Walter and Miller’s Textbook of

Radiotherapy: Radiation Physics,

Therapy and Oncology 8th Edition
Edition Paul Symonds
Visit to download the full and correct content document:
https://ebookmass.com/product/walter-and-millers-textbook-of-radiotherapy-radiation-
physics-therapy-and-oncology-8th-edition-edition-paul-symonds/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Practical Radiation Oncology Physics: A Companion to

Gunderson & Tepper's Clinical Radiation Oncology, 1e
Sonja Dieterich Phd

https://ebookmass.com/product/practical-radiation-oncology-
physics-a-companion-to-gunderson-teppers-clinical-radiation-
oncology-1e-sonja-dieterich-phd/

Fundamentals of Radiation Oncology: Physical,

Biological, and Clinical

https://ebookmass.com/product/fundamentals-of-radiation-oncology-
physical-biological-and-clinical/

Clinical Radiation Oncology, 4e Fourth Edition Bogart

https://ebookmass.com/product/clinical-radiation-
oncology-4e-fourth-edition-bogart/

Handbook of Palliative Radiation Therapy 1st Edition

https://ebookmass.com/product/handbook-of-palliative-radiation-
therapy-1st-edition/
Hematology – Oncology Therapy 2nd Edition

https://ebookmass.com/product/hematology-oncology-therapy-2nd-
edition/

Imaging for Clinical Oncology [Radiotherapy in

Practice] 2nd Edition Peter Hoskin

https://ebookmass.com/product/imaging-for-clinical-oncology-
radiotherapy-in-practice-2nd-edition-peter-hoskin/

Principles and Practice of Radiation Therapy E Book 4th

Edition, (Ebook PDF)

https://ebookmass.com/product/principles-and-practice-of-
radiation-therapy-e-book-4th-edition-ebook-pdf/

Gunderson & Tepper’s Clinical Radiation Oncology 5th

Edition Joel Tepper

https://ebookmass.com/product/gunderson-teppers-clinical-
radiation-oncology-5th-edition-joel-tepper/

Gunderson & Tepper’s Clinical Radiation Oncology 5th

Edition Edition Joel Tepper

https://ebookmass.com/product/gunderson-teppers-clinical-
radiation-oncology-5th-edition-edition-joel-tepper/
Walter and Miller’s

TEXTBOOK OF
RADIOTHERAPY
This page intentionally left blank
Walter and Miller’s

TEXTBOOK OF
RADIOTHERAPY
Radiation Physics, Therapy and Oncology
EIGHTH EDITION

Edited by

Paul Symonds TD MD FRCP FRCR

Emeritus Professor of Clinical Oncology, University of Leicester, Leicester, UK; Honorary
Consultant Oncologist, University Hospitals of Leicester, Leicester, UK

John A. Mills PhD MIPEM CPhys

Physicist, MACS-Quality Control Provider, James Watt House, Hinckley, UK

Angela Duxbury FCR TDCR MSc

Emeritus Professor of Therapeutic Radiography, Sheffield Hallam University, Sheffield, UK
© 2019, Elsevier Limited. All rights reserved.

First edition 1950

Second edition 1959
Third edition 1979
Fourth edition 1979
Fifth edition 1993
Sixth edition 2003
Seventh edition 2012

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other
than as may be noted herein).

Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds or experiments described herein. Because of rapid advances
in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be
made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors
for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise,
or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

ISBN: 978-0-7020-7485-1

Content Strategist: Poppy Garraway Smith/Serena Castelnovo

Content Development Specialist: Veronika Watkins
Project Manager: Manchu Mohan
Design: Bridget Hoette
Illustration Manager: Narayanan Ramakrishnan

Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
 CONTENTS

Contributors, xix Beam Hardening, 21

International System of Units and Prefixes for Physical Energy Absorption, 22
Quantities, xxiii Photo-Nuclear Interactions, 22
Photon Depth Dose and the Build-Up Effect, 22
Kerma and Absorbed Dose for Radiotherapy
SECTION 1
beams, 24
Kerma, 24
1 Atoms, Nuclei and Radioactivity, 2
Absorbed Dose, 24
Elizabeth M. Parvin
Units of Kerma and Dose, 25
Introduction, 2
Heavy Charged Particle Interactions, 25
Atomic Structure, 2
Protons, 25
Particles, 2
Carbon Ions and Pions, 25
The Atom and the Nucleus, 3
Neutron Interactions, 26
The Forces, 3
References, 27
Electron Energy Levels, 4
Further Reading, 27
Band Theory of Solids, 4
Impurity Bands, 5 3 Radiation Detection and Measurement, 28
Particles in Electric and Magnetic Fields, 5 Andrew Poynter, Andrzej Kacperek, and John A. Mills
Electric Fields, 5 Introduction, 28
Magnetic Fields, 5 Radiation Detection, 28
The Lorentz Equation, 5 Gas Amplification Devices, 29
Waves, 5 Scintillation Devices, 30
Transverse and Longitudinal Waves, 5 Ideal Air Ionisation Chamber, 30
Electromagnetic Radiation, 6 Proton Beam Detection, 30
Continuous Spectra and Characteristic Radiation, 7 Measurement and Standardisation of Dose, 31
Radioactive Decay, 8 Dose Standards, 31
Stable and Unstable Isotopes, 8 Traceability of Measurement, 31
Half-life, 9 Standard Calorimeter, 32
Alpha Decay, 9 The Free Air Chamber, 33
Beta Decay, 10 The Proton Beam Dose Standard, 34
Gamma Decay, 10 Practical Ionisation Chambers, 34
Electron Capture and Internal Conversion, 11 Bragg–Gray Cavity Theory, 34
Radioactive Decay Series, 11 Dose Determination Based on Calibrated
Radionuclides of Medical Interest, 12 Instruments, 35
References, 12 Requirements for Practical Ionisation Chambers, 35
Further Reading, 12 Thimble Ionisation Chamber, 35
Physical Description, 35
2 Interactions of Ionising Radiation With Matter, 13
Measurement of Dose and Dose Rate, 36
Shakardokht Jafari and Michael Wynne-Jones
The Parallel-Plate Ionisation Chamber, 37
Introduction, 13
The Beam Monitor Chamber, 37
Charged and Uncharged Particles, 13
Intercomparisons With Secondary Standard
Excitation and Ionisation, 13
Instruments, 38
Electron Interactions, 14
Strontium Consistency Check Device, 38
Collisional and Radiative Energy Loss, 14
Ionisation Chamber Corrections, 38
X-Ray Production, 14
Ion Recombination Losses, 38
Characteristic X-Rays and Auger Electrons, 16
Correction for Atmospheric Conditions, 38
Stopping Power and Linear Energy Transfer, 16
Chamber Stem Effect, 39
Range and Path Length, 17
Polarity Effect, 39
Photon Interactions, 17
Alternative Dose Measurement Systems, 39
The Photoelectric Effect, 17
Film Dosimetry, 39
The Compton Effect, 18
Semiconductor Detectors, 40
Pair Production, 19
Thermoluminescent Dosimetry, 42
Exponential Attenuation, 19
Chemical and Biochemical Detectors, 43
Attenuation of Photon Spectra, 21
Fricke Dosimetry, 43
v
vi CONTENTS

