Medical Radiology • Radiation Oncology Series Editors: L.W. Brady · J.J. Lu Mark Trombetta Jean-Philippe Pignol Paolo Montemaggi Luther W. Brady Editors Alternate Fractionation in Radiotherapy Paradigm Change Medical Radiology Radiation Oncology Series editors Luther W. Brady Jiade J. Lu Honorary editors Hans-Peter Heilmann Michael Molls For further volumes: http://www.springer.com/series/4353 Mark Trombetta • Jean-Philippe Pignol Paolo Montemaggi • Luther W. Brady Editors Alternate Fractionation in Radiotherapy Paradigm Change Editors Mark Trombetta Jean-Philippe Pignol Allegheny General Hospital Radiation Oncology Department Allegheny Health Network Cancer Erasmus University Medical Center Institute Rotterdam Drexel University College of Medicine The Netherlands Pittsburgh, PA USA Luther W. Brady Hylda Cohn/American Cancer Society Paolo Montemaggi Drexel University College of Medicine Allegheny Health Network Philadelphia, PA Temple University School of Medicine USA Pittsburgh Campus Pittsburgh, PA USA ISSN 0942-5373 ISSN 2197-4187 (electronic) Medical Radiology ISBN 978-3-319-51197-9 ISBN 978-3-319-51198-6 (eBook) https://doi.org/10.1007/978-3-319-51198-6 Library of Congress Control Number: 2018946650 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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(Jack) Fowler DSc, PhD, MD (Hon), FIPEM, FInstP, FRCR, FACR, FASTRO, FAAPM The authors of this book have dedicated it to Dr. Jack Fowler, an incredibly internationally renowned radiation biologist, radiation ther- apy physicist, as well as a major and signifi- cant supporter of all of the research efforts in radiation oncology. Dr. Fowler was renowned for his leadership at the Gray Laboratory in London and, upon his retirement, spent 7 years as professor at the University of Wisconsin, in Madison. His work in biology, particularly in reference to altered fractionation technologies and the desig- nation of alpha beta ratios of normal tissues and tumor tissues, was critically important in the evolution and development of stereotactic body radiosurgery. It was his groundbreaking contributions that led to the justification of altering fractionation technologies, which had not changed significantly since 1921. He pointed out that with the appropriate use of alpha beta ratios one could alter the fractionation and protraction techniques to shorter periods with larger doses without compromising normal tissue toxicities, but with improved outcome relative to management when compared with other tech- nologies in radiation therapy. Stereotactic body radiosurgery upon this foun- dation is now being employed in the treatment of tumors in all locations in the body from primary and secondary brain tumors, to head and neck tumors, to lung tumors, gastrointestinal tumors, pelvic tumors, bladder and prostate tumors. His contributions have been revolutionary in character substantiated by firm foundations in data to support the concept. It is upon Dr. Fowler’s basic scientific work that the present programs allow for altered fractionation technology with excellent results and without significant increase in complications. vi To Dr. Fowler, we owe a great debt of gratitude for his wise counsel, his innovative leadership, and his significant contributions to the field of radia- tion oncology. Luther W. Brady, MD Mark Trombetta, MD Jean-Philippe Pignol, MD, PhD Paolo Montemaggi, MD Contents Introduction .............................................. 1 Theodore E. Yaeger, Paolo Montemaggi, Mark Trombetta, Jean-Philippe Pignol, and Luther Brady The Radiobiological Aspects of Altered Fractionation ........... 5 Alan E. Nahum and Richard P. Hill Technological Advance Enabling Alternate Fractionation ........ 21 Olivier Gayou Workflow and Quality Assurance in Altered Fractionation ....... 31 Geoffrey S. Ibbott The Future of Altered Fractionation .......................... 41 Brian J. Gebhardt, Zachary D. Horne, and Sushil Beriwal Brachytherapy: The Original Altered Fractionation ............ 65 Mark Trombetta and Janusz Skowronek Part I D isease Site Specific Topics Altered Fractionation in Radiotherapy of CNS Tumors .......... 77 John C. Flickinger Head and Neck Cancer ..................................... 91 Olgun Elicin and E. Mahmut Ozsahin Whole-Breast Hypofractionated Radiotherapy ................. 127 Fernand Missohou, Mark Trombetta, and Jean-Philippe Pignol Accelerated Partial Breast Irradiation ........................ 141 Jean-Philippe Pignol, Nienke Hoekstra, Fernand Missohou, and Mark Trombetta Lung Cancer ............................................. 157 Mauro Loi and J.J. Nuyttens Alternate Fractionation for Hepatic Tumors ................... 