Practical Essentials of Intensity Modulated Radiation Therapy

444 Pages·2013·76.05 MB·English

by  K.S. Clifford Chao

(c) 2015 Wolters Kluwer. All Rights Reserved.
Practical Essentials of
Intensity Modulated
Radiation Therapy
Third Edition
(c) 2015 Wolters Kluwer. All Rights Reserved.
75813_fm_pi-x.indd 1 01/08/13 9:02 PM
Practical Essentials of
Intensity Modulated
Radiation Therapy
Third Edition
EDITOR
K. S. Clifford Chao, MD
Chu H. Chang Distinguished Professor and Chairman
Radiation Oncology
College of Physicians and Surgeons
Columbia University
Professor and Chief
Radiation Oncology
Weill Cornell Medical College
Radiation-Oncologist-in-Chief
New York-Presbyterian Hospital
New York, New York
ASSOCIATE EDITORS
Tony J. C. Wang, MD
Assistant Professor of Radiation Oncology
Department of Radiation Oncology
College of Physicians and Surgeons
Columbia University
New York, New York
Tim Marinetti, PhD
Senior Grants Specialist
Department of Radiation Oncology
College of Physicians and Surgeons
Columbia University
New York, New York
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First edition copyright 2003, Lippincott Williams & Wilkins
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Library of Congress Cataloging-in-Publication Data
Practical essentials of intensity modulated radiation therapy / editor, K.S. Clifford Chao;
associate editors, Tony J.C. Wang, Tim Marinetti. — Third edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4511-7581-3 (hardback)
I. Chao, K. S. Clifford, editor of compilation. II. Wang, Tony J. C., editor of compilation.
III. Marinetti, Tim, editor of compilation.
[DNLM: 1. Radiotherapy, Intensity-Modulated—methods. 2. Neoplasms—radiotherapy.
WN 250.5.R2]
RC271.R3
616.99'40642—dc23 2013022753
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Contributing Authors
Anesa Ahamad, MD, FACR, DABR Clinical Director, Daniela Addeo, MD Physician, Department of
Radiation Oncologist, 21st Century Oncology, Radiation Oncology, Columbia University, New York,
Key West, Florida New York
Edgar Ben-Josef, MD Professor, Vice-Chair for David P. Horowitz, MD Chief Resident, Department of
Translational Research, Department of Radiation Radiation Oncology, New York-Presbyterian Hospital,
Oncology, University of Pennsylvania, Philadelphia, Columbia University Medical Center, New York,
Pennsylvania New York
Micah Berman, MD Resident Physician, Department of Nicole M. Hsu, MD Resident, Department of
Otolaryngology-Head and Neck Surgery, Columbia Otolaryngology—Head and Neck Surgery, New York-
University, New York-Presbyterian Hospital, Presbyterian Hospital, Weill Cornell Medical College
Columbia University Medical Center, New York, and Columbia University College of Physicians and
New York Surgeons, New York, New York
Eric L. Chang, MD Professor and Chairman, Department Anshu K. Jain, MD Resident Physician, Department of
of Radiation Oncology, Keck School of Medicine of Radiation Oncology, Columbia University Medical
University of Southern California, Medical Director, Center, New York-Presbyterian Hospital, New York,
Department of Radiation Oncology, Norris Cancer New York
Hospital, Los Angeles, California Ritsuko Komaki, MD Professor, Department of Radiation
K. S. Clifford Chao, MD Chu H. Chang Distinguished Oncology, The University of Texas MD Anderson
Professor and Chairman, Radiation Oncology, College Cancer Center, Houston, Texas
of Physicians and Surgeons, Columbia University, Katherine Lameka, MD Clinical Instructor, Department
Professor and Chief, Radiation Oncology, Weill Cornell of Radiology—Division of Nuclear Medicine,
Medical College, Radiation-Oncologist-in-Chief, Columbia University College of Physicians and
New York-Presbyterian Hospital, New York, New York Surgeons, Columbia University Medical Center,
Simon K. Cheng, MD, PhD Assistant Professor, New York-Presbyterian Hospital, New York,
Department of Radiation Oncology, Columbia New York
University, New York, New York David Leung, MD, PhD Assistant Professor, D epartment
Christopher H. Crane, MD Professor, Program Director of Radiology, Columbia University Medical Center,
and Section Chief, Gastrointestinal Section, New York-Presbyterian Hospital, New York,
Department of Radiation Oncology, The University of New York
Texas MD Anderson Cancer Center, Houston, Texas Zhongxing Liao, MD Professor and Clinical Medical
Prajnan Das, MD, MS, MPH Associate Professor, Director, Department of Radiation Oncology,
Department of Radiation Oncology, The University of The University of Texas MD Anderson Cancer
Texas MD Anderson Cancer Center, Houston, Texas Center, Houston, Texas
Prashant Desai, MD, MS Radiation Oncology, Weill Lilie L. Lin, MD Assistant Professor, Department of
Cornell Medical College, Resident, Radiation Radiation Oncology, University of Pennsylvania,
Oncology, New York-Presbyterian Hospital, Philadelphia, Pennsylvania
New York, New York Usama Mahmood, MD Assistant Professor,
Israel Deutsch, MD Assistant Professor of C linical Department of Radiation Oncology, The University
