Quality assurance in radiotherapy

Chapter 23 discusses quality assurance of the patient pathway, concentrating on quality control of treatment planning and delivery. There is also discussion on relevant legislation associated with the radiotherapy process as well as a section on quality assurance for clinical trials.

Sarcomas of soft tissue and bone

Chapter 20 covers sarcomas of soft tissue and bone and includes discussion of radiotherapy for soft tissue sarcomas (including indications for radiotherapy, essential investigations for planning radiotherapy, patient preparation, planning imaging required for target definition, target definition, dose fractionation, and critical organs and tolerance doses,including the sites forearm, hands and feet, retroperitoneum, chest wall, and spinal/para-spinal), particular histologies (angiosarcoma and fibromatosis), particular radiotherapy techniques, and palliative treatment (including cerebral and lung secondaries),

Upper gastrointestinal tract

Chapter 7 discusses the upper gastrointestinal tract, and addresses the technical challenges of these cancersin relation to tumour volumes, anatomical situation, and poor normal tissue tolerance, particularly of the intra-abdominal contents. More contemporaneous treatment techniques such as intensity-modulated radiotherapy and stereotactic ablative radiotherapy have not currently made significant impact in the routine treatment of upper gastrointestinal tumours in the UK.

Radiotherapy planning for metastatic disease

Chapter 22 discusses radiotherapy planning for metastatic disease, predominantly for patients with bone metastasis, spinal cord compression, and brain metastasis. The techniques for such treatments are specific to this indication rather than the primary tumour site.

Head and neck cancer

Chapter 18 covers head and neck cancer emphasising the importance of a multidisciplinary team, comprising specialist surgeons, oncologists, pathologists, radiologists, and palliative care doctors, together with dieticians, speech and language therapists, and clinical nurse specialists. Radiotherapy for tumours of oral cavity, oropharynx, larynx, hypopharynx and nasal sinuses are discussed. .

Central nervous system tumours

Chapter 17 discusses central nervous system tumours, including principles, planning volumes, dose distribution, high- and low-grade glioma, ependymoma, medulloblastoma, germ cell tumours , vestibular (acoustic) schwannoma, pituitary tumours (including craniopharyngioma), meningioma, and primary spinal cord tumours.

Lymphomas

Chapter 16 discusses lymphomas, including discussion on nodal and extranodal non-Hodgkin lymphoma, and Hodgkin lymphoma. , treatment of early and late stage lymphomas, radiation therapy volume and dose, and planning techniques. It includes skin lymphomas and total body electron treatment, toxicity after radiotherapy for lymphoma, and second malignancies.

Testis

Chapter 12 discusses the role of radiotherapy in testicular cancer and how it is becoming less prominent. The mainstay of treatment is radical orchidectomy and, where there is a risk of metastatic disease, combination chemotherapy. Radiotherapy may be indicated in the following situations: 1) stage I and IIa testicular seminoma delivering prophylactic para-aortic lymph nodes irradiation, and 2) palliative treatment in the management of chemotherapy resistant disease.

Prostate cancer

Chapter 10 discusses prostate cancer and includes discussion on indications including radical radiotherapy to prostate ± seminal vesicles, pelvic radiotherapy, post-prostatectomy radiotherapy, palliative radiotherapy to prostate ± pelvis, palliative radiotherapy to metastases, and breast bud radiotherapy for the prevention or treatment of gynaecomastia, radical radiotherapy planning, target volume definition , dose distribution, implementation, verification, dose prescription, toxicity and care during treatment, the role of hormonal therapy in combination with radical radiotherapy, treatment outcome, and future developments.

Breast radiotherapy

Chapter 5 discusses breast radiotherapy and includes discussion on the evidence-based rationale for radiotherapy, including adjuvant loco-regional radiotherapy and other indications, adverse effects of breast and lymphatic radiotherapy, pre-planning procedures, radiotherapy planning, treatment and verification, and patient assessment and follow-up.