Gastrointestinal Cancer: Radiation Therapy PDF
Preview Gastrointestinal Cancer: Radiation Therapy
MEDICAL RADIOLOGY Diagnostic Imaging and Radiation Oncology Editorial Board L. W. Brady, Philadelphia· M. W. Donner, Baltimore H.-P. Heilmann, Hamburg· F. Heuck, Stuttgart Gastrointestinal Cancer Radiation Therapy Contributors Y.l.Belcastro . P.P.Carbone . B.J.Cummings . L.J.A.DiDio RRDobelbower, lr. . D.E.Dosoretz . RA.DuBrow . RJ.Fadell F.B.Gelder· P.l.Goldblatt . M.Haghbin . E.J.Hinson . J.M.Howard M.l.Katin· K.Kim . L.Komarnicky . J.Korinek . B.Levin J. H. Meerwaldt . W. M. Mendenhall . R R Million . M. Mohiuddin Y. B. Pinto· G. Ramirez· B. Sischy . St. M. Wagner Edited by Ralph R. Dobelbower, Jr. Foreword by Luther W. Brady and Hans-Peter Heilmann With 76 Figures Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong RALPH R.DoBELBOWER, JR., M.D., Ph.D., F.A.C.R. Professor and Chainnan Department of Radiation Therapy Professor of Neurological Surgery (Radiation Therapy) Medical College of Ohio 3000 Arlington Avenue C.S.10008 Toledo, OH 43699 USA MEDICAL RADIOLOGY· Diagnostic Imaging and Radiation Oncology Continuation of Handbuch der medizinischen Radiologie Encyclopedia of Medical Radiology ISBN-13: 978-3-642-83659-6 8-ISBN-13: 978-3-642-83657-2 001: 10.1007/978-3-642-83657-2 Library of Congress Cataloging-in-Publication Data. Gastrointestinal cancer: radiation therapy I contributors, V.J. Bel castro ... let al.l ; edited by Ralph R. Dobelbower, Jr. ; foreword by Luther W. Brady and Hans-Peter Heilmann. p. cm. - (Medical radiology) Includes bibliographical references. 1. Digestive organs -Cancer. 2. Digestive organs -Cancer - Radiotherapy. I. Belcastro, V.l. (Vincent J.) II. Dobelbower, Ralph R. III. Series. [DNLM: 1. Digestive System Neoplasms - radiotherapy. WI 149 G2568l RC280.D5G374 1990 616.99'4330642 -dc20 DNLM/DLC 89-21870 CIP This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, spe cifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9,1965, in its version of June 24, 1985, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1990 Softcover reprint of the hardcover 1st edition 1990 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific state ment, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publishers can give no guarantee for information about radiation or drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. This book is dedicated to my wife, Mary Louise Dobelbower, and our seven children, without whose patience, love, dedication, and sacrifice this work would not have come to fruition. RALPH R. DOBELBOWER, JR., 1989 "The answers to my questions are not found in any book" RALPH R. DOBELBOWER, SR., in his ninth decade 1981 List of Contributors VINCENT J. BELCASTRO, M. D. DANIEL E. DOSORETZ, M. D. Belcastro and Carrasquillo Radiation Therapy Regional Center Surgical Associates Radiation Therapy Associates Cape Coral Hospital 3680 Broadway 708 Del Prado Blvd. Fort Myers, FL 33901 Cape Coral, FL 33990 USA USA RONELLE A. DuBROW, M. D. PAUL P.CARBONE, M.D., Professor Associate Professor University of Wisconsin Division of Diagnostic Imaging Department of Human Oncology and Department of Diagnostic Radiology Wisconsin Clinical Cancer Center The University of Texas System Cancer 600 Highland Avenue Center Madison, WI 53792 M. D. Anderson Hospital and Tumor USA Institute 1515 Holcombe Blvd. B.J.CUMMINGS, M.B., Ch.B., FRCPC, Houston, TX 77030 F. R C. R, F. R A. C. R. USA Radiation Oncologist, Professor Department of Radiology RONALD J. F ADELL, M. D. University of Toronto Department of Radiology The Princess Margaret Hospital Medical College of Ohio 500 Sherbourne Street 3000 Arlington Avenue Toronto, Ontario, M4X 1 K9 C.S.l0008 Canada Toledo, OH 43699 USA LIBERATO J. A. DIDIO, M. D., D. Sc., Ph. D., Professor of Anatomy FRANK B. GELDER, Ph. D. Department of Anatomy Associate Professor of Surgery, Pathology, Medical College of Ohio and