Radiation Therapy for Genitourinary Malignancies: A Practical and Technical Guide (Practical Guides in Radiation Oncology)

✍ Scribed by Abhishek A. Solanki (editor), Ronald C. Chen (editor)

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 361
• Category: Library

✦ Synopsis

This book is a comprehensive guide to the use of modern radiation therapy techniques for prostate cancer and other common and rare genitourinary malignancies. It will be an ideal resource for clinicians and trainees wishing to delve more deeply into the practical and technical aspects of radiotherapy for these malignancies and will serve to enhance day-to-day management in clinical practice. The first section is devoted to prostate cancer and includes coverage of low dose rate and high dose rate brachytherapy, conventionally fractionated, moderately hypofractionated, and ultra-hypofractionated external beam radiotherapy, and proton therapy. The second section focuses on radiotherapy considerations in relation to bladder cancer, testicular cancer, renal cell carcinoma, and rare malignancies such as penile cancer and urethral cancer. Radiotherapeutic treatment of patients with genitourinary malignancies now involves unprecedented precision and complexity, and this book will enable readers to exploit fully the exciting advances that have been achieved in recent years.

✦ Table of Contents

Preface
Contents
Part I: Prostate Cancer
1: The Management of Prostate Cancer
1.1 Epidemiology
1.2 Anatomy and Physiology
1.3 Pathology
1.3.1 Histology
1.3.2 Prostate Adenocarcinoma Grading
1.4 Diagnosis
1.5 Staging and Risk Groupings
1.6 Management of Intact Prostate Cancer
1.6.1 Low Risk
1.6.2 Favorable Intermediate Risk
1.6.3 Unfavorable Risk (Unfavorable Intermediate to Very High Risk)
1.7 Post-prostatectomy Radiation Therapy
1.8 Treatment of Metastatic Prostate Cancer
1.9 Technological Advancements in Radiotherapy
1.10 Focus on Patient Reported Quality of Life
1.11 Follow-Up and Survivorship
References
2: Imaging in Prostate Cancer
2.1 Overview of Imaging Modalities in Prostate Cancer
2.2 Imaging in Prostate Cancer Diagnosis and Staging
2.2.1 Prostate Cancer Screening
2.2.2 MRI-Directed Biopsies
2.2.3 Exclusion of Metastasis
2.2.4 Characterization of Metastatic Disease
2.3 Imaging in Prostate Cancer Treatment Decisions and Treatment Planning
2.3.1 Functional Anatomy at Consultation to Predict Quality of Life Outcomes After Treatment
2.3.2 Imaging in Radiation Planning
2.4 Prostate and Surrounding Structure Anatomy on MRI
2.4.1 General Prostate Anatomy
2.4.1.1 Zonal Anatomy
2.4.1.2 Dynamic Anatomy
2.4.2 Apex Anatomy
2.4.2.1 Variant Anatomy
2.4.2.2 Dynamic Anatomy
2.4.2.3 Tumor Anatomy
