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Radiation Oncology in Palliative Cancer Care

Wiley-Blackwellerschienen am01.07.2013
'This textbook, Radiation Oncology in Palliative Cancer Care, represents the full evolution of radiation therapy, and of oncology in general. ( ... ) [It] is an acknowledgment that palliative radiotherapy is now a sub-specialty of radiation oncology. This formally makes palliative radiotherapy a priority within patient care, academic research, quality assurance, and medical education.' - From the Foreword by Nora Janjan, MD, MPSA, MBA, National Center for Policy Analysis, Dallas, TX, USA

Palliative Medicine is the professional medical practice of prevention and relief of suffering and the support of the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. The most common cause for palliative care referral is terminal cancer, and a large proportion of those referrals include patients who will need palliative radiotherapy during the course of their disease. Still, there are barriers to coordinated care between radiation oncologists and palliative care physicians that differ from one country to another. Until now, one overarching limitation to appropriate concurrent care between the specialties across all countries has been the lack of a comprehensive yet concise reference resource that educates each of the specialties about the potential synergistic effects of their cooperation. This book fills that void.

Radiation Oncology in Palliative Cancer Care:
Is the first book-length treatment of this important topic available on the market
Is authored by world-renowned experts in radiation oncology and palliative medicine
Uses a multidisciplinary approach to content and patient treatment
Features decision trees for palliative radiotherapy based upon factors such as patient performance status and prognosis
Pays careful attention to current best practices and controversies in the delivery of end-of-life cancer care

This book is an important resource for practicing radiation oncologists and radiation oncologists in training, as well as hospice and palliative medicine physicians and nurses, medical oncologists, and geriatricians.



Stephen Lutz is one of only a small number of Radiation Oncologists who is also board certified in Hospice and Palliative Medicine.?He has served as the liaison between the US radiotherapy and palliative care communities for the past several years. His main research interests have included the formation of palliative radiotherapy treatment guidelines as well as the collaboration between the two specialties with regard to research, education, and patient advocacy.
Edward Chow is a Professor in the Department of Radiation Oncology at the University of Toronto?and is a senior scientist in the Sunnybrook Research Institute. He is Chair of the Rapid Response Radiotherapy Program and Bone Metastases Site Group in the Odette Cancer Center at?Sunnybrook Health Sciences Centre.
Peter Hoskin is a UK clinical oncologist with long standing research interests in palliative radiotherapy, in particular the management of bone metastases and spinal cord compression. He was a clinical research fellow in Palliative Medicine working in opioid pharmacology before focusing his interests in clinical oncology and was Chair of the International Consensus in Palliative Radiotherapy in 2000 and ESTRO Co-chair in 2010. He has written extensively on the role of radiotherapy in palliative care in original publications and major book chapters.mehr
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Klappentext'This textbook, Radiation Oncology in Palliative Cancer Care, represents the full evolution of radiation therapy, and of oncology in general. ( ... ) [It] is an acknowledgment that palliative radiotherapy is now a sub-specialty of radiation oncology. This formally makes palliative radiotherapy a priority within patient care, academic research, quality assurance, and medical education.' - From the Foreword by Nora Janjan, MD, MPSA, MBA, National Center for Policy Analysis, Dallas, TX, USA

Palliative Medicine is the professional medical practice of prevention and relief of suffering and the support of the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. The most common cause for palliative care referral is terminal cancer, and a large proportion of those referrals include patients who will need palliative radiotherapy during the course of their disease. Still, there are barriers to coordinated care between radiation oncologists and palliative care physicians that differ from one country to another. Until now, one overarching limitation to appropriate concurrent care between the specialties across all countries has been the lack of a comprehensive yet concise reference resource that educates each of the specialties about the potential synergistic effects of their cooperation. This book fills that void.

Radiation Oncology in Palliative Cancer Care:
Is the first book-length treatment of this important topic available on the market
Is authored by world-renowned experts in radiation oncology and palliative medicine
Uses a multidisciplinary approach to content and patient treatment
Features decision trees for palliative radiotherapy based upon factors such as patient performance status and prognosis
Pays careful attention to current best practices and controversies in the delivery of end-of-life cancer care

This book is an important resource for practicing radiation oncologists and radiation oncologists in training, as well as hospice and palliative medicine physicians and nurses, medical oncologists, and geriatricians.



