Fifty to sixty percent of all cancer patients in the United States receive radiation therapy each year as definitive therapy, for palliation, or as an adjunct to surgery or chemotherapy. In 1986, according to American Cancer Society estimates, 960,000 new cases of invasive cancer, 45,000 new cases of carcinoma in situ of the uterine cervix, 5,000 new cases of carcinoma in situ of the female breast, and 400,000 new cases of non-melanomatous skin cancer were diagnosed in the United States. About 71% of patients with invasive cancer presented with disease apparently limited to the local region; 29% had metastases at the time of the initial presentation. Of those who presented with locoregional disease, 56% will be cured and 44% will develop recurrent cancer. Therefore, a substantial portion of the resources in cancer care should be devoted to control of the locoregional tumor, including the use of radiation therapy.

The management of the patient with cancer has evolved into a complex, closely integrated application of sophisticated technology to evaluate and stage the tumor and, using various modalities, to obtain optimal therapeutic results, emphasizing the quality of life of the patient. Principles and Practice of Radiation Oncology is designed to contribute to a better understanding of the physical methods of radiation application, of the effects of irradiation on normal tissues, and of the most judicious ways in which radiation therapy can be employed in the case of any particular patient, either as a single modality or as part of a multimodality treatment program.

Chapters are included on basic radiation biology, radiation therapy physics and treatment planning, multimodal integrated programs for patient management, and such technical applications of irradiation as electron beam therapy, brachytherapy, and high LET radiations.

The chapters discussing disease by anatomical site are all organized in a similar fashion to enable complete coverage of pertinent information on each tumor. The format includes sections on epidemiology, pathology, diagnostic workup, treatment techniques, the applications of surgery and chemotherapy, the end results of treatment, and pertinent clinical trials.

We recognize that there is a great deal of individuality in the techniques of irradiation, and we have attempted to include descriptions of various technical approaches, leaving to the individual reader the critical task of selecting the most appropriate one for the particular patient under consideration. We believe that the comprehensive and rigorous approach to the assessment of each tumor site set forth in this text provides the foundation for proper application of radiation therapy techniques and multimodal programs in the treatment of patients with cancer.

It is our intent that Principles and Practice of Radiation Oncology should advance the effort to apply clinical and research activities in cancer management in a manner compatible with the current state of knowledge. It is our hope that this contribution will help foster new knowledge that will lead to improved delivery for radiation therapy and ultimately to a reduction in the time lost from other activities, in cost to the health care system, and in the human suffering occasioned by cancer.

Carlos A. Perez, MD
Luther W. Brady, MD