Ceric Dosimetry, 44 Production of X-Rays for Imaging, 65

Gel Dosimetry, 44 Information From Absorption and Scattering, 66
Fricke Gels and FXG Gels, 44 Differential Attenuation in the Primary Beam, 66
Polymer Gels, 44 Contrast Media, 66
Alanine-Electron Paramagnetic Resonance Scatter as Unwanted Background, 66
Dosimetry, 44 Antiscatter Grid, 66
Biological Dosimetry, 45 Planar Imaging, 67
Biological Molecules, 45 Film and Screen Detection, 67
Genetic Structures, 45 Characteristic Curve, 68
Cells and Biological Structures, 45 Digital Computed Radiography Using
Composite Detectors and Arrays, 45 Photostimulable Phosphors, 68
Linear Detector Arrays, 45 Fluoroscopic Imaging With Image Intensifier
Area Arrays, 45 Chain, 68
Volume Detectors Arrays, 46 Digital Fluoroscopy and Radiography Using Solid
Electronic Portal Dosimetry, 46 State Detectors, 69
Alternative Systems for Proton Beams Dose Assessment of Image Quality, 69
Measurement, 46 Magnification Distortion, 69
References, 47 Resolution, Geometric Unsharpness and Movement, 69
Image Signal and Noise, 70
4 Radiation Protection, 49
Dose, 70
Mike Dunn
Tomographic Imaging, 70
Introduction, 49
Computed Tomographic Reconstruction From
Biological Effects of Radiation, 49
Projections, 70
Stochastic Hereditary Effects, 49
Practical Configurations, 70
Stochastic Somatic Effects, 50
Dedicated Radiotherapy Systems, 71
Nonstochastic Somatic Effects, 50
Simulator, 71
Dose Descriptors, 50
Computed Tomography Virtual Simulator, 71
Equivalent Dose, 50
Treatment Verification Systems, 71
Effective Dose, 50
Magnetic Resonance Imaging, 72
Background Radiation, 52
Overview of the Magnetic Resonance Imaging
Legislative Requirements, 53
Process, 72
The Ionising Radiations Regulations 2017, 53
Producing a Signal, 72
The Ionising Radiation (Medical Exposure)
Returning to Thermal Equilibrium, 72
Regulations 2017, 56
Imaging Sequences, 73
Administration of Radioactive Substances Advisory
How Contrast Is Altered in a Magnetic Resonance
Committee, 57
Image, 73
Environmental Permitting (England and Wales)
How Positional Information Is Encoded in the
Regulations 2016, 58
Signal, 73
High Activity Sealed Radioactive Sources and Orphan
Magnetic Resonance Imaging Scanners, 75
Sources Regulations 2005, 58
Spectroscopy, 76
Protective Measures, 58
Clinical Applications of Magnetic Resonance Imaging
Time, 58
in oncology, 77
Distance, 58
Brain Tumours, 77
Barriers, 58
Body Tumours, 77
Contamination, 59
Ultrasound Imaging, 77
Building Materials, 59
Overview of Ultrasound Imaging Process, 77
Monitoring of Radiation Levels, 60
Physical Characteristics of Ultrasound Waves, 77
Personal Radiation Dosimeters, 60
Interactions at Interfaces, 81
Radiation Records, 61
Attenuation and Interference, 81
Other Requirements, 61
Ultrasound Scanners, 81
References, 62
Production of Ultrasound for Imaging, 81
5 Imaging With X-Ray, Magnetic Resonance Imaging and Derivation of an Ultrasound Image, 82
Ultrasound, 64 Brightness Mode Ultrasound Imaging, 82
Andy Rogers, Carl Tiivas, and Sarah Wayte Linear Array Ultrasound Imaging, 82
Introduction, 64 Intracavitary and Endoscopic Probes, 82
X-Ray Imaging, 65 Harmonic Imaging, 82
Overview of X-Ray Imaging Process, 65 Dynamic Imaging, 82
 CONTENTS vii