Microbiology IImmunology 3000 Arlington Avenue Director of Clinical Immunology C.S.l0008 Louisiana State University Medical Center Toledo, OH 43699 1501 Kings Highway USA Shreveport, LA 71130 USA RALPH R DOBELBOWER, JR., M. D., Ph. D., F. A. C. R., Professor and Chairman PETER J.GOLDBLATT, M.D. Department of Radiation Therapy Professor and Chairman Professor of Neurological Surgery Department of Pathology (Radiation Therapy) Dean of Graduate School Medical College of Ohio Medical College of Ohio 3000 Arlington Avenue 3000 Arlington Avenue C.S.10008 c. S. 10008 Toledo, OH 43699 Toledo, OH 43699 USA USA VIII List of Contributors MAHROO HAGHBIN, M. D. JOSEF KORINEK, M. D., Ph. D. Clinical Assistant Professor of Radiation Section of Gastrointestinal Oncology and Oncology Digestive Diseases, Division of Medicine School of Medicine and Dentistry The University of Texas University of Rochester Medical Center M. D. Anderson Cancer Center, Houston Rochester, NY 14620 P.O. Box 78,1515 Holcombe Blvd. USA Houston, TX 77030 USA E. JOSEPHINE HINSON, R. T. T. Research Assistant, Daisy Marquis Jones BERNARD LEVIN, M. D. Radiation Oncology Center Section of Gastrointestinal Oncology Highland Hospital and Digestive Diseases 1000 South Avenue Division of Medicine Rochester, NY 14620 The University of Texas USA M. D. Anderson Cancer Center, Houston P.O. Box 78, 1515 Holcombe Blvd. JOHN M. How ARD, M. D. Houston, TX 77030 Professor of Surgery USA Department of Surgery Medical College of Ohio 3000 Arlington Avenue J.H.MEERWALDT, M.D., Ph.D. c. S. 10008 The Dr. Daniel den Hoed Cancer Center Toledo, OH 43699 and Rotterdam Radio-Therapeutic Institute USA Department of Radiotherapy P. O. Box 5201 MICHAEL 1. KATIN, M. D. 3008 AE Rotterdam Radiation Therapy Regional Center The Netherlands Radiation Therapy Associates 3680 Broadway WILLIAM M. MENDENHALL, M. D. Fort Myers, FL 33901 Associate Professor of Radiation Therapy USA Department of Radiation Therapy University of Florida College of Medicine KITAI KIM, M. D. Box J-385, J. Hillis Miller Health Center Professor of Pathology Gainesville, FL 32610-0385 Department of Pathology USA Medical College of Ohio 3000 Arlington Avenue RODNEY R. MILLION, M. D. C.S.10008 Professor of Radiation Therapy Toledo, OH 43699 Department of Radiation Therapy USA University of Florida College of Medicine Box J-385, J. Hillis Miller Health Center LYDIA KOMARNICKY, M. D. Gainesville, FL 32610-0385 Department of Radiation Therapy USA and Nuclear Medicine Thomas Jefferson University Hospital Eleventh and Walnut Street MOHAMMED MOHIUDDIN, M. D. Philadelphia, PA 19107 Professor of Radiation Therapy USA and Nuclear Medicine Department of Radiation Therapy and Nuclear Medicine Thomas Jefferson University Hospital Eleventh and Walnut Street Philadelphia, PA 19107 USA List of Contributors IX VALERIAN B. PINTO, Doctoral Candidate BEN SISCHY, M. D. Department of MicrobiologyI Immunology Director Louisiana State University Medical Center Clinical Professor of Radiation Oncology 1501 Kings Highway School of Medicine and Dentistry Shreveport, LA 71130 University of Rochester Medical Center USA Daisy Marquis Jones Radiation Oncology Center GUILLERMO RAMIREZ, M. D. Highland Hospital Professor of Oncology 1000 South Avenue University of Wisconsin Rochester, NY 14620 Department of Human Oncology USA Wisconsin Clinical Cancer Center 600 Highland Avenue STEVEN M. WAGNER, M. D. Madison, WI 53792 Clinical Associate Professor USA of Medicine Department of Medicine Medical College of Ohio 3000 Arlington Avenue C.S.10008 Toledo, OH 43699 USA Foreword Primary malignant tumors of the gastrointestinal tract account for 23% of all invasive cancers and 24% of all the deaths in 1988. In the United States, the American Cancer Society estimates that there will be 227500 new cases of gastrointestinal malignancy di agnosed, with 122350 deaths. This includes 9800 new cases of carcinomas of the esopha