Stephen Lutz is one of only a small number of Radiation Oncologists who is also board certified in Hospice and Palliative Medicine.?He has served as the liaison between the US radiotherapy and palliative care communities for the past several years. His main research interests have included the formation of palliative radiotherapy treatment guidelines as well as the collaboration between the two specialties with regard to research, education, and patient advocacy.
Edward Chow is a Professor in the Department of Radiation Oncology at the University of Toronto?and is a senior scientist in the Sunnybrook Research Institute. He is Chair of the Rapid Response Radiotherapy Program and Bone Metastases Site Group in the Odette Cancer Center at?Sunnybrook Health Sciences Centre.
Peter Hoskin is a UK clinical oncologist with long standing research interests in palliative radiotherapy, in particular the management of bone metastases and spinal cord compression. He was a clinical research fellow in Palliative Medicine working in opioid pharmacology before focusing his interests in clinical oncology and was Chair of the International Consensus in Palliative Radiotherapy in 2000 and ESTRO Co-chair in 2010. He has written extensively on the role of radiotherapy in palliative care in original publications and major book chapters.
Details
Weitere ISBN/GTIN9781118607169
ProduktartE-Book
EinbandartE-Book
FormatPDF
Erscheinungsjahr2013
Erscheinungsdatum01.07.2013
Seiten400 Seiten
SpracheEnglisch
Dateigrösse7815
Artikel-Nr.2877118
Rubriken
Genre9201

