The first edition of Principles and Practice of Radiation Oncology was published in 1987. This sixth edition is being published in 2013. After 26 years, approximately 11,000 pages of printed text, many tens of thousands of pages of typed and computer-printed text, and an immeasurable number of meetings, phone calls, letters, emails, faxes, and text messages utilized to produce these six volumes, many things have changed and others have stayed the same.

What has stayed the same? For 26 years radiation therapy has remained a major component of the curative and palliative therapy of cancer and plays a major role in the management of many benign diseases. Patients with cancer are generally best managed by a combined modality approach that requires the participation of a well-informed, well-trained, and well-equipped radiation oncologist directing a radiation oncology team. The radiation oncologist must be capable of taking a detailed medical history; performing a thorough and accurate physical examination of the patient; assessing and integrating the information from diagnostic imaging, gross and microscopic pathology, and clinical chemistry; and formulating and implementing a treatment plan that is cognizant of the wishes of the patient and realistic in its goals. For this book in particular, what has also stayed the same since its inception is the vision and participation of Carlos A. Perez and Luther W. Brady.

What has changed? There has been an explosion of knowledge concerning the molecular biology of cancer and tumor physiology. Concepts that were unknown in the 1980s are now considered fundamental building blocks of knowledge concerning cancer. As it concerns the technology of this specialty, when the first edition of this book was published, cobalt-60 machines remained in widespread use; simulation using diagnostic radiographs still vied with clinical setups of treatment fields using surface anatomy; and many radiation oncologists carried slide rules, protractors, and rulers to calculate and map radiation dose distributions. Now, elaborate linear accelerators with multileaf collimators, particle machines, intensity-modulated and/or image-guided radiation therapy, complex brachytherapy devices, dose painting, image fusion, metabolic imaging, and increasingly powerful computers that support the preceding list of technologies have become the norm in the developed world. (And, unfortunately, the paucity of even the most minimal radiation therapy services in many parts of the world persists.) In some diseases, the diagnostic and staging workup has changed profoundly in the past quarter of a century––for example, the role of staging laparotomy in Hodgkin disease. In other diseases, the role of radiotherapy in treatment has shifted dramatically, as demonstrated by the decline in the role of radiation therapy in the management of retinoblastoma and the change in the use of radiation therapy for breast and prostate cancer. The editors have also changed: Edward C. Halperin joined the editorial team with the fourth edition and David Wazer with the fifth edition.

The editors have striven to be cognizant of change by constantly adding and pruning chapters to document the current state of knowledge of cancer biology; medical radiation physics; clinical radiation oncology; and radiation oncology economics, ethics, and policy. Particular attention in the fifth and sixth editions has been devoted to an attractive and useable design of the printed version of this book and the new electronic versions. We have taken care to have this book evolve with the times, and we have simultaneously striven to be true to the core mission of being “the book of record” for clinical care, providing the data that justifies treatment recommendations as well as comprehensive illustrations and references in radiation oncology.

We have been gratified by the public reception of this book. Sales of the fifth edition rose dramatically compared to the fourth edition––an atypical pattern in the medical book business. It is, we like to believe, evidence that the pact wordlessly exchanged between the editors, the chapter authors, and our readers is being honored by all parties.

The editors sincerely hope that this sixth edition of Principles and Practice of Radiation Oncology will continue to advance understanding of the causes, prevention, and treatment of human cancer. We pray that this new edition will contribute to the cure of some malignancies, the amelioration of suffering for many patients and their families, the relief of pain, and the ultimate triumph of human knowledge over cancer.

Edward C. Halperin, MD, MA
David E. Wazer, MD, FASTRO
Carlos A. Perez, MD
Luther W. Brady, MD