

Gross Tumor Volume

Internal Target Volume or Internal GTV

Clinical Target Volume (CTV)

Planning Target Volume (PTV)

Case Contouring: A Case Example

Treatment Planning

Treatment Planning Assessment

Recommended Treatment Algorithm for Treatment of Thymoma

Recommended Algorithm for Follow-Up

References

17: Surgical Staging and Advanced Surgical Techniques in Thymic Cancers

Introduction

Surgery in Thymic Malignancies

Surgery in Recurrent Thymic Malignancies

Case 1

Case 2

References

18: Systemic Therapies in Thymic Malignancies

Introduction

ITMIG

Presentation and Diagnosis

Imaging and Differential Diagnosis

Compartments of the Mediastinum

Differential Diagnosis of Prevascular Compartment Mass

Approach for Diagnosis

Be Aware of Demographics

Communicate Clinical Information

Radiological Appearance

Other Imaging Studies

PET/CT

Radionuclide Scan

Need for Biopsy

Pathology

Staging

Treatment

The Difficulty of Interpreting Studies for the Treatment of TETs

Upfront Resectable Disease

Importance of Lymph Nodes

Potentially Resectable Disease

Is There a Role of Surgery in Locally Advanced Thymoma?

Is There a Role for Debulking Surgery for Thymoma or Thymic Carcinoma?

Is There a Role of Neoadjuvant Concurrent Chemoradiotherapy?

What Is the Role of Induction Chemotherapy Alone?

Adjuvant Therapy

Stage-Based Adjuvant Treatment Summary

Chemotherapy

Radiotherapy

Advanced Disease

Chemotherapy

Can We Replace Cisplatin with Carboplatin?

Previously Treated

Cap-Gem

Paclitaxel (or Nab-Paclitaxel) and Platinum Compounds

Docetaxel

Pemetrexed

S-1

What Are the Best Chemotherapy Choices for Second-Line Treatment of Thymic Carcinoma?

Targeted Therapies

Somatostatin Receptor Analogs

Octreotide

Radionuclide Treatment

mTOR: Everolimus

Multi-targeted Tyrosine Kinase Inhibitors: Sunitinib

IGF-1R: Cixutumumab

Histone Deacetylase Inhibitor: Belinostat

c-KIT and PDGFR: Imatinib

Anti-PD1 Treatments

EGFR and VEGF: Gefitinib, Erlotinib, and Bevacizumab

Src Inhibitor: Saracatinib

References

19: Target Volume Delineation Guidelines in Malignant Pleural Mesothelioma

Introduction

Patient Simulation

Target Volume Delineation

Delineation of the Organs at Risk

Liver

Contouring

Dose-Volume Constraints and Toxicity

Kidneys

Contouring

Dose-Volume Constraints and Toxicity

Conclusion

References

20: Modern Radiotherapy Techniques in Malignant Pleural Mesothelioma

Introduction

Role of Adjuvant Radiotherapy in MPM

Role of Radiotherapy in Unresectable MPM

Role of Radiotherapy for Drain Sites of MPM

Hemithoracic Radiotherapy Techniques

Treatment with Three-Dimensional Conformal Radiation Therapy

Treatment with Intensity-Modulated Radiation Therapy

Treatment with Arc Therapy

Treatment with Protons and Heavy Particles

Conclusion

References

21: Modern Surgical Techniques in Malignant Pleural Mesothelioma

Introduction

Cytoreductive Surgery

References

22: Systemic Therapies in Malignant Pleural Mesothelioma

Introduction

First-Line Therapies

Cisplatin Plus Pemetrexed

Carboplatin Plus Pemetrexed

Pemetrexed-Cisplatin Plus Bevacizumab

Raltitrexed Plus Cisplatin

Gemcitabine Plus Cisplatin

Gemcitabine-Cisplatin Plus Bevacizumab

Methotrexate

Raltitrexed

Anthracycline

Vinca Alkaloids

Second-Line Therapies

Cisplatin

Pemetrexed

Gemcitabine and Combinations

Gemcitabine Plus Vinorelbine

Novel Therapies

Vorinostat

Thalidomide

Imatinib

Pembrolizumab

Tremelimumab

m-TOR Inhibitors

References

23: Radiation-Induced Toxicities and Management Strategies in Thoracic Malignancies

Introduction

Lung

Contouring

Dose-Volume Constraints and Toxicity

Heart

Contouring

Dose-Volume Constraints and Toxicity

Esophagus

Contouring

Dose-Volume Constraints and Toxicity

Spinal Cord

Contouring

Dose-Volume Constraints and Toxicity

Brachial Plexus

Contouring

Dose-Volume Constraints and Toxicity

Chest Wall and Ribs

Contouring

Dose-Volume Constraints and Toxicity

Trachea and Proximal Bronchial Tree

Contouring

Dose-Volume Constraints and Toxicity

Conclusion

References

24: Quality Assurance of Modern Radiotherapy Techniques in Thoracic Malignancies

Introduction

Patient Simulation

Setup and Immobilization

Image Acquisition

Respiratory Monitoring Devices

Quality Assurance of CT Simulators

Patient Planning

Consideration of Tumor Margins During the Planning Process

Practice of Plan Quality Evaluation

TPS Dose Calculation Verification

Pretreatment Patient-Specific QA

Patient Setup and Delivery

Setup and Pretreatment Imaging

QA of Imaging Systems

QA of Delivery Systems

End-to-End Testing of the Treatment Process

Conclusion

References

Index

 

An aparitie	2016
Autor	Ozyigit
Dimensiuni	16.13 x 3.33 x 24.13 cm
Editura	Springer
Format	Hardcover
ISBN	9783319287591
Limba	Engleza
Nr pag	550