Inhalt/Kritik

Inhaltsverzeichnis
1;Cover;1
2;Title page;5
3;Copyright page;6
4;Contents;7
5;Contributor list;17
6;Foreword;21
7;PART 1: General principles of radiation oncology;25
7.1;CHAPTER 1: A brief history of palliative radiation oncology;27
7.1.1;Introduction;27
7.1.2;The early years;27
7.1.3;Fractionation;30
7.1.4;Advances in radiotherapy technique: the 1950s and 1960s;31
7.1.5;Fractionation revisited: explicit palliation;34
7.1.6;Stereotactic radiotherapy;35
7.1.7;Prognostication and tailoring palliative radiotherapy to anticipated survival;35
7.1.8;Conclusion;36
7.1.9;References;37
7.2;CHAPTER 2: The radiobiology of palliative radiation oncology;39
7.2.1;Introduction;39
7.2.2;Radiation effect on cells;39
7.2.2.1;Direct and indirect effect of radiation;39
7.2.2.2;Shape of the cell survival curves;41
7.2.3;Cell cycle characteristics;42
7.2.4;Interaction of cell cycle and radiotherapy fractionation;42
7.2.5;Radiotherapy fractionation characteristics;43
7.2.6;Conclusion;44
7.2.7;References;44
7.3;CHAPTER 3: The physics of radiation oncology;46
7.3.1;Introduction;46
7.3.2;The development of radiation therapy technology;48
7.3.2.1;The early understanding of radiation therapy;48
7.3.2.2;The development of teletherapy machines;48
7.3.2.3;The proliferation of linear accelerators;48
7.3.2.4;The advent of intensity modulated radiation therapy;49
7.3.2.5;Brachytherapy radiation;50
7.3.2.6;The impact of diagnostic improvements on radiotherapy delivery;50
7.3.3;Process of radiation therapy;51
7.3.3.1;Simulation;51
7.3.3.2;Dosimetry;51
7.3.3.3;Initiation of therapy;52
7.3.3.4;Patient immobilization;52
7.3.3.5;Management of patients during treatment;52
7.3.4;Special considerations in developing countries;52
7.3.5;Conclusion;53
7.3.6;References;53
7.4;CHAPTER 4: Curative intent versus palliative intent radiation oncology;55
7.4.1;Introduction;55
7.4.2;The determination of cure plus palliation intent versus pure palliative intent;57
7.4.3;Clinical diagnoses;59
7.4.3.1;High grade glioma;59
7.4.3.2;Pancreatic and biliary tract cancer;60
7.4.3.3;Lung cancer;60
7.4.3.4;Esophageal cancer;61
7.4.3.5;Gynecologic malignancies;61
7.4.3.6;Genitourinary cancer;61
7.4.3.7;Gastric cancer;62
7.4.3.8;Colorectal cancer;62
7.4.3.9;Advanced head and neck cancers;62
7.4.4;Special considerations in developing countries;62
7.4.5;Conclusion;63
7.4.6;References;63
7.5;CHAPTER 5: Side effects of palliative radiotherapy;67
7.5.1;Introduction;67
7.5.2;Issues with interpreting palliative radiotherapy toxicity data;68
7.5.3;Acute side effects;69
7.5.3.1;General;69
7.5.3.2;Fatigue;69
7.5.3.3;Hematologic;72
7.5.3.4;Skin and bone;72
7.5.3.5;Head and neck;73
7.5.3.6;Thorax;73
7.5.3.7;Abdomen and pelvis;73
7.5.3.8;Central nervous system (CNS);74
7.5.4;Late side effects;74
7.5.4.1;General;74
7.5.4.2;Fatigue;74
7.5.4.3;Skin and bone;75
7.5.4.4;Thorax;76
7.5.4.5;Abdomen and pelvis;76
7.5.4.6;Central nervous system;76
7.5.4.7;Second malignancies;77
7.5.5;Additive toxicity;77
7.5.6;Clinical advice;77
7.5.7;New technologies;79
7.5.8;Challenges in developing countries;79
7.5.9;Conclusion;80
7.5.10;References;80
8;PART 2: General principles of palliation and symptom control;85
8.1;CHAPTER 6: A history of hospice and palliative medicine;87
8.1.1;Introduction;87
8.1.2;Before the modern movement;87
8.1.3;St. Christopher s and the modern hospice;88
8.1.4;Palliative care in the United States;90
8.1.5;Global development of hospice and palliative care;92
8.1.6;Continuing challenges;93
8.1.7;References;93
8.2;CHAPTER 7: Radiation therapy and hospice care;96
8.2.1;Introduction;96
8.2.2;Hospice care around the world;96
8.2.3;Hospice care in the United States;97
8.2.3.1;Prognosis;100
8.2.3.2;Plan of care (POC);100
8.2.3.3;Physician role;100
8.2.3.4;Places of care;100
8.2.3.5;Payment to the hospice;101
8.2.4;Palliative radiation and hospice;101
8.2.5;Conclusion;103
8.2.6;References;103
8.3;CHAPTER 8: The current status of palliative care and radiotherapy;105
8.3.1;What is palliative care?;105
8.3.2;Who can benefit from palliative care?;105
8.3.3;What are the goals of palliative care and what features of a palliative care program help to accomplish these goals?;107