gus, 24800 carcinomas of the stomach, 2500 new cases of malignant tumors of the small intestine, 105000 new cases of tumors of the large intestine, and 42000 new cases of car cinoma of the rectum, 14000 new cases involving the liver and biliary passages, 27000 new cases of carcinoma of the pancreas, and 2400 other unspecified digestive tract ma lignancies. This combined incidence is second only to the number of new cases of lung cancer. Bleeding from the gastrointestinal tract represents one of the earliest findings with re gard to malignancy of the gastrointestinal tract. In general, personal or family history of colon and rectal cancer, personal or family history of polyps in the colon or rectum, or inflammatory bowel disease are high risk factors with regard to tumors in these loca tions. Dietary behavior is also important in that a diet high in fat and/or low in fiber content may be a significant causative factor. In the assessment of patients with lesions involving the colon and rectum, a rectal ex amination should be performed every year after the age of 40, and if stool specimens re veal the presence of blood then a proctosigmoidoscopy should be carried out in order to precisely define the cause of the rectal bleeding. As the sites of most colorectal cancers appear to be shifting higher in the colon, the longer flexible instruments that are now available are required for adequate exploration of the entire colon, which is not possible with rigid proctoscopes. If abnormalities are found, then more extensive studies such as colonoscopy, barium enema, etc., should be carried out. In primary malignant tumors of the esophagus, the onset of symptoms is insidious in character and unfortunately delays diagnosis. The same is true for primary malignant tu mors involving the stomach, small intestine, liver and biliary passages, and pancreas. In these instances, there is a pressing need for appropriate diagnostic studies that would al low earlier diagnosis. Any insidious symptom relative to esophagitis, dysphagia, abdom inal pain, discomfort, or distress should be investigated fully in order to define the cause of the difficulty. In 1989, the management of malignant tumors involving the gastrointestinal tract has progressed to where combined integrated multimodal programs of management are ap propriate for essentially all tumor sites. Surgery plays an important role not only from the standpoint of diagnosis but in many instances from the standpoint of surgical resec tion. Oftentimes postoperative radiation therapy is appropriate in the period following surgical resection. Multidrug systemic chemotherapy is being studied more actively now in the treatment not only of advanced disease but also in those patients at high risk or local persistence or recurrence of their disease process. Various techniques for radiation therapy are finding important applications in malig nant tumors of the gastrointestinal tract including not only intraluminal placement of ra dioactive sources in order to boost the radiation dosage beyond that achieved by exter nal beam radiation therapy but also intraoperative radiation therapy for malignant tumors of the stomach, pancreas, biliary tree, and retroperitoneal lymph nodes. Intersti- XII Foreword tial implantation techniques using radioactive sources are appropriate for certain tumor sites such as the pancreas. With the growing number of primary malignant tumors of the digestive tract, more ef fort is now toward multimodal management than in the past, with gradual progressive improvement in terms of long-term survival without disease. The book put forth by Ralph R. Dobelbower, Jr. et al. addresses these questions in depth and makes recommendations as to appropriate techniques for early diagnosis, tu mor assessment, and staging as well as treatment procedures. LUTHER W. BRADY HANS-PETER HEILMANN Philadelphia Hamburg
The list of books you might like
