Patricia Eifel - Gynecologic Radiation Oncology: A Practical Guide

Patricia J. Eifel, MD

Professor, Section of Gynecology
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas

Ann H. Klopp, MD, PhD

Associate Professor, Section of Gynecology
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas

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Library of Congress Cataloging-in-Publication Data

Names: Eifel, Patricia, author. | Klopp, Ann H., author.

Title: Gynecologic radiation oncology : a practical guide / by Patricia J. Eifel, Ann H. Klopp.

Description: Philadelphia : Wolters Kluwer, [2017] | Includes bibliographical references and index.

Identifiers: LCCN 2016009430 | ISBN 9781451192650

Subjects: | MESH: Genital Neoplasms, Femaleradiotherapy

Classification: LCC RC280.G5 | NLM WP 145 | DDC 616.99/465dc23 LC record available at https://lccn.loc.gov/2016009430

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To our husbands, Dr. James Belli and David Klopp, whose unwavering support and patience made this project possible. Also, to our patients, whose lives and stories have become a part of us and of this book. We thank them for trusting us to care for them, for inspiring us, and for teaching us so much.

The radiation treatment of gynecologic cancers can be challenging but also extremely rewarding. Specialized knowledge, skill, attention to detail, and close multidisciplinary collaboration are required to design and deliver highly successful treatments. However, those treatments are very often curative, and the satisfaction derived from knowing that a woman with locoregionally advanced gynecologic cancer has been successfully treated and gone on to lead a normal life is unmatched. We have been fortunate to be able to devote most of our careers to the study and treatment of these patients. During the years of our tenure at MD Anderson, approximately 10,000 patients have been treated on the gynecologic radiation oncology service; we have treated more than 1,500 gynecologic cancer patients with IMRT and have performed more than 5,000 intracavitary and interstitial brachytherapy procedures. The better part of our academic careers has been spent collating these experiences, analyzing and reporting outcomes, studying the findings of other investigators, and searching for ways to understand and improve the treatment of these diseases.

Our experiences and those of other dedicated gynecologic radiation oncologists have led to the publication of thousands of manuscripts, review articles, and textbook chapters. However, although peer-reviewed manuscripts and general textbooks can provide valuable insights about specific topics and useful surveys of relevant literature, they tend not to be ideal vehicles for describing the techniques, methods, and difficult deliberations that characterize the day-to-day practice of gynecologic radiation oncology. Also, the content of these scattered resources is not always readily accessible when it is needed in the course of daily practice.

With this book, our primary goal was to address practical aspects of gynecologic radiation oncologyhow to evaluate the role of radiation therapy in various clinical settings; how to explain the rationale for treatment recommendations to referring physicians and patients; when and how to apply various external beam and brachytherapy techniques to address specific clinical problems; and how to monitor and manage patients during and after treatment. Although we have not attempted to exhaustively catalogue the gynecologic radiation oncology literature, we have cited references that we have found particularly helpful in our clinical decision making, emphasizing important clinical trials, meta-analyses of relevant data, and high-quality review articles. Throughout this book, and particularly in , we have tried to explain not only the insights gained from the clinical literature but also the opportunities for misinterpretation, suggesting how trial results can be more accurately applied to everyday clinical practice.

The concepts discussed in Gynecologic Radiation Oncology have been illustrated with more than 700 figures and tables. Using these aids and the accompanying text, we have sought to describe in detail each aspect of radiation oncology practice from the initial patient evaluation and treatment recommendation, through the process of radiation treatment planning and delivery, to the posttreatment monitoring of patients for recurrence and treatment-related side effects. Because the multidisciplinary and technical aspects of gynecologic radiation oncology tend to apply to gynecologic cancers of various types and sites of origin, the principles of tumor biology, multidisciplinary management, clinical evaluation, radiation therapy treatment planning and delivery, and symptom management are discussed in general terms in of this book. Subsequent chapters focus more specifically on the features of individual disease sites and on the bases for site-specific management decisions. With this structure, we have minimized repetition of broadly relevant content; however, to help readers navigate the text, we have extensively cross-referenced the material contained in individual chapters. To further unify these concepts and to demonstrate how they can be applied in real clinical situations, we have included 54 case studies that are cited throughout the text; these are found at the end of the relevant disease site chapters, with each group of case studies preceded by a summary of the cases and a list of abbreviations.