Principles of radiation therapy

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When considering treatment options for a solid tumour, often the first choice is to use a single modality, commonly surgery. This chapter deals with indications for radiation therapy; principles of radiation therapy; acute and late radiation effects; tumour radiation responsiveness; future directions; nuclear radiation therapy.

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8.1 Sagittal CT image of the caudal abdomen of a dog with an incompletely resected anal sac tumour (no gross tumour is present) and regional lymph node metastasis. The green stepped lines represent a radiation field configured using a multileaf collimator (see text). Computer software enables radiation doses to be estimated once a treatment configuration is chosen. In this image the white, purple and yellow lines represent the periphery of areas receiving at least 49, 48 and 47 Gy, respectively. By assessing radiation dose in the tumour and adjacent normal tissue, the treatment configuration can be optimized.
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8.3 Radiation side effects seen in the skin. Marked confluent moist desquamation of the skin seen near the end of radiation therapy. Mild patchy desquamation of the skin seen at the end of radiation therapy. Permanent alopecia and hyperpigmentation of the skin after definitive radiation therapy.
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8.4 Acute radiation side effects seen in the oral cavity. Oral mucositis of the caudal tongue. Oral mucositis of the buccal mucosa.
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8.7 Portal radiograph of a dog being treated for an anal sac carcinoma. The treatment field, configured by a multileaf collimator, is shown superimposed on a digitally reconstructed radiograph of the caudal abdomen. The field is relatively large in the region of the primary tumour, but then becomes more conformal for treatment of regional lymph nodes, sparing the ventral colon wall and the cauda equina. Shaping a field this extensively is essentially impossible without use of a multileaf collimator. This is the same field shown in Figure 8.1 .
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