8.3.4;What is the evidence regarding the benefits and risks of palliative care? When should palliative care be introduced to a patient?;108
8.3.5;Are there standards for palliative care? If so, what are the defining measures?;112
8.3.6;How does palliative care fit in with radiation oncology?;114
8.3.7;References;116
8.4;CHAPTER 9: Palliative care in low and middle income countries: A focus on sub-Saharan Africa;119
8.4.1;Introduction;119
8.4.2;The need for palliative care;119
8.4.3;Radiotherapy;120
8.4.4;Specific clinical indications for palliative radiotherapy in Africa;121
8.4.4.1;Kaposi sarcoma;121
8.4.4.2;Cervical cancer;121
8.4.5;Challenges of palliative care delivery;122
8.4.6;Addressing challenges to adequate palliative care;122
8.4.6.1;Palliative care in medical training curricula;122
8.4.6.2;Leadership;123
8.4.6.3;The role of governments;124
8.4.7;Palliative care research;124
8.4.8;Delivery of palliative care;125
8.4.9;Conclusion;126
8.4.10;References;126
8.5;CHAPTER 10: Pain management;129
8.5.1;Introduction;129
8.5.2;Pain assessment;129
8.5.3;Analgesia ladder;130
8.5.4;Primary pharmacologic interventions;131
8.5.4.1;Non-steroidal anti-inflammatory drugs;131
8.5.4.2;Opioids;131
8.5.5;Adjuvant medications;132
8.5.5.1;Steroids;132
8.5.5.2;Anti-epileptics;132
8.5.5.3;Anti-depressants;133
8.5.6;End-of-life considerations;133
8.5.7;Conclusion;133
8.5.8;References;134
9;PART 3: Locally advanced or locally recurrent diseases;137
9.1;CHAPTER 11: Primary tumors of the central nervous system;139
9.1.1;Introduction;139
9.1.1.1;Incidence/prevalence, at-risk populations;139
9.1.1.2;Symptoms;139
9.1.1.3;Survival;140
9.1.2;Radiotherapy;140
9.1.2.1;Elderly and poor prognosis patients;142
9.1.2.2;Recurrent tumor after prior irradiation;142
9.1.2.3;Radiosurgery;143
9.1.2.4;Hypofractionated radiotherapy;143
9.1.3;Side-effect risks;144
9.1.3.1;Acute;144
9.1.3.2;Late;144
9.1.4;Radiotherapy limitations;144
9.1.5;Adjuvant treatment modalities;145
9.1.5.1;Radiotherapy combined with systemic therapy;145
9.1.6;Promise of newer technologies;145
9.1.6.1;Radioimmunotherapy;145
9.1.7;Special considerations in developing countries;146
9.1.8;Conclusion;146
9.1.9;References;146
9.2;CHAPTER 12: The role of palliative care in head and neck cancer;150
9.2.1;Introduction;150
9.2.2;Current management of head and neck squamous cell carcinomas;150
9.2.3;Patient selection for palliative treatment;151
9.2.4;Use of palliative radiotherapy in head and neck squamous cell carcinomas;154
9.2.5;Recurrent disease;158
9.2.6;The promise of emerging technologies;159
9.2.7;Chemotherapy in palliative head and neck squamous cell carcinomas;159
9.2.8;Non-squamous cell carcinomas histologies;160
9.2.9;Specific issues in palliation of head and neck squamous cell carcinomas;161
9.2.10;Special considerations in developing countries;162
9.2.11;Conclusion;162
9.2.12;References;163
9.3;CHAPTER 13: The role of palliative radiotherapy in breast cancer;169
9.3.1;Introduction;169
9.3.2;Rates of palliative loco-regional radiotherapy;172
9.3.3;Biologic considerations;172
9.3.4;Definitions, clinical features, and multi-disciplinary approach;172
9.3.5;Clinical scenarios;174
9.3.5.1;Locally advanced disease;174
9.3.5.2;Flap recurrence after mastectomy;174
9.3.5.3;Recurrence within a previously irradiated area;175
9.3.5.4;Hyperthermia with or without additional radiotherapy or systemic therapy;176
9.3.5.5;Axillary recurrence and brachial plexopathy;177
9.3.5.6;Supraclavicular node metastases;177
9.3.6;Symptom control;177
9.3.6.1;Bleeding;177
9.3.6.2;Ulceration, discharge, and infection;178
9.3.7;Palliative loco-regional radiotherapy for oligometastatic disease;178
9.3.8;Radiotherapy dosing schedules;178
9.3.8.1;Standard dose fractionation;178
9.3.8.2;Alternative fractionation;178
9.3.9;Radiotherapy technique and the promise of newer technology;180
9.3.10;Special considerations in developing countries;182
9.3.11;Follow up;182
9.3.12;Conclusion;183
9.3.13;References;183
9.4;CHAPTER 14: Palliative radiotherapy in advanced lung cancer;187
9.4.1;Introduction;187
9.4.2;Radiotherapy treatment;189
9.4.2.1;Overview;189
9.4.2.2;External beam dose fractionation;189
9.4.2.3;Endobronchial brachytherapy;192
9.4.2.4;Concurrent chemotherapy integrated with palliative thoracic radiotherapy;193
9.4.3;The impact of emerging technologies;193
