Pocket Radiation Oncology, 2nd Edition
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DEDICATION
We dedicate this book in memory of Dr. Cullen Taniguchi, MD, PhD, a true physician scientist
and invaluable mentor, friend, and colleague to all.
CONTRIBUTORS
Chike Abana, MD, PhD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Lauren Andring, MD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Peter Balter, MD, PhD
Professor
Department of Radiation Physics
The University of Texas MD Anderson Cancer Center
Houston, Texas
Thomas Beckham, MD, PhD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Vincent Bernard, MD, PhD
Resident
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Andrew Bishop, MD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Julianna Bronk, MD, PhD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Elaine Cha, MD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Joe Chang, MD, PhD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Seungtaek Choi, MD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Lauren Elizabeth Colbert, MD, MSCR
Assistant Professor
Department of Radiation Oncology
Division of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Kelsey Corrigan, MD, MPH
Resident
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Bouthaina Dabaja, MD
Professor
Department of Radiation Oncology
Division of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Prajnan Das, MD, MS, MPH
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Brian De, MD
Resident
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Kevin Diao, MD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Stephanie Dudzinski, MD, PhD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Penny Fang, MD, MBA
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Ahsan Farooqi, MD, PhD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Steven J. Frank, MD
Deputy Division Head and Executive Director, Particle Therapy Institute
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Clifton David Fuller, MD, PhD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Saumil Gandhi, MD, PhD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Adam Garden, MD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Amol Ghia, MD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Adam Grippin, MD, PhD
Resident
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Aaron Grossberg, MD, PhD
Assistant Professor
Department of Radiation Medicine
Oregon Health & Science University
Portland, Oregon
David Grosshans, MD, PhD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Ashleigh Guadagnolo, MD, MPH
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Jillian Gunther, MD, PhD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Karen E. Hoffman, MD, MHSc, MPH
Professor of Radiation Oncology
Department of Genitourinary Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Emma Holliday, MD
Associate Professor
Department of Gastrointestinal Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Anuja Jhingran, MD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Ann Klopp, MD, PhD
Professor
Department of Radiation Oncology–Gynecology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Eugene Koay, MD, PhD
Associate Professor
Department of Gastrointestinal Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Albert C. Koong, MD, PhD
Division Head and Chair
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Ramez Kouzy, MD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Jing Li, MD, PhD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Zhongxing Liao, MD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Anna Likhacheva, MD, MPH
Staff Physician
Department of Radiation Oncology
Sutter Health
Sacramento, California
Lilie L. Lin, MD
Professor
Department of Radiation Oncology–Gynecology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Steven Lin, MD, PhD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Yufei Liu, MD, PhD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Ethan Ludmir, MD
Assistant Professor
Department of Gastrointestinal Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Gohar Manzar, MD, PhD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Kathryn Marqueen, MD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Mary McAleer, MD, PhD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Wendy McGinnis, MD, MCR
Resident
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Susan L. McGovern, MD, PhD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Devarati Mitra, MD, PhD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Amy Moreno, MD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Quynh-Nhu Nguyen, MD, MHCM
Professor of Radiation Oncology
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Jared Ohrt, MS
Medical Physicist
Department of Radiation Physics
The University of Texas MD Anderson Cancer Center
Houston, Texas
Arnold Paulino, MD
Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Subha Perni, MD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Jack Phan, MD, PhD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Chelsea C. Pinnix, MD, PhD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Jay Reddy, MD, PhD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Mike Rooney, MD
Resident
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Mohammad Salehpour, PhD
Professor and Director of Education
Department of Radiation Physics
The University of Texas MD Anderson Cancer Center
Houston, Texas
Ugur Selek, MD, FASTRO
Professor
Department of Radiation Oncology
Koc University
Istanbul, Turkey
Aaron Seo, MD, PhD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Shalin Shah, MD
Professor/Section Chief-Houston Area Locations
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Alex Sherry, MD
Resident
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Alan Sosa, MD