Radiation Oncology, Director of Brachytherapy of Texas MD Anderson Cancer Center, Houston,
Services, Department of Radiation Oncology, Texas
New York-Presbyterian Hospital, Columbia Tim Marinetti, PhD Senior Grants Specialist,
University Medical Center, New York, New York Department of Radiation Oncology, College of
Chaitanya R. Divgi, MD Professor of Radiology, Physicians and Surgeons, Columbia University,
Department of Radiology, Columbia University New York, New York
Medical Center, New York, New York Hasan Murshed, MD, MS Medical Director, Department
Lei Dong, PhD Director, Chief of Medical Physics, of Radiation Oncology, Hope Radiation Cancer Center,
Scripps Proton Therapy Center, San Diego, California Lynn Haven, Florida
v
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vi Contributing Authors
Gokhan Ozyigit, MD Professor of Radiation Oncology, Neha Sharma, MD New York-Presbyterian Hospital,
Department of Radiation Oncology, Hacettepe Cornell University Medical College, New York,
University, Faculty of Medicine, Oncology Hospital, New York
Ankara, Turkey Alexander M. Stessin, MD, PhD Resident Physician,
Department of Radiation Oncology, New York-
Bhupesh Parashar, MD Associate Professor,
Presbyterian Hospital, Weill Cornell Medical College,
Department of Radiation Oncology, Weill Cornell
New York, New York
Medical Center, New York-Presbyterian Hospital,
Department of Radiation Oncology, New York, Chiaojung Jillian Tsai, MD, PhD Resident Physician,
New York Department of Radiation Oncology, The University of
Texas MD Anderson Cancer Center, Houston, Texas
Ugur Selek, MD Associate Professor, Department of
Radiation Oncology, Koc University School of Tony J. C. Wang, MD Assistant Professor of Radiation
Medicine, Istanbul, Turkey and, The University of Oncology, Department of Radiation Oncology,
Texas MD Anderson Cancer Center, Houston, Texas, Columbia University, New York, New York
Department Chief, MD Anderson Radiation Cheng-Chia Wu, MD Resident Physician, Department of
Treatment Center, American Hospital, Istanbul, Radiation Oncology, Columbia University Medical
Turkey Center, New York, New York
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Preface
The rapid evolutionary pace of intensity-modulated The remaining chapters focus on those disease sites, which
radiation therapy (IMRT) was evident in the previ- have shown demonstrable benefits from IMRT either in
ous edition of this book. As predicted in its Foreword, locoregional control, survival, or, very importantly, the
new editions have become necessary to keep pace with reduction in radiation-induced morbidities and better
advances in technology and clinical practice. This third patient quality of life.
edition is intended not only for readers who want updates Chapters 4 through 11, which cover management of
on the most important changes in the field but also for head and neck cancers, have been updated with summa-
those interested in a broader and more detailed view of ries of the latest clinical studies and new target delineation
clinical management of specific malignancies. graphics. The chapters on breast and gynecologic cancers
IMRT has grown from a specialized experimental have been completely rewritten to reflect the magnitude
technique implemented by a few major institutions into of new material in these areas. New chapters on pancre-
the standard of care available at most cancer treatment atic, rectal, and anal canal cancers are provided, reflecting
hospitals, and a large number of vendors are now produc- IMRTs contributions to the treatment of these diseases.
ing treatment planning and RT delivery systems. The great The chapter on lung cancer has been augmented with a
promise of IMRT is its ability to employ a large number new section on stereotactic RT, which shows promise for
of beamlets, the intensity and direction of which are indi- previously intractable tumors.
vidually controlled. This allows for deliverance of high More than 90 new patient treatment graphics are
fluence to tumors of complex shapes, while minimizing included, most of which are panels consisting of 6 images
dosage to adjacent normal tissues. When coupled with the each. We have also replaced old black and white anatomi-
latest three-dimensional imaging modalities, such as CT, cal drawings with new color images. At the same time,
PET, and MRI, and the vast increase in affordable com- we have retained much of the historical data on disease
puting power, truly image-guided therapy is at hand. The etiology, diagnosis, and management to give the reader a
true limitation for the radiation oncologist is often less the more complete picture. To appreciate the potential and
accuracy of the treatment plan or of the megavolt photon demonstrated advantages of IMRT, one has to understand
sources, than are the biologic and anatomical uncertainties the successes and problems associated with past clinical
as to the actual tissues infiltrated or threatened by malig- treatment modalities.
