An Overview of Hypofractionation and Introduction to This Issue of Seminars in Radiation Oncology

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The Early Use of Hypofractionation

At the onset of using radiation to treat cancer soon after the discovery of x-rays in 1895 and radioactivity in 1896, treatments were mostly hypofractionated. Many of the early practitioners of radiation therapy for cancer were surgeons who were accustomed to single-session interventions. Treatments were technologically crude giving more dose to skin and superficial structures than to a deep-seated target. There were few standards to ensure dose deposition was accurately quantified or

Intraoperative Radiotherapy and Investigations of Dose Tolerance From Hypofractionated Radiotherapy

Although never in widespread use because mostly of its logistic challenges, intraoperative radiotherapy has played an important role as a weapon in the arsenal of cancer treatments. The treatment has been particularly useful for selected patients with gastrointestinal tumors in which radial margins are often close as compared with the margins at the anastomosis. In these circumstances, the region at risk is well identified at the time of surgery, even without clips or other indirect guideposts

Degrees of Hypofractionation

The main objective of therapeutic radiation is to disrupt clonogenicity. Clonogenicity is the ability of cells to form colonies by cellular division. Cellular division is a very complicated process regulated by a multitude of genes. Because damage to any one of these genes can disrupt the process, the entire process can be stymied by a relatively modest dose of radiation. In contrast, cellular function, like the secretion of a hormone, is usually only coded for by 1 gene or a few genes.

This Issue of Seminars in Radiation Oncology

Only 10 to 15 years ago, a review of the topic of hypofractionation would be limited to IORT, SRS, and the more moderate hypofractionated regimens associated with breast and prostate cancer. With the increasing use of SBRT to treat a number of cancers, the topic has dramatically broadened with dose per fraction of over 30 Gy. Implementing hypofractionation within any daily dose beyond conventional for curable patients constitutes an extremely contentious topic. Clinical practice may be ahead of

References (57)

  • J.E. Tepper et al.

    Tolerance of canine anastomoses to intraoperative radiation therapy

    Int J Radiat Oncol Biol Phys

    (1983)
  • T.J. Kinsella et al.

    Tolerance of the canine bladder to intraoperative radiation therapy: An experimental study

    Int J Radiat Oncol Biol Phys

    (1988)
  • B.E. Powers et al.

    Bone necrosis and tumor induction following experimental intraoperative irradiation

    Int J Radiat Oncol Biol Phys

    (1989)
  • W.F. Sindelar et al.

    Response of canine esophagus to intraoperative electron beam radiotherapy

    Int J Radiat Oncol Biol Phys

    (1988)
  • M. Barnes et al.

    Response of the mediastinal and thoracic viscera of the dog to intraoperative radiation therapy (IORT)

    Int J Radiat Biol Phys

    (1987)
  • M. Barnes et al.

    Response of the mediastinal and thoracic viscera of the dog to intraoperative radiation therapy (IORT)

    Int J Radiat Oncol Biol Phys

    (1987)
  • E.L. Gillette et al.

    Response of aorta and branch arteries to experimental intraoperative irradiation

    Int J Radiat Oncol Biol Phys

    (1989)
  • S.L. Gillette et al.

    Ureteral injury following experimental intraoperative radiation

    Int J Radiat Oncol Biol Phys

    (1989)
  • F.H. Williams

    Treatment of certain forms of cancer by the x-rays

    JAMA

    (1901)
  • F.H. Williams

    The use of x-rays in the treatment of diseases of the skin, of new growth, of the glandular system and of other diseases and as a means of relief of pain

    Trans Assoc Am Physicians

    (1903)
  • H. Heineke

    Ueber die Einwirkung der Rötgenstrahlen auf innere Organe

    Münch Med Wochenschr

    (1904)
  • G. Forssell

    Quelques observations de radiumtherapie de tumerurs cancereuses

    Arch d'Electr Med Exper et Cliniques

    (1910)
  • F. Dessauer

    Beiträge zur Bestrahlung tiefliegender Prozesse

    Med Klin

    (1905)
  • F. Dessauer

    My studies on the special foundations of deep therapy treatment

    AJR Am J Roentgenol

    (1921)
  • C. Regaud et al.

    Actions des rayons X sur les diverses generations de la lignee spermatique: Extreme sensibilite des spermatogonies a ces rayons

    Compt Rend Soc de Biol

    (1906)
  • J. Bergonie et al.

    Interpretation de quelques resultats de la radiotherapie et essai de fixaation d'une technique rationelle

    Compt Rend Acad Sci Paris

    (1906)
  • L. Seitz et al.

    Unsere Methode der Rontgen-Tiefentheapie und ihre Erfolge

    (1920)
  • L. Freund

    Die gengenwartigen Methoden und Erfolge de Krebsbestrahlung mit verteilten Dosen

    Strahlentherapie

    (1930)
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