General Principles of Radiotherapy

Abstract

The daily practice of any established branch of medicine should be based on some acceptable principles. This chapter is concerned with the general principles on which the radiotherapy of the Manchester school is based. Though many radiotherapists in other centres would doubtless accept these principles, there are sufficiently wide differences in practice throughout the world to suggest that some therapists adhere to a fundamentally different philosophy. We believe it is important, especially for those beginning their formal training in radiotherapy, to subscribe to an internally consistent school of thought, employing methods of treatment for each type of lesion in each anatomical site that are based on accepted principles and subjected to continuous rigorous scrutiny to test their effectiveness. Not only must each therapeutic technique be evaluated, but the underlying principles too must be questioned if and when this seems indicated. It is a feature of this hospital that similar lesions are all treated by the same technique, so long as statistical evidence justifies such a policy. All members of the staff adhere to the accepted policy until or unless reliable reasons are adduced to change this policy. These views are embodied in the detailed technical descriptions in Chaps. 6–17 and this agreed approach to patient management permits and ensures effective evaluation. Needless to say, these principles are not purely clinical, but also involve physicists, radiobiologists, pathologists, and others jointly concerned with the total care ofpatients. The radiotherapist is a clinician who should have and should accept full clinical responsibilityfor his patients from the time the decision is taken that irradiation is the treatment of choice. Who takes this initial decision? Medical men have long been open to the general criticism that when a patient finds himself, virtually by chance, in the hands of a surgeon he is likely to be treated surgically even if an alternative therapeutic approach would have been more appropriate. No doubt patients have been treated by irradiation when surgery would have been preferable. Fortunately, in most established cancer hospitals, it is now appreciated that when dealing with malignant disease the correct choice of treatment is crucial for the patient. The aphorism that the first chance to cure cancer is often the last chance rests on the fact that a wrong first choice of treatment can so readily prove fatal. There is, therefore, a need for consultation between all concerned. The patient with a cancer of the larynx needs expert examination and investigation by a surgical otolaryngolog-ist. But he needs the equally expert advice of a radiotherapist on the prospect of curative irradiation as an alternative to ablative surgery. If a patient is suffering from a tumour of the ovary, the brain, or the bladder, the surgeon concerned would be a gynaecologist, neurosurgeon, or urological surgeon. A chemotherapist or medical oncologist would also take part in these joint consultations and, of course, important contributions to the discussion will be made by the pathologist, diagnostic radiologist, clinical pharmacologist,physicist—indeed anyone whose expertise can be applied to the needs of patient in question.