Alternate Fractionation in Radiotherapy Paradigm Change 1st edition by Mark Trombetta, Jean Philippe Pignol, Paolo Montemaggi, Luther Brady ISBN 3030095967 978-3030095963

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Product details:

ISBN 10: 3030095967 
ISBN 13: 978-3030095963
Author: Mark Trombetta, Jean Philippe Pignol, Paolo Montemaggi, Luther Brady 

Describes alternate fractionation strategies using an evidence-based approach

Enhances patient care through precise dosing and targeting

Delivers reductions in regimen toxicity, treatment time, and cost

Written by leading international experts

Alternate Fractionation in Radiotherapy: Paradigm Change 1st Table of contents:

1. Introduction to Radiotherapy and Fractionation

• Fundamentals of Radiotherapy: An introduction to the principles of radiation therapy, including the physics of radiation, types of radiation used, and their effects on human tissues.

• Historical Overview of Fractionation: The development of traditional fractionation schedules, such as daily treatments with small doses of radiation, and their widespread use in clinical practice.

• Need for Alternate Fractionation: Why alternative fractionation schemes are being considered, including patient outcomes, treatment efficiency, and the biological rationale behind fractionation changes.

2. Principles of Fractionation in Radiotherapy

• Conventional Fractionation: Detailed discussion on conventional fractionation methods and their success, along with limitations in certain clinical situations.

• Radiobiological Considerations: The role of radiobiology in determining the efficacy of radiation fractionation schedules, including dose-response relationships and tumor cell sensitivity.

• Radiation Response Curves: Exploration of how tumors and normal tissues respond to different radiation doses and fractionation schemes.

3. Alternate Fractionation Approaches

• Hypofractionation: Description of hypofractionation (delivering larger doses of radiation per session over fewer treatments) and its clinical applications, especially in prostate cancer, breast cancer, and palliative care.

• Hyperfractionation: Exploring hyperfractionation (smaller doses of radiation delivered more than once a day), which is used to increase tumor control without increasing normal tissue toxicity.

• Accelerated Fractionation: The role of accelerated fractionation, including techniques that speed up the overall course of treatment while maintaining or improving tumor control.

• Stereotactic Body Radiotherapy (SBRT): Advanced techniques like SBRT, where very high doses of radiation are given in fewer sessions, often for small, well-defined tumors.

• Radiosensitization and Radioresistance: Understanding how tumor radiosensitivity and resistance influence the choice of fractionation schedules.

4. Clinical Applications of Alternate Fractionation

• Breast Cancer: Analysis of how alternate fractionation schemes like hypofractionation have been integrated into breast cancer treatment, with evidence of efficacy and potential benefits over conventional methods.

• Prostate Cancer: Detailed exploration of hypofractionated regimens in prostate cancer, including clinical trials and long-term results.

• Head and Neck Cancers: Use of accelerated fractionation and other alternative techniques in head and neck cancers, where the challenge of tumor control and normal tissue toxicity is prominent.

• Brain Tumors: The role of hypofractionation, radiosurgery, and other fractionation modifications in the treatment of brain tumors, such as gliomas and metastases.

• Palliative Radiotherapy: The application of alternative fractionation schedules in palliative settings for symptomatic relief, particularly in bone metastases and other advanced cancers.

5. Technological Advancements Supporting Alternate Fractionation

• Imaging Advancements: The impact of advances in imaging (such as CT, MRI, and PET) on the precision and planning of alternate fractionation schemes, enabling better targeting of tumors and sparing of normal tissues.

• Treatment Delivery Systems: The role of advanced treatment technologies like intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and proton therapy in delivering alternative fractionation regimens.

• Personalized Radiotherapy: How patient-specific factors, including genetic and molecular characteristics, are influencing the design of alternate fractionation schedules to optimize treatment.

6. Evidence and Clinical Trials Supporting Alternate Fractionation

• Clinical Trials Overview: A review of key clinical trials that have studied alternate fractionation schemes, including landmark studies in various cancers that support the use of hypofractionation, hyperfractionation, and accelerated regimens.

• Patient Outcomes and Toxicity: Analysis of outcomes such as tumor control, survival rates, and side effects for patients treated with alternate fractionation schedules compared to traditional methods.

• Cost-Effectiveness and Practical Considerations: Evaluating the economic implications of adopting alternate fractionation schedules, including resource use, treatment duration, and cost-effectiveness.

7. Future Directions in Radiotherapy Fractionation

• Emerging Techniques: The future of fractionation approaches, including the potential integration of immunotherapy, targeted therapy, and personalized medicine with radiotherapy.

• Adaptive Radiotherapy: Exploring how adaptive radiotherapy, where treatment plans are modified based on real-time tumor response and normal tissue changes, could further refine fractionation methods.

• Artificial Intelligence and Machine Learning: The role of AI in optimizing fractionation schedules, treatment planning, and predicting patient responses to radiation therapy.

8. Challenges and Controversies in Alternate Fractionation

• Biological and Clinical Challenges: Discussion of the biological challenges in validating and implementing alternate fractionation schedules, including inter-patient variability and tumor heterogeneity.

• Radiation Toxicity: Balancing higher doses and shorter treatment courses with the risk of acute and late toxicity, particularly in organs at risk near tumors.

• Regulatory and Institutional Barriers: Addressing the challenges in widespread adoption of alternate fractionation schedules, including regulatory approval, reimbursement, and clinical practice standards.

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