
Contents
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Introduction Introduction
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Historical perspective Historical perspective
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Radiobiology of normal tissues Radiobiology of normal tissues
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Radiosensitivity of normal tissues Radiosensitivity of normal tissues
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Acute effects of radiation Acute effects of radiation
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Late effects of radiotherapy Late effects of radiotherapy
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Radiation effects in specific tissues Radiation effects in specific tissues
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Skin: acute effects Skin: acute effects
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Skin: late effects (months/years) Skin: late effects (months/years)
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Oral mucosa Oral mucosa
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Gastrointestinal tract Gastrointestinal tract
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CNS CNS
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Lung Lung
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Kidney Kidney
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Heart Heart
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Normal tissue tolerance to re-treatment Normal tissue tolerance to re-treatment
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Carcinogenesis Carcinogenesis
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Repair of radiation-induced DNA damage Repair of radiation-induced DNA damage
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Hypoxia Hypoxia
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Radiotherapy fractionation Radiotherapy fractionation
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Objective Objective
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Linear quadratic model Linear quadratic model
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Number of treatments Number of treatments
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Few large daily fractions Few large daily fractions
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Many small daily fractions Many small daily fractions
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Radiosensitivity of tumours Radiosensitivity of tumours
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Tolerance doses of normal tissues Tolerance doses of normal tissues
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The inter-fraction interval The inter-fraction interval
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Hyperfractionation Hyperfractionation
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Overall treatment time and accelerated radiotherapy Overall treatment time and accelerated radiotherapy
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The optimum fractionation regimen The optimum fractionation regimen
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Radical radiotherapy Radical radiotherapy
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Palliative radiotherapy Palliative radiotherapy
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External beam radiotherapy External beam radiotherapy
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Basic principles Basic principles
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Superficial X-ray therapy Superficial X-ray therapy
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Cobalt teletherapy Cobalt teletherapy
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Megavoltage radiotherapy Megavoltage radiotherapy
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Electron therapy Electron therapy
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The planning process The planning process
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1. Beam dosimetry 1. Beam dosimetry
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2. Planning computer 2. Planning computer
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3. Target drawing 3. Target drawing
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4. Dose planning 4. Dose planning
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5. Treatment verification 5. Treatment verification
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6. Treatment prescription and delivery 6. Treatment prescription and delivery
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Progress in external beam radiotherapy Progress in external beam radiotherapy
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3D planning 3D planning
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Conformal treatment/multileaf collimators Conformal treatment/multileaf collimators
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Further reading Further reading
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Recent advances in external beam radiotherapy Recent advances in external beam radiotherapy
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Volume definition Volume definition
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Image-guided radiotherapy Image-guided radiotherapy
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Inverse planned intensity-modulated radiotherapy Inverse planned intensity-modulated radiotherapy
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Stereotactic radiotherapy Stereotactic radiotherapy
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Electron beam therapy Electron beam therapy
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Production of electron beams Production of electron beams
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Dosimetric characteristics of electron beams Dosimetric characteristics of electron beams
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Depth dose characteristics Depth dose characteristics
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Effect of incident energy Effect of incident energy
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Beam profile and penumbra Beam profile and penumbra
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Brachytherapy Brachytherapy
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Indications Indications
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Advantages Advantages
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Disadvantages Disadvantages
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Types Types
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Radionuclides Radionuclides
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Gamma emitters Gamma emitters
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Beta emitters Beta emitters
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Dosimetry Dosimetry
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Future developments Future developments
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Further reading Further reading
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Intra-operative radiotherapy Intra-operative radiotherapy
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Specific tumours Specific tumours
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Conclusions Conclusions
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The role of unsealed radionuclides The role of unsealed radionuclides
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Radiolabelled tracers Radiolabelled tracers
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Scintigraphic methods Scintigraphic methods
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Positron emission tomography (PET) Positron emission tomography (PET)
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Applications in diagnosis and follow-up Applications in diagnosis and follow-up
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Bone scintigraphy Bone scintigraphy
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Thyroid scintigraphy Thyroid scintigraphy
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Therapy with unsealed radioactive sources Therapy with unsealed radioactive sources
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Iodine-131 therapy in differentiated thyroid cancer Iodine-131 therapy in differentiated thyroid cancer
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131I-meta-iodobenzylguanidine (MIBG) therapy in neural crest tumours 131I-meta-iodobenzylguanidine (MIBG) therapy in neural crest tumours
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Bone-seeking radiopharmaceuticals for metastatic bone disease Bone-seeking radiopharmaceuticals for metastatic bone disease
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Intracavitary therapy Intracavitary therapy
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Monoclonal antibodies Monoclonal antibodies
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Total body irradiation (TBI) Total body irradiation (TBI)
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Aims of TBI Aims of TBI
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Indications for high-dose therapy Indications for high-dose therapy
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Haematological malignancies Haematological malignancies
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Other malignancies Other malignancies
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Types of haemopoietic reconstitution Types of haemopoietic reconstitution
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Pre-treatment screening Pre-treatment screening
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Preparation Preparation
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Technique Technique
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Calculation of dose Calculation of dose
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Dose schedules Dose schedules
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Toxicity of treatment Toxicity of treatment
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Acute effects Acute effects
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Late toxicity Late toxicity
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Cite
Extract
Introduction
Radiation oncology or radiotherapy is the treatment of malignant disease with ionizing radiation, most commonly using high-energy X-ray beams, external beam radiotherapy (EBRT). This treatment modality has been developed over the last 100 years, with considerable technical and clinical advances. It is now arguably the most important non-surgical cancer therapy, used in more than 50% of all patients with malignant disease.
Historical perspective
1896 Discovery of X-rays
1898 Discovery of radium
1899 Successful treatment of skin cancer with X-rays
1915 Treatment of cervical cancer with radium implant
1922 Cure of laryngeal cancer with a course of X-ray therapy
1928 Roentgen defined as unit of radiation exposure
1934 Dose fractionation principles proposed
1950s Radioactive cobalt teletherapy (1 MV energy)
1960s Production of megavoltage X-rays by linear accelerators
1990s 3-dimensional radiotherapy planning
2000s Intensity-modulated (IMRT), image-guided (IGRT), and stereotactic radiotherapy
When X-rays pass through living tissue, energy is absorbed, resulting in ionization of a number of molecules, with generation of fast-moving electrons and free radicals. Biologically, the most important effects involve DNA, where radiation may cause damage including breaks in the DNA double helix.
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