Lawrence R. Coia, MD

This chapter provides a brief overview of the principles of radiation therapy. The topics to be discussed include the physical aspects of how radiation works (ionization, radiation interactions) and how it is delivered (treatment machines, treatment planning, and brachytherapy). Recent relevant techniques of radiation oncology, such as conformal and stereotactic radiation therapy, also will be presented. These topics are not covered in great tech­nical detail. It is hoped that a basic understanding of radiation treatment will benefit those practicing in other disciplines of cancer management. This chapter does not address the principles of radiobiology, which guide radiation oncologists in determining issues of treatment time, dose, and fractionation or in combining radiation with sensitizers, protectors, and chemotherapy or hormones.

This chapter provides a brief overview of the principles of radiation therapy. The topics to be discussed include the physical aspects of how radiation works (ionization, radiation interactions) and how it is delivered (treatment machines, treatment planning, and brachytherapy).

The fundamental principle behind this book, as stated by the publisher, The Oncology Group (also publisher of the journal ONCOLOGY and news magazine Oncology News International) was to provide a truly integrated, multidisciplinary approach to the management of cancer patients. For this updated 10th edition, the editors have enlisted 114 medical, surgical, and radiation oncologists, whose contributions provide an excellent overview of the important principles of cancer management.

This chapter provides a brief overview of the principles of radiation therapy.The topics to be discussed include the physical aspects of how radiation works(ionization, radiation interactions) and how it is delivered (treatment machines,treatment planning, and brachytherapy). Recent relevant techniques of radiationoncology, such as conformal and stereotactic radiation therapy, also willbe presented. These topics are not covered in great technical detail, and noattempt is made to discuss the radiobiological effects of radiation therapy. It ishoped that a basic understanding of radiation treatment will benefit those practicingin other disciplines of cancer management. This chapter does not addressprinciples of radiobiology, which guide radiation oncologists in determiningissues of treatment time, dose, and fractionation or in combining radiationwith sensitizers, protectors, and chemotherapy or hormones.

Dr. Kummar and her coauthors have tackled the difficult task of reviewing small bowel adenocarcinoma so that we might have a better understanding of this uncommonly encountered malignancy. The task is unusually difficult, not because of the need to critically review reams of publications on the topic, but rather because so little literature exists on the topic of optimal management. Nonetheless, the authors have succeeded in educating the reader on several important issues, including the need for close follow-up of patients with small bowel adenocarcinoma, who are not only at risk for recurrence but also have a relatively high risk of other gastrointestinal tumors. Additionally, the authors identify factors associated with poor prognosis, including age > 75 years, lack of surgical resection, advanced disease stage, and tumor arising in the duodenum.

Dr. Minsky’s two-part review of primary and adjuvant treatment of esophageal cancer is current and comprehensive. In it, he details our present understanding of esophageal cancer management by reviewing the most important studies conducted over the past 2 decades.

Dr. Krasna provides a thoughtful review of thoracoscopy as an emerging technique for the staging of patients with lung and esophageal cancers. In lung cancer, thoracoscopy can be used as a complement to cervical mediastinoscopy in the evaluation of mediastinal and hilar lymph nodes. This is especially true in patients who have left-sided neoplasms with enlarged lymph nodes in the aortico-pulmonary window--a region typically inaccessible to cervical mediastinoscopy.