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Shane Stecklein, MD, PhD
Assistant Professor
Department of Radiation Oncology
University of Kansas Cancer Center
Kansas City, Kansas
Chad Tang, MD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Cullen Taniguchi, MD, PhD
Associate Professor
Department of Gastrointestinal Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Martin Tom, MD
Assistant Professor
Department of Gastrointestinal Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Gary Walker, MD, MPH, MS
Adjunct Associate Professor
Department of Radiation Oncology
Banner MD Anderson Cancer Center
Gilbert, Arizona
Chenyang Wang, MD, PhD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Wendy Woodward, MD, PhD
Professor and Chair
Department of Breast Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Susan Wu, MD
Assistant Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Jinzhong Yang, PhD
Assistant Professor
Department of Radiation Physics
The University of Texas MD Anderson Cancer Center
Houston, Texas
D. Nana Yeboa, MD
Associate Professor
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
Alison Yoder, MD, MPH
Resident Physician
Department of Radiation Oncology
The University of Texas MD Anderson Cancer Center
Houston, Texas
ACKNOWLEDGMENTS
The editors would like to acknowledge the contributors who worked on the first edition:
Mitchell S. Anscher, MD
Alexander Augustyn, MD, PhD
Zeina Ayoub, MD
Alexander F. Bagley, MD, PhD
Houda Bahig, MD
Michael Bernstein, MD
Eric D. Brooks, MD, MHS
Samantha M. Buszek, MD
Bhavana S. Vangara Chapman, MD
Kaitlin Christopherson, MD
Caroline Chung, MD, MSc
Brian J. Deegan, MD, PhD
Patricia J. Eifel, MD
Adnan Elhammali, MD, PhD
Daniel Gomez, MD
Stephen Grant, MD
Stephen Hahn, MD
Jennifer C. Ho, MD
Rachit Kumar, MD
Jennifer Logan, MD
Geoffrey V. Martin, MD
Shane Mesko, MD, MBA
Sarah Milgrom, MD
Bruce Minsky, MD
Shalini Moningi, MD
Hubert Young Pan, MD
Dario Pasalic, MD
Curtis A. Pettaway, MD
Courtney Pollard III, MD, PhD
Tommy Sheu, MD, MPH
Shervin ‘Sean’ Shirvani, MD, MPH
Lisa Singer, MD, PhD
Erik P. Sulman, MD, PhD
Nikhil G. Thaker, MD
Jeena Varghese, MD
Christopher Wilke, MD, PhD
FOREWORD
Rapid access to practical, up-to-date information is critical for the busy clinician juggling
many demands. Given the multiple sources of information that is often just a mouse click
away, it is near impossible to determine the most credible sources of medical information
and to synthesize all of the data into actionable recommendations.
National guidelines regarding how to deliver radiation therapy for specific disease sites
can be vague. Textbooks are either too broad or too lengthy for practitioners to interpret
key concepts necessary to deliver care and become outdated rapidly. While we recognize
that there are other pocket books available, we have intentionally narrowed our focus and
scope of this pocket handbook to include the best practices that we have determined are
necessary to deliver safe, multidisciplinary evidence-based care to our patients. This was
accomplished by curating years of experience and expertise of senior radiation oncologists
at MD Anderson, many of which created the cutting edge technologies discussed in this
handbook. The MD Anderson residents and fellows both past and current played a major
part in the creation of this pocket handbook and reviewed each of the chapters.
The goal of this pocket handbook is to provide an updated, practical set of radiation
therapy guidelines that can be used to guide the active management and review of specific
cases. This pocketbook is not intended to serve as a comprehensive resource; however, all
of the fundamental principles are covered here to provide the practitioner with the
necessary tools and information to dig deeper into specific cases as needed.
In this handbook, we have covered all of the major stages of commonly treated diseases
and included treatment techniques for both common and rare malignancies. Unlike most
pocket references, we have a section that is dedicated to treatment planning and dose
constraints. This section also includes specific figures which are helpful in determining how
treatment planning may be approached including normal tissue considerations for
radiation therapy.
Recognizing the limited time that physicians and trainees have, we included only those
references that drive the current clinical standards. We hope that this handbook will serve
as a valuable resource for you and your peers as we endeavor to provide appropriate, safe,
and quality care to our patients.
ALBERT C. KOONG, MD, PHD
Professor and Department Chair, Radiation Oncology
PREFACE
We are delighted to introduce the second edition of Pocket Radiation Oncology: The MD
Anderson Cancer Center Handbook of Radiation Oncology. While there are many excellent
textbooks on radiation oncology, in an era of constantly evolving evidence and rapidly
changing technology, there is a great need for an easily accessible handbook with clinically
relevant and evidence-based information, presented in a concise and easily accessible
format. We were very pleased by the response to the first edition, and we believe that the
second edition will provide a timely update, while appealing to the learning styles of
today’s generation of adult learners.
We are grateful to all the current and past The University of Texas MD Anderson Cancer
Center resident and faculty contributors who made Pocket Radiation Oncology possible. All
chapters were created by resident and attending pairs, and all chapters were reviewed by a
senior attending who specialized in that disease site. We are also grateful to the past and
present faculty at The University of Texas MD Anderson Cancer Center, whose clinical
experience and knowledge are reflected in this handbook.
PRAJNAN DAS AND CHELSEA C. PINNIX, ADVISORS