2.4.3 Seminal Vesicle Involvement
2.4.3.1 Functional Anatomy
2.4.3.2 Tumor Anatomy
2.4.4 Extra-capsular Extension
2.4.5 Base Anatomy
2.4.5.1 Variant Anatomy
2.4.5.2 Functional Anatomy
2.4.5.3 Tumor Anatomy
2.4.5.4 Dynamic Anatomy
2.4.6 Genitourinary Diaphragm
2.4.6.1 Variant Anatomy
2.4.7 Rectourethralis (RU)
2.4.7.1 Dynamic Anatomy
2.4.8 Sexual Preservation
2.4.8.1 Functional Anatomy
2.4.8.2 Variant Anatomy
2.5 Imaging in Prostate Cancer Recurrence
2.5.1 Post-prostatectomy
2.5.1.1 Variant Anatomy
2.5.1.2 Functional Anatomy
2.5.1.3 Tumor Anatomy
2.5.1.4 Dynamic Anatomy
2.5.2 Post-radiotherapy
2.6 Summary
References
3: Androgen Deprivation Therapy for Patients with Intact Prostates Undergoing Radiation Therapy
3.1 Introduction
3.2 Low Risk Prostate Cancer
3.3 Intermediate-Risk Prostate Cancer
3.3.1 Favorable Intermediate-Risk Disease
3.3.2 Unfavorable Intermediate-Risk Disease
3.4 High-Risk Disease
3.5 Clinically Node Positive Disease with Prostate Intact
3.6 ADT in the Setting of Post-operative Radiotherapy
3.7 Biochemical Recurrence After Definitive Intact Prostate RT
3.8 Table Summary
3.9 Toxicities of ADT and Supportive Care Considerations
References
4: Conventional and Moderately Hypofractionated Radiation Therapy for Prostate Cancer
4.1 Introduction and Background
4.2 Patient Selection
4.3 Simulation
4.3.1 Before Simulation
4.3.2 Simulation
4.4 Treatment Planning
4.4.1 Margins
4.4.2 Organs at Risk
4.5 Treatment Delivery
4.6 Disease Outcomes
4.7 Follow Up
4.8 Toxicities and Management
References
5: Low Dose Rate Brachytherapy: Uses and Advanced MRI Techniques in Prostate Cancer
5.1 Introduction
5.2 History of Prostate LDR Brachytherapy
5.3 Rationale for Brachytherapy
5.4 Pertinent Anatomic Issues for Brachytherapy
5.5 MRI-Assisted RadioSurgery (MARS)
5.6 Brachytherapy Workflow
5.6.1 Patient Selection
5.6.2 Simulation
5.6.3 Treatment Planning
5.6.4 Assess Readiness for the Procedure
5.6.5 Guidelines for Implantation (Day of Treatment)
5.6.6 Post-implant Evaluation
5.7 Follow Up and Toxicity
References
6: High Dose Rate Prostate Brachytherapy
6.1 Introduction
6.2 History of Prostate HDR Brachytherapy
6.3 Rationale for Prostate HDR Brachytherapy
6.4 Pertinent Anatomy for Prostate HDR Brachytherapy
6.5 Patient Selection
6.6 Pre-operative Assessments and Procedures
6.7 Operative Procedure
6.8 Treatment Planning
6.9 Target and Organ at Risk Delineation
6.10 Treatment Delivery Using the Remote Afterloading System
6.11 Dose and Fractionation Considerations
6.12 Toxicity
6.13 Follow-Up
6.14 Salvage Prostate HDR Brachytherapy for Local Recurrence After Curative-Intent Radiotherapy
6.15 Conclusions
References
7: Ultra-hypofractionated Radiotherapy (Stereotactic Body Radiotherapy)