Contrast and Tissue Characteristic Imaging, 83 Comforters and Carers, 108

Clinical Applications of Ultrasound Imaging, 83 Outpatient Therapies, 108
General Imaging, 83 Waste Disposal, 108
Advantages and Disadvantages, 83 References, 109
Imaging for Cancer, 84
8 Radiotherapy Devices With Kilovoltage X-Rays and
Clinical Therapeutic Ultrasound, 84
Radioisotopes, 110
References, 84
Claire Fletcher and John A. Mills
6 Imaging With Radionuclides, 85 Introduction, 110
Paul Hinton Kilovoltage X-Ray Production, 110
Introduction, 85 X-Rays From Electrons, 110
Overview of the Radionuclide Imaging Process, 85 High-Voltage Circuits, 110
Gamma Cameras, 86 Kilovoltage X-Ray Characteristics, 111
Scintillation Gamma Cameras, 86 Superficial and Deep Kilovoltage Machines, 111
Solid-State Gamma Cameras, 87 Tube Stand, 112
Image Construction, 87 Collimation, 112
Imaging Techniques, 88 Skin and Eye Shielding, 112
Positron Emission Tomography Scanners, 90 Control of Output, 113
Radiopharmaceuticals, 92 Calibration of Dose Output, 113
The Radionuclide, 92 Contact Kilovoltage Machine, 113
Type of Radiation, 92 Grenz Kilovoltage Machine, 113
Physical Half-Life, 92 Radionuclide Characteristics, 114
Specific Activity, 92 Gamma Emitters, 114
Radionuclide Purity, 92 Beta Emitters, 114
Chemical Properties, 92 Brachytherapy and Afterloading Machines, 114
The Ideal Radionuclide for Imaging, 92 The High Dose Rate Afterloading Machine, 116
Mechanisms of Localisation, 92 Implanted Kilovoltage Machine, 116
Production and Quality Control of Beta-Ray Machine, 117
Radiopharmaceuticals, 93 Gamma-Ray Machine, 117
Clinical Applications, 94 Radioisotope Source, 118
Bone Imaging, 94 Beam Collimation, 118
Tumour Imaging, 94 Design of Gamma-Ray Teletherapy Machines, 119
Imaging Thyroid Cancer, 96 Radiosurgery, 120
Cardiac Imaging, 96 Radiation Safety, 120
Kidney Imaging, 97 Commissioning and Quality Control, 120
Infection Imaging, 98 Conclusion, 120
Sentinel Node Mapping, 99 References, 121
Positron Emission Tomographic Imaging, 99
9 Beam Production: Megavoltage Accelerators, 122
Conclusions, 101
Andrzej Kacperek and John A. Mills
References, 101
Introduction, 122
7 Therapy With Unsealed Radionuclides, 102 The Medical Linear Accelerator, 122
Matthew Aldridge and Sofia Michopoulou Linear Accelerator Layout and Components, 123
Introduction, 102 X-Ray Beam, 124
Iodine-131 in the Treatment of Thyroid Disease, 103 Electron Beam, 126
Thyroid Cancer, 103 Linear Accelerator Control Systems, 127
Benign Thyroid Disease, 105 Nonstandard Linear Accelerators, 127
Palliation of Bone Pain, 105 Intensity-Modulated Radiotherapy, 127
Molecular Radiotherapy Treatment of Neuroendocrine CyberKnife, 127
Tumours, 106 Tomotherapy, 127
Selective Internal Radiation Therapy, 106 Volumetric-Modulated Arc Therapy, 127
Phosphorus-32 in the Treatment of Refractory Stereotactic Ablative Radiotherapy, 127
Myeloproliferative Disease, 107 Flattening Filter-Free Dose Delivery, 128
Intraarticular and Intracavitary Treatments, 107 Patient Alignment for X-Ray and Electron Therapy, 128
Radioimmunotherapy, 107 Radiation Safety, 131
Radiation Protection, Waste and Regulations, 108 Acceptance, Commissioning and Quality Control, 131
Hospital Requirements, 108 Treatment Room Design for X-Ray and Electron
Facilities, 108 Protection, 131
viii CONTENTS

Special Techniques With Linear Accelerators, 132
The Development of Clinical Proton and Heavier
Charged Particle Accelerators, 133
Particle Accelerator Layout and Components, 134
Basic Components of a Cyclotron, 134
Basic Theory of Classic Cyclotron
11 Radiation Treatment Planning: Beam Models, Principles
Operation, 134
and Practice, 162
Ion Source Operation, 135
Maria Mania Aspradakis
Characteristics and Limitations for Therapy, 136
Synchrocyclotrons, 136
Azimuthal Vertical Focussing or Isochronous
Cyclotrons, 136
Synchrotrons, 137
Passive-Scattered Beams and Pencil Beam Scanning
Beams, 138
Gantries, 142
Types of Proton and Ion Accelerators, 143
Clinical Proton Therapy Centres, 143
Clinical Carbon Ion Therapy Centres, 145
Noncircular Accelerators, 145
Neutron and Other Beams, 146
Fast Neutron Beam Therapy, 146
Boron Neutron Capture Therapy, 146
Proton Boron Capture Therapy, 146
Pion Therapy, 147
Antiproton Therapy Beams, 147
Laser-Induced Proton and Particle
Beams, 147
Shielding of Proton Therapy Accelerators and
Treatment Rooms, 148
Nanoparticle-Enhanced Therapy, 148
Future Design, 149
Record and Verify Systems, 149
Conclusion, 150
References, 150
10 Radiation Treatment Planning: Immobilisation,
Localisation and Verification Techniques, 152
Andrew Penny and Phil Sharpe
Introduction, 152
Patient Immobilