MODERN PRACTICES IN RADIATION THERAPY Edited by Gopishankar Natanasabapathi Modern Practices in Radiation Therapy Edited by Gopishankar Natanasabapathi Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Iva Simcic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from [email protected] Modern Practices in Radiation Therapy, Edited by Gopishankar Natanasabapathi p. cm. ISBN 978-953-51-0427-8 Contents Preface IX Part 1 External Beam RT and New Practices 1 Chapter 1 Stereotactic Body Radiotherapy for Pancreatic Adenocarcinoma: Set-Up Error Correction Using Internal Markers and Its Association with the Patient’s Body Mass Index 3 Chi Lin, Shifeng Chen and Michael J. Baine Chapter 2 STAT RAD: A Potential Real-Time Radiation Therapy Workflow 23 David Wilson, Ke Sheng, Wensha Yang, Ryan Jones, Neal Dunlap and Paul Read Chapter 3 Segmentation Techniques of Anatomical Structures with Application in Radiotherapy Treatment Planning 41 S. Zimeras Chapter 4 Involved-Field Radiation Therapy (IF-RT) for Non-Small Cell Lung Cancer (NSCLC) 59 Tomoki Kimura Part 2 Particle Therapy 67 Chapter 5 Scanned Ion Beam Therapy of Moving Targets with Beam Tracking 69 Nami Saito and Christoph Bert Chapter 6 Neutron Influence in Charged Particle Therapy 85 Su Youwu, Li Wuyuan, Xu Junkui, Mao Wang and Li Zongqiang Chapter 7 The Stopping Power of Matter for Positive Ions 113 Helmut Paul VI Contents Part 3 Brachytherapy and Intraoperative Radiation Treatments 133 Chapter 8 Prostate Seed Brachytherapy – Methods to Improve Implant Characteristics 135 Bruce Libby, Matthew D. Orton, Haidy Lee, Mark E. Smolkin, Stanley H. Benedict and Bernard F. Schneider Chapter 9 Intra-Operative Radiotherapy with Electron Beam 145 Ernesto Lamanna, Alessandro Gallo, Filippo Russo, Rosa Brancaccio, Antonella Soriani and Lidia Strigari Chapter 10 Intraoperative Radiotherapy for Early Breast Cancer 169 Masataka Sawaki Part 4 Scope of Radiation Therapy for Specific Diseases 179 Chapter 11 Enhancing Therapeutic Radiation Responses in Multiple Myeloma 181 Kelley Salem and Apollina Goel Chapter 12 Radiation Therapy and Skin Cancer 207 Jonathan D. Tward, Christopher J. Anker, David K. Gaffney and Glen M. Bowen Part 5 Radiation Induced Effects and Overcoming Strategies 247 Chapter 13 Critical Normal Tissue and Radiation Injury: The Stomach 249 Mineur Laurent, Jaegle Enric, Pourel Nicolas and Garcia Robin Chapter 14 The Cytoprotective Effect of Amifostine Against Radiation Induced Toxicity 257 Vassilis E. Kouloulias and John R. Kouvaris Chapter 15 Abscopal Effect of Radiation Therapy: Current Concepts and Future Applications 275 Kenshiro Shiraishi Part 6 Emerging Dosimeters and New QA Practices 189 Chapter 16 Quality Assurance (QA) for Kilovoltage Cone Beam Computed Tomography (CBCT) 291 Joerg Lehmann and Stanley Skubic Contents VII Chapter 17 Polymer Gel Dosimetry for Radiation Therapy 309 Senthil Kumar Dhiviyaraj Kalaiselven and James Jebaseelan Samuel Emmanvel Rajan Chapter 18 Digital Filtering Techniques to Reduce Image Noise and Improve Dose Resolution in X-Ray CT Based Normoxic Gel Dosimetry 327 N. Gopishankar, S. Vivekanandhan, A. Jirasek, S. S. Kale, G. K. Rath Sanjay Thulkar, V. Subramani, S. Senthil Kumaran and R. K. Bisht Part 7 Enhancing Patient Care in RT 339 Chapter 19 Information and Support for Patients Throughout the Radiation Therapy Treatment Pathway 341 Michelle Leech and Mary Coffey Preface Cherish the help of men of skill, Who ward and safe-guard you from ill. Thiruvalluvar (An Indian Poet) Cancer is a dreadful disease that confiscates million of people’s life every year. It has created trepidation in the human minds for significant amount of time. General perception about cancer is it often leads to death. A large number of cancer patients today can expect to recover from this increasingly treatable illness. This achievement is due to significant advances over the last 50 years in the technology for treating cancer with radiation. While radiation therapy technology has progressed considerably in the last half-century, the basic goal of such treatment is unchanged: To target and kill cancer cells while exposing the surrounding healthy tissue to as little as possible. Radiation therapy kills cancer cells by damaging their DNA either directly or indirectly by creating free radicals within the cells that can in turn damage the DNA. Radiation may be delivered by a higher energy radiation generating equipments to shrink tumors and kill cancer cells. Does radiation therapy kill only cancer cells? The answer is no. It can also damage normal cells leading to side effects as well. How far has radiation therapy technology progressed and how is the future of radiation therapy. Does this treatment modality for cancer have any role in treating tumors which usually prefer other treatments? All answers for these questions are found in this book entitled “Modern Practices in Radiation Therapy”. This book contains 19 exceptional chapters contributed by renowned world-class radiotherapy professionals and researchers who have overwhelming knowledge in this field. To make this more interesting, all the chapters were further grouped into sections so that the readers could pursue their specific subjects of interest in radiation treatment. Section I entitled “External Beam RT and New Practices” brings together chapters related to external beam radiotherapy which is defined as the methodology for treating tumors with radiation generation equipments like linear accelerators, cobalt units, etc. In recent times a remarkable advancement has happened in this treatment technique. This section groups chapters discussing relatively new type of external beam radiation therapy delivery system such as Stereotactic Body Radiotherapy X Preface (SBRT), Involved-Field Radiation Therapy (IF-RT), a rapid clinical work flow STAT RAD using tomotherapy system and in addition it discusses about segmentation techniques of anatomical structures for planning in External beam RT which is also useful in Brachytherapy planning as well. Section II entitled “Particle Therapy” has blended chapters pertinent to treatment modalities such as ion beam therapy. Main advantage of this technique is that it provides supreme dose conformity. Chapter 5 discusses about beam tracking system for moving targets treatment using ion beam therapy. Chapter 6 is about influence of neutron in charged particle therapy. Chapter 7 enumerates stopping power data which is determines the characteristics of ion beam therapy. Section III entitled “Brachytherapy and Intraoperative Radiation Treatments” has unified chapters related to delivery of radiation locally to the tumor with rapid dose fall-off in the surrounding normal tissue. New technical developments in brachytherapy such as transperineal seed implantation and Intra-operative radiotherapy, is discussed in this section. Section IV entitled “Scope of Radiation Therapy for Specific Diseases” contains two chapters; first one reveals the recent advances in the treatment of multiple myeloma (MM) such as targeted radiotherapy. Second chapter of this section mentions about underutilized radiation therapy modality for skin cancer which could be effective treatment for this disease if proper communication is established between the dermatologist’s and radiation oncologist’s. Section V entitled “Radiation Induced Effects and Overcoming Strategies“ congregates chapters discussing complications associated with radiation treatment and methods to protect normal tissue from radiation damage. There is one chapter in this section which reveals facts about anti-tumor effect at a non irradiated location in patients. Section VI entitled ”Emerging Dosimeters and New QA Practices” focuses on topics which are essential to determine and enhance the quality of the radiation equipment for patient treatment. With the introduction of new technology into the field of radiation oncology, a need arises to have a quality assurance program that is customized to these newer treatment