9.4.4;Important circumstances;195
9.4.4.1;Patient selection;195
9.4.4.2;Patient preferences;196
9.4.4.3;Economic considerations;196
9.4.5;Special considerations in developing countries;197
9.4.5.1;Resource constrained practice;197
9.4.6;Conclusion;197
9.4.7;References;198
9.5;CHAPTER 15: Palliative radiotherapy for gastrointestinal and colorectal cancer;201
9.5.1;Introduction;201
9.5.2;Treatment of dysphagia;202
9.5.3;Gastric cancer;204
9.5.4;Palliation of biliary obstruction;205
9.5.5;Nodes at origin of the superior mesenteric artery;205
9.5.6;High dose rate brachytherapy;206
9.5.7;Locally advanced/recurrent rectal cancer;206
9.5.8;Re-irradiation;208
9.5.9;Anal cancer;208
9.5.10;The promise of highly conformal therapy;208
9.5.11;Special considerations in developing countries;208
9.5.12;Conclusion;209
9.5.13;References;209
9.6;CHAPTER 16: Genitourinary malignancies;212
9.6.1;Introduction;212
9.6.2;Incidence and etiology;212
9.6.3;Clinical behavior;214
9.6.4;Bladder cancer;214
9.6.5;Prostate cancer;214
9.6.6;Renal cancer;214
9.6.7;Palliative radiotherapy and other approaches for management of primary disease;216
9.6.7.1;Bladder cancer;216
9.6.7.2;Prostate cancer;216
9.6.7.3;Renal cancer;217
9.6.7.4;Other approaches;218
9.6.8;Specific management of metastatic disease in urologic malignancies;218
9.6.8.1;Prostate cancer;218
9.6.8.2;Renal cancer;219
9.6.9;The promise of highly conformal therapy;220
9.6.10;Special considerations in developing countries;221
9.6.11;Conclusion;221
9.6.12;References;221
9.7;CHAPTER 17: Palliative radiotherapy in locally advanced and locally recurrent gynecologic cancer;223
9.7.1;Introduction;223
9.7.2;Patterns of loco-regional failures for gynecologic cancers;224
9.7.3;Management;225
9.7.4;Treatment of recurrent carcinoma of the cervix;230
9.7.5;Recurrence after definitive radiation;230
9.7.6;Recurrence after definitive surgery;231
9.7.7;The promise of newer technologies;231
9.7.8;Special considerations in developing countries;231
9.7.9;Conclusion;232
9.7.10;References;233
9.8;CHAPTER 18: Hematologic malignancies and associated conditions;234
9.8.1;Introduction;234
9.8.2;Diagnoses;234
9.8.3;Specific clinical circumstances;237
9.8.3.1;Large bulky lymph nodes;237
9.8.3.2;Enlarged spleen;238
9.8.3.3;Chloromas (granulocytic sarcoma);239
9.8.3.4;Osseous involvement by plasma cell malignancies;240
9.8.4;Locally advanced and recurrent disease;240
9.8.5;Future directions;240
9.8.6;Special considerations in developing countries;241
9.8.7;Conclusion;241
9.8.8;References;241
9.9;CHAPTER 19: Pediatric palliative radiation oncology;244
9.9.1;Introduction;244
9.9.2;Delivery of radiation treatment;245
9.9.3;Differences between pediatric and adult populations;246
9.9.4;Background;246
9.9.5;Clinical indications for palliative radiotherapy;248
9.9.5.1;Superior vena cava syndrome and superior mediastinal syndrome;248
9.9.5.2;Bone and soft tissue metastases;250
9.9.5.3;Ewing sarcoma;252
9.9.5.4;Metastatic neuroblastoma;253
9.9.5.5;Other palliative options;253
9.9.5.6;Spinal cord compression;254
9.9.5.7;Brain metastases;255
9.9.6;Caring for the pediatric patient;256
9.9.7;Barriers to the use of palliative radiotherapy;257
9.9.8;Special considerations in developing countries;257
9.9.9;Conclusion;258
9.9.10;References;258
10;PART 4: Metastatic disease;263
10.1;CHAPTER 20: Bone metastases;265
10.1.1;Introduction;265
10.1.2;Clinical implications and treatment modalities;265
10.1.3;Clinical symptoms;266
10.1.3.1;Pain;266
10.1.3.2;Impending or pathologic fracturing;273
10.1.4;Technical considerations;274
10.1.5;Prognosis and choice for treatment;274
10.1.6;Proactive approach;275
10.1.7;Special considerations in developing countries;275
10.1.8;Conclusion;275
10.1.9;References;277
10.2;CHAPTER 21: Spinal cord compression;281
10.2.1;Introduction;281
10.2.1.1;Definition and incidence;281
10.2.1.2;Pathophysiology;281
10.2.1.3;Clinical presentation and diagnosis;282
10.2.1.4;Survival rates and life expectancy;283
10.2.2;Treatment;283
10.2.2.1;Surgery;283
10.2.2.2;Radiotherapy;285
10.2.2.3;Adjuvant treatment modalities;287
10.2.3;Promise of newer technologies;288
10.2.4;Re-irradiation;289
10.2.5;Special considerations in developing countries;289
10.2.6;Conclusion;290
10.2.7;References;291
10.3;CHAPTER 22: Brain metastases;294
10.3.1;Introduction;294
10.3.1.1;Incidence, prevalence, and symptoms;294
10.3.1.2;Survival rates/life expectancy;294
10.3.2;Radiotherapy treatment;295
10.3.2.1;Poor prognosis patients;298
10.3.2.2;Good prognosis patients;299
10.3.2.3;Side effects;300
10.3.3;Radiotherapy limitations;301
10.3.4;Promise of newer technologies and areas of ongoing research;301
10.3.5;International patterns of care and special considerations in developing countries;302
10.3.6;Conclusion;302
10.3.7;References;303
10.4;CHAPTER 23: Liver metastases;307
10.4.1;Introduction;307
10.4.1.1;Incidence/prevalence, at-risk populations;307
10.4.1.2;Symptoms;307
10.4.1.3;Survival rates/life expectancy;308
10.4.2;Radiotherapy treatment;308
10.4.3;Whole-liver radiation therapy;310
10.4.3.1;Side effects of WLRT;312
10.4.4;Conformal radiation therapy;312
10.4.4.1;Systemic or regional chemotherapy in conjunction with WLRT or CRT;312
10.4.4.2;Limitations of WLRT and conventional conformal external beam radiation therapy (EBRT);313
10.4.5;Brachytherapy;313
10.4.6;Selective internal radiation therapy;313
10.4.7;Surgery for liver metastases;314
10.4.8;Radiofrequency ablation;314
10.4.9;Promising new radiotherapy techniques;314
10.4.9.1;Stereotactic body radiation therapy;314
10.4.9.2;Side effects of stereotactic body radiation therapy;317
10.4.9.3;Limitations of SBRT;317
10.4.10;Practice variation among different countries;317
10.4.11;Conclusion;318
10.4.12;Acknowledgments;318
10.4.13;References;318
10.5;CHAPTER 24: Palliative radiotherapy for malignant neuropathic pain, adrenal, choroidal, and skin metastases;323
10.5.1;Malignant neuropathic pain;323
10.5.1.1;Clinical circumstance;323
10.5.1.2;Radiotherapy treatment;325
10.5.1.3;Conclusion;326
10.5.2;Adrenal metastases;326
10.5.2.1;Clinical circumstance;326
10.5.2.2;Radiotherapy treatment;329
10.5.2.3;Newer technologies;330
10.5.2.4;Special considerations in developing countries;332
10.5.2.5;Conclusion;332
10.5.3;Choroidal metastases;332
10.5.3.1;Clinical circumstance;332
10.5.3.2;Radiotherapy treatment;333
10.5.3.3;Special considerations in developing countries;335
10.5.3.4;Conclusion;335
10.5.4;Skin metastases (A.H. Wolfson);336
10.5.4.1;Special considerations in developing countries;337
10.5.5;Conclusion;338
10.5.6;References;338
11;PART 5: Integration of radiation oncology and palliative care;341
11.1;CHAPTER 25: Design challenges in palliative radiation oncology clinical trials;343
11.1.1;Introduction;343
11.1.2;Challenges with the validation of palliative metrics;343
11.1.3;Evolution of palliative care clinical trials: the Radiation Therapy Oncology Group experience;344
11.1.3.1;Bone metastases;345
11.1.3.2;Brain metastases;348
11.1.4;International research efforts;349
11.1.5;Conclusion;350
11.1.6;References;350
11.2;CHAPTER 26: Radiation oncology cost-effectiveness;353
11.2.1;Introduction;353
11.2.2;Cost-effectiveness;354
11.2.3;Newer technologies;356
11.2.4;Conclusion;357
11.2.5;References;357
11.3;CHAPTER 27: Quality measures and palliative radiotherapy;359
11.3.1;Introduction;359
11.3.2;Quality measures: characteristics;360
11.3.3;Developing quality measures;362
11.3.4;Desirable attributes of quality measures;364
11.3.5;Uses of quality measures;364
11.3.6;Current uses of quality measures in radiation oncology;365
11.3.7;International quality measures in radiation oncology;366
11.3.8;Conclusion;367
11.3.9;References;368
11.4;CHAPTER 28: Use of technologically advanced radiation oncology techniques for palliative patients;371
11.4.1;Introduction;371
11.4.2;Overview of technologically advanced radiotherapy techniques;371
11.4.3;Clinical applications reported in the literature;373
11.4.4;Brain metastasis;373
11.4.5;Stereotactic radiosurgery;373
11.4.6;Scalp-sparing whole brain radiation therapy;375
11.4.7;Hippocampus-sparing whole brain radiation therapy;375
11.4.8;Stereotactic radiation therapy;375
11.4.9;Spinal metastasis;376
11.4.10;Spinal cord compression;376
11.4.11;Bone metastasis;379
11.4.12;Adrenal metastasis;379
11.4.13;Toxicities associated with palliative radiotherapy using advanced technologies;380
11.4.14;Conclusion;381
11.4.15;References;381
12;Index;385
13;Supplemental Images;403mehr