nant disease. Hence, further research in molecular mark- Our goal in this new third edition continues to be that
ers and biologic imaging will be necessary for IMRT to of the second: to assist residents, fellows, and clinicians in
achieve maximal therapeutic ratios. radiation oncology in learning the practical essentials for
In order to concentrate on the new clinical aspects the clinical valuation, decision-making, and technical pro-
of IMRT, we have trimmed the introductory chapters on ficiency of IMRT. This is not a static, but rather, a dynamic
IMRT physics, mechanics, and quality assurance, and also interaction—it is from our targeted readership that future
CT and MRI. Excellent monographs and plentiful review innovations in IMRT planning and delivery will come.
articles are available; we have referenced such sources for
the interested reader. Given its importance in treatment K. S. Clifford Chao, MD
planning, we have a new chapter on molecular imaging, Tony J. C. Wang, MD
focusing on new PET tracers for image-guided therapy. Tim Marinetti, PhD
vii
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Acknowledgments
We would like to acknowledge the contributions of Mayr, MD; Shawn W. McNeely, MS; Cynthia Ménard, MD;
numerous colleagues in their work on the second Radhe Mohan, PhD; Allen R. Molloy, MD; Allan P ollack,
edition of this book, which formed the basis for prepara- MD, PhD; Robert A. Price, PhD, DABR; W. Roy Smythe,
tion of the new third edition: K.-Kian Ang, MD, PhD; Smith MD; Craig W. Stevens, MD, PhD; Wade L. Thorstad, MD;
Apisarnthanarax, MD; Angel Blanco, MD; Thomas A. Buch- Franz J. Wippold II, MD; Ping Xia, PhD.
holz, MD; Steven J. Feigenberg, MD; Kenneth M. Forster, We would also like to acknowledge A. Gabriella Wer-
PhD; Adam S. Garden, MD; Eric M. Horwitz, MD; Anuja nicke, MD, MSc, for her work on the initial draft of Chap-
Jhingran, MD; Michael V. Knopp, MD; Nancy Y. Lee, MD; ter 20, and to Michelle Rosenstam for the assistance with
H. Helen Liu, PhD; Homer A. M acapinlac, MD; Nina A. preparation of the bibliographies.
viii
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Contents
Contributing Authors v
Preface vii
Acknowledgments viii
CHAPTER 1 Delivery of Precision Radiation Therapy: IMRT, IGRT, Proton Beam Therapy ........................001
Tim Marinetti • Lei Dong
CHAPTER 2 Advances in Molecular Imaging to Guide Radiotherapy ........................................................033
Katherine Lameka • David Leung • Chaitanya R. Divgi
CHAPTER 3 Skull Base and CNS Glial Tumors ..........................................................................................043
Ugur Selek • Eric L. Chang
CHAPTER 4 Nodal Target Volume for Head and Neck Cancer and Normal Tissue Dose Constraints .......078
Tony J. C. Wang • Cheng-Chia Wu • K. S. Clifford Chao
CHAPTER 5 Paranasal Sinuses and Nasal Cavity ......................................................................................105
Anshu K. Jain • Nicole M. Hsu • Tony J. C. Wang • K. S. Clifford Chao
CHAPTER 6 Nasopharynx ..........................................................................................................................121
Tony J. C. Wang • K. S. Clifford Chao
CHAPTER 7 Oral Cavity .............................................................................................................................150
Anshu K. Jain • Nicole M. Hsu • K. S. Clifford Chao
CHAPTER 8 Oropharynx.............................................................................................................................171
Alexander M. Stessin • Gokhan Ozyigit • K. S. Clifford Chao
CHAPTER 9 Hypopharynx and Larynx ........................................................................................................204
David P. Horowitz • Micah Berman • Tony J. C. Wang • K. S. Clifford Chao
CHAPTER 10 Thyroid Carcinoma .................................................................................................................236
Prashant Desai • Tony J. C. Wang • Anesa Ahamad • K. S. Clifford Chao
CHAPTER 11 Metastatic Carcinoma in Neck Node with Unknown Primary ............................................... 258
Neha Sharma • Gokhan Ozyigit • K. S. Clifford Chao
CHAPTER 12 Breast .....................................................................................................................................269
Daniela Addeo
CHAPTER 13 Lung Cancer ...........................................................................................................................295
Simon K. Cheng • Bhupesh Parashar • Ritsuko Komaki • Hasan Murshed
ix
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