Intensity Modulated Radiation Therapy (IMRT), Image Guided Radiation Therapy (IGRT) and Stereotactic Body Radiation Therapy (SBRT) have been buzz words in radiotherapy technology for more than a decade. The technologies as such, and their applications, have been evolving significantly over this time and it is interesting to have an attempt at taking stock. The present compilation of review articles does this nicely.
The format is well suited to the topic. More than 40 authors provide an update on technological developments and their clinical applications in 24 chapters over nearly 500 pages. Each chapter is more a review article in itself than a chapter of a book; one can start reading anywhere in the book and cross references are few. This makes the book a useful text for practitioners who seek an update on a particular aspect of their work, and the practical focus of many chapters supports this. The authors are mostly radiation oncologists and medical physicists from North America, who have first-hand experience in the technology they describe.
The book is structured into five sections. The introduction consists of two overview chapters on advances in radiotherapy planning and delivery. The reader will enjoy these chapters which cover similar territory, but are complementary rather than repetitive. This also illustrates an important feature of the new technologies – it is not all black and white and IMRT, IGRT and SBRT can be realised in many different ways. The third introductory chapter is concerned with the adoption of new technology from a health economics point of view. While seen largely from a North American perspective, this chapter covers important aspects of health care in general and would be excellent reading for clinical trainees – not necessarily to agree with everything written in the chapter, but to be prepared for the discussions we have to have.
The three main sections of the book are dedicated to IMRT, IGRT and SBRT. The structure is clever, as it combines IMRT and IGRT for the first two sections, the first technology focused and the second clinical. This is appropriate, as the excellent dose distributions that IMRT can produce rely on IGRT to get them in the right spot within the patient, and most of the modern technology described here integrates IMRT and IGRT.
The clinical section on IMRT and IGRT is the longest section in the book and structured along clinical applications. There are chapters on head and neck cancers, thoracic cancer, breast cancer, upper gastrointestinal cancer, lymphomas and prostate cancer. These chapters provide valuable information for clinicians and many chapters conclude with a section entitled ‘Guidelines for clinical practice’. These are not necessarily guidelines as set out by professional organisations or cancer Institutes, but bullet lists of important information which make it easy to quickly recap a chapter.
The section on stereotactic body radiotherapy has a distinct clinical flavour. Thoracic, gastrointestinal and genitourinary cancers each have a chapter dedicated to them. The book concludes with two chapters on proton beam radiotherapy. This feels a bit like an afterthought, as proton radiotherapy is not new. However, it has the potential to benefit significantly from the new developments of IMRT and IGRT, as covered for photons in the rest of the book.
The book comes with a subject index and a (very) brief list of frequently used abbreviations. Several authors also provide on-line supplementary material. While the book works well without the supplementary material, some of the animations help the reader to appreciate a particular aspect of the technology.
In summary, this book provides a good overview of the current state of radiotherapy technology. A lot of the material is also published elsewhere, however it is the compilation of authoritative summaries with plenty of references which makes this book valuable. It would be good reading for most radiotherapy professionals and can be considered essential for everyone involved in teaching modern radiotherapy.