7.1 Introduction
7.2 Patient Selection
7.3 Simulation
7.4 Treatment Planning
7.5 Treatment Delivery
7.6 Disease Outcomes
7.7 Follow-Up
7.8 Toxicities and Management
References
8: Proton Therapy for the Treatment of Prostate Cancer
8.1 Introduction
8.1.1 Rationale for Proton Beam Therapy
8.1.2 Proton Beam Therapy Advantages
8.1.3 Limitations of PBT
8.2 Patient Selection
8.3 Simulation
8.4 Treatment Planning
8.4.1 Modality
8.4.2 Dose Fractionation
8.4.3 Target/OAR Contouring
8.5 Treatment Delivery
8.6 Disease Outcomes
8.7 Follow-Up
8.8 Toxicities and Management
8.8.1 Acute Toxicity Management
8.8.2 Late Toxicity Management
8.9 Conclusion
References
9: Postoperative Radiotherapy for Prostate Cancer
9.1 Introduction
9.2 Patient Selection
9.2.1 Pathologic Risk Factors After Radical Prostatectomy
9.2.2 Prospective Trials: Adjuvant RT
9.2.3 Adjuvant RT vs. Early Salvage RT
9.2.4 Lymph Node-Positive Disease
9.2.5 Predictive Tools: Who Benefits?
9.2.6 Novel Imaging: Potential Applications for Post-prostatectomy Salvage RT
9.3 Treatment
9.3.1 Dose and Fractionation
9.3.2 Adding Hormonal Therapy to sRT
9.3.3 Patient Evaluation
9.3.4 Treatment Planning, Target Delineation, and Normal Tissue Constraints
9.4 Patient Management on Treatment
9.4.1 Urinary Toxicity
9.4.2 Gastrointestinal Toxicity
9.4.3 Limiting Toxicity
9.5 Disease Outcomes, Late Toxicity, and Follow-Up
9.6 Summary
References
10: Radiotherapy for Oligometastatic Prostate Cancer
10.1 Introduction
10.2 Patient Selection
10.2.1 De Novo Oligometastatic Prostate Cancer
10.2.2 Oligorecurrent Prostate Cancer
10.2.3 Oligoprogressive Prostate Cancer
10.2.4 Systemic Therapy
10.3 Simulation and Immobilization
10.3.1 Prostate-Directed Therapy
10.3.2 Metastasis-Directed Therapy
10.4 Treatment Planning
10.4.1 Prostate-Directed Therapy
10.4.2 Metastasis-Directed Therapy
10.5 Treatment Delivery
10.5.1 Prostate-Directed Therapy
10.5.2 Metastasis-Directed Therapy
10.6 Follow-Up
10.6.1 Prostate-Directed Therapy
10.6.2 Metastasis-Directed Therapy
10.7 Conclusion
References
Part II: Non-prostate Genitourinary Malignancies
11: Bladder Cancer Radiotherapy
11.1 Epidemiology
11.2 Anatomy
11.3 Pathology
11.4 Staging
11.5 Role of Radiation Therapy
11.6 General Principles of Radiation Therapy [5]
11.7 Radiation Therapy Simulation and Treatment Planning
11.7.1 Intact Bladder Setting
11.7.1.1 Simulation Considerations
11.7.1.2 Radiation Schema Options
11.7.1.3 Normal Structure Constraints and Compliance Criteria
11.7.2 Adjuvant/Post-cystectomy Setting
11.7.3 Palliative Setting
11.8 Post-bladder Preservation Radiotherapy Follow-Up [5]
11.9 Toxicities and Quality of Life
References
12: Testicular Cancer Radiotherapy
12.1 Epidemiology
12.1.1 Risk Factors
12.1.2 Diagnosis and Workup
12.1.2.1 Trans-scrotal Testicular Ultrasound
12.1.2.2 Serum Tumor Markers
12.1.2.3 Radical Inguinal Orchiectomy
12.1.2.4 Imaging
12.1.2.5 Semen Analysis and Sperm Banking
12.2 Anatomy
12.2.1 Lymphatic Spread
12.3 Pathology
12.3.1 Serum Tumor Markers
12.3.1.1 A Few Key Points
12.4 Staging
12.4.1 The American Joint Commission on Cancer (AJCC) TNM Cancer Staging System (Table 12.4)
12.4.2 The Eighth Edition of the AJCC Cancer Staging Manual Has Made Important Updates
12.4.3 The International Germ Cell Cancer Consensus Group (IGCCCG) Classification System
12.4.4 Utilizing These Staging Schemata
12.5 Role of Radiation Therapy
12.5.1 Seminoma Germ Cell Tumors
12.5.1.1 Clinical Stage IA/B Seminoma
12.5.1.2 Clinical Stage IIA Seminoma
12.5.1.3 Clinical Stage IIB Seminoma
12.5.2 Nonseminoma Germ Cell Tumors
12.5.2.1 NSGCT Stage I
12.5.2.2 NSGCT Stage IS
12.5.2.3 NSGCT Stage IIA
12.5.2.4 NSGCT Stage IIB
12.5.2.5 Metastatic NSGCT
12.5.3 Sex Cord-Stromal Cell Tumors
12.5.4 Lymphoma of the Testis
12.5.5 Management of Residual Masses After Primary Treatment
12.5.6 Radiation Technique
12.5.6.1 Three-Dimensional Conformal Radiation Therapy (3D-CRT)
12.5.6.2 Intensity-Modulated Radiation Therapy (IMRT)
12.5.6.3 Proton Therapy
12.5.6.4 Other Strategies
12.6 Radiation Therapy Simulation and Treatment Planning
12.6.1 Simulation Considerations
12.6.2 Treatment Planning Considerations
12.6.2.1 Stage I Seminoma Target Volume and Field Borders
Para-aortic Strip Fields
Para-aortic Strip Fields vs. Traditional Dog-Leg/Hockey-Stick Fields
Special Considerations
Key Trial
12.6.2.2 Stage I Seminoma Dose Considerations
Key Trial
12.6.2.3 Stage II Seminoma Target Volume and Field Borders
Special Considerations
12.6.2.4 Stage II Seminoma Dose Considerations
12.6.2.5 Unique Considerations
Brain Metastases
Human Immunodeficiency Virus
Bilateral Testicular Germ Cell Tumor
Spermatocytic Seminoma
12.7 Disease Outcomes, Follow-Up, and Toxicity Management
12.7.1 Stage I Seminoma Outcomes and Survivorship
12.7.1.1 Surveillance
Studies
12.7.1.2 Adjuvant Radiotherapy
12.7.1.3 Adjuvant Chemotherapy
One Cycle of Carboplatin
Two Cycles of Carboplatin
12.7.1.4 Prognostic Indicators of Relapse for Stage I Seminoma
12.7.2 Stage II Seminoma Outcomes and Survivorship
12.7.2.1 Stage IIA
12.7.2.2 Stage IIB
12.7.2.3 Prognostic Indicators of Relapse for Stage II Seminoma
12.7.3 Nonseminoma Outcomes and Survivorship
12.7.3.1 Prognostic Indicators of Relapse for Nonseminoma GCTs
12.7.4 Advanced Disease Outcomes and Survivorship
12.7.5 Follow-Up
12.7.5.1 Follow-Up During Active Surveillance: Stage I Seminoma
12.7.5.2 Follow-Up After Adjuvant Treatment: Stage I Seminoma
12.7.5.3 Follow-Up for Pure Seminoma Stage IS
12.7.5.4 Follow-Up for Pure Seminoma Stages IIA and Non-bulky IIB
12.7.6 Quality of Life
12.7.7 Sequelae of Radiotherapy
12.7.7.1 Secondary Malignant Neoplasms
12.7.7.2 Gonadal Toxicity
12.7.7.3 Cardiovascular Toxicity
References
13: Radiation Therapy for Renal Cell Carcinoma
13.1 Epidemiology
13.2 Anatomy
13.3 Pathology
13.4 Staging
13.5 Role of Radiation Therapy
13.6 Radiation Therapy Simulation and Treatment Planning
13.6.1 SBRT for Primary Renal Cell Carcinoma
13.6.1.1 Simulation Considerations
13.6.1.2 Treatment Planning Considerations for SBRT
13.6.1.3 Treatment Considerations for IORT
13.6.2 Disease Outcomes
13.6.3 Follow-Up
13.6.4 Toxicity Management
References
14: Rare Genitourinary Malignancies (Penile, Urethral, Renal Pelvis, and Ureteral Cancers)
14.1 Penile Cancer
14.1.1 Epidemiology
14.1.2 Pathology
14.1.2.1 Routes of Spread
14.1.3 Staging
14.1.4 Role of Radiotherapy in Penile Cancer
14.1.5 Radiotherapy Treatment Recommendations by Stage
14.1.6 Principles of External Beam Radiotherapy Treatment Planning
14.1.7 Principles of Brachytherapy
14.1.8 Example Case
14.1.9 Normal Tissue Toxicity and Management of External Beam/Brachytherapy Both Acute and Long Term
14.1.10 Follow-Up
14.1.11 Palliation
14.2 Urethral Cancer
14.2.1 Epidemiology
14.2.2 Pathology
14.2.3 Anatomy
14.2.4 Staging
14.2.5 Staging and Prognosis by Stage: AJCC 8th Edition (Chart)
14.2.6 Treatment Options by Stage
14.2.7 Radiotherapy Treatment Recommendations by Stage
14.2.8 Principles of External Beam Radiotherapy Treatment Planning
14.2.9 Principles of Brachytherapy
14.2.10 Example Case
14.2.11 Normal Tissue Toxicity and Management of External Beam/Brachytherapy
14.2.12 Follow-Up
14.3 Renal Pelvis/Ureteral Cancer
14.3.1 Epidemiology
14.3.2 Pathology
14.3.3 Staging and Prognosis by Stage: AJCC 8th Edition (Fig. 14.1)
14.3.4 Treatment Recommendations
14.3.5 Radiotherapy Treatment Recommendations by Stage
14.3.6 Principles of External Beam Radiotherapy Treatment Planning
14.3.7 Example Case
14.3.8 Normal Tissue Toxicity of External Beam Radiotherapy
References