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Book review |
This hardback publication aims to cover the renaissance of brachytherapy brought about by the introduction of remote afterloading units and major technological advances in imaging techniques and computerized planning. The editors have set out to provide a reference book that gives the trainee clinical oncologist the scientific background (physics and radiobiology) and the principles of brachytherapy afterloading techniques as well as to update those who specialize in brachytherapy.
The book is presented in three sections: physics, radiobiology and clinical treatment. The editors have made the book easy to navigate with a consistent and well structured format and minimal repetition. Most chapters are easy to "dip" into and refer to when needed.
As a physicist I turned to the physics section first and was very impressed at the clear and well presented chapters covering all aspects of brachytherapy physics giving the right balance between modern dosimetry and the classical empirical brachytherapy systems, from which all current techniques have evolved. My feeling is that this section has been pitched correctly so that all disciplines of the brachytherapy team can refer to it and understand the content. All chapters give clear basic definitions of the principles described and go into more depth where needed.
The layout of the section is very well structured. However Chapter 7 on afterloading units, might have been more useful if it appeared straight after the "Sources in Brachytherapy" chapter, as most of the earlier chapters refer to afterloading units.
I particularly liked the elegant chapter on "computers in brachytherapy dosimetry", which covers all aspects of computerized optimization; plan evaluation and recent developments in image reconstruction. It introduces the optimization algorithms concisely before going into more depth. Finally the authors touch on future developments including 3D dose calculation using Monte Carlo, which will take into account inhomogenieties.
The second section covers the radiobiology of brachytherapy concentrating on the dose rate effect. Overall, this section is excellent and comprehensive, only let down by the introductory chapter which contains excessive detail of the history of the subject. Beyond this there is an excellent explanation of the linear quadratic model and 
/ß ratio with regards to ionizing radiation effects.
The remaining chapters of this section are excellent. Chapter 12 gives a very good account on factors affecting dose rate and also on the relevance of point sources of cell kill and radiobiology in general. Chapter 13 covers the linear quadratic model exceptionally well containing all the factors involved and the basic equations required for modelling. Chapter 15 gives a very good account of radiobiology in practice.
At the end of the Chapter 13 there is a very useful glossary, which could have been even more useful if it was expanded to cover all the chapters in this section and referenced at the start.
The format and layout of the clinical treatment section is consistent, well structured and covers most of the treatment sites where afterloading techniques are used. Each author gives a general introduction and background history of the treatment of the clinical site described. This includes discussion on staging and treatment strategies. the technique used by the author is described form the actual insertion right through the planning stage (including techniques, localization, prescription and critical organs) and then actual treatment delivery. Each chapter also includes a review of other treatment strategies, trials related to the treatment area and the management of complications. This section complements any clinical training received by giving the reader a comprehensive background to the evolution of treatments strategies and the overall management of the patient's treatment.
One of the problems with training in the specialized area of brachytherapy is that you may only be exposed to very common treatment sites, e.g. gynaecology, however this book gives an introduction to all areas of brachytherapy treatment. I found the two chapters on the treatment of Head and Neck cancer, were extremely well presented, clear and informative. The HDR section in these chapters covered not only the treatment strategies but also looked at the radiobiological consideration for changing dose rate, with the principles used very clearly written. In addition the text was well supported visually aiding the understanding of the treatments discussed.
The final few chapters cover issues that are important in any clinical practice, how to ensure quality management through quality control, quality assurance, audits and the clinical aspects of quality management. The chapter on safe practice and prevention of accidents in afterloading brachytherapy addresses all the necessary procedures and facilities to ensure safe practice is achieved.
Overall I found this book to be excellently written and edited. It covers all current aspects of afterloading brachytherapy (with the exception of intravascular brachytherapy), and would complement clinical training, whether it is for the oncologist, physicist or radiographer. The breadth and scope packed into 450 pages of this book results in a focused and succinct book, which provides an excellent training book and should be an essential reference book for every brachytherapy department.
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