173 Alejandra Méndez Romero, Thomas B. Brunner, Alexander V. Kirichenko, Wolfgang A. Tomé, Yun Liang, Nathan Ogden, and Ben J. M. Heijmen vii viii Contents Stereotactic Body Radiotherapy with Functional Treatment Planning in Hepatocellular Carcinoma ................... 203 Alexander Kirichenko, Eugene J. Koay, Shaakir Hasan, and Christopher Crane Gastrointestinal Cancer: Pancreas ........................... 211 Linda Chen, Lauren M. Rosati, and Joseph M. Herman Hypofractionation in Patients with Rectal Cancer .............. 229 Te Vuong, Slobodan Devic, and Krzysztof Bujko Hypofractionated Radiotherapy in Genitourinary Cancer: Better with Less ....................................... 241 Ruud C. Wortel and Luca Incrocci Fractionation Regimens for Gynecologic Malignancies .......... 257 Joanne Jang, Patrizia Guerrieri, and Akila N. Viswanathan Skin: The Case for Altered Fractionation in the Treatment of Both Malignant and Benign Conditions ........................ 273 James Fontanesi, Brian Kopitzki, and Richard Zekman Radiotherapy for Primary and Metastatic Soft Tissue Sarcomas: Altered Fraction Regimens with External Beam and Brachytherapy .................................... 307 Sara Alcorn and Stephanie Terezakis Stereotactic Body Radiotherapy ............................. 323 Gargi Kothari, Simon S. Lo, Matthew Foote, Arjun Sahgal, Irene Karam, Michael Lock, Gerrit J. Blom, Matthias Guckenberger, Ben J. Slotman, and Shankar Siva Altered Fraction Radiotherapy in Palliation ................... 397 Srinivas Raman, Natalie Logie, Joshua Jones, Eric Chang, Steven Lutz, and Edward Chow Erratum to: The Radiobiological Aspects of Altered Fractionation ......................................... 419 Alan E. Nahum and Richard P. Hill Index .................................................... 421 Contributors Sara Alcorn The Johns Hopkins Hospital, Baltimore, MD, USA Sushil Beriwal Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA Gerrit J. Blom Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands Luther Brady Hylda Cohn/American Cancer Society, Drexel University College of Medicine, Philadelphia, PA, USA Thomas B. Brunner Freiburg University Medical Center, Freiburg, Germany Krzysztof Bujko The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland Eric Chang University of Southern California, Los Angeles, CA, USA Linda Chen Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Edward Chow University of Toronto, Toronto, ON, Canada Christopher Crane Memorial Sloan Kettering Cancer Center, New York, NY, USA Slobodan Devic McGill University, Montreal, QC, Canada Olgun Elicin Department of Radiation Oncology, Inselspital, University Hospital of Bern, University of Bern, Bern, Switzerland John C. Flickinger University of Pittsburgh, Pittsburgh, PA, USA James Fontanesi William Beaumont Health Systems, Farmington Hills, Cancer Center, Oakland University School of Medicine, Rochester, MI, USA Matthew Foote Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia University of Queensland, Brisbane, Queensland, Australia Olivier Gayou John D Cronin Cancer Center, Lexington, KY, USA Brian J. Gebhardt Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA ix x Contributors Matthias Guckenberger Department of Radiation Oncology, University Hospital Zurich (USZ), Zurich, Switzerland Patrizia Guerrieri Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA Shaakir Hasan Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA Ben J.M. Heijmen Erasmus Medical Center, Rotterdam, The Netherlands Joseph M. Herman Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA Richard P. Hill Princess Margaret Cancer Centre, Toronto, ON, Canada Nienke Hoekstra Department of Radiation Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands Zachary D. Horne Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA Geoffrey S. Ibbott Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX, USA Luca Incrocci Erasmus Medical Center, Rotterdam, The Netherlands Joanne Jang Beth Israel Deaconess Medical Center, Boston, MA, USA Joshua Jones University of Pennsylvania, Philadelphia, PA, USA Irene Karam Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada Alexander V. Kirichenko Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA Eugene J. Koay MD Anderson Cancer Center, Houston, TX, USA Brian Kopitzki Clarkston Dermatology, Clarkston, MI, USA Gargi Kothari The Royal Marsden Hospital NHS Foundation Trust, London, UK Yun Liang Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA Michael Lock Division of Radiation Oncology, London Health Science Centre, London, ON, Canada Department of Oncology, Western University Radiation, London, ON, Canada Department of Medical Biophysics, Western University Radiation, London, ON, Canada Lawson Health Research Institute, London, ON, Canada London Regional Cancer Program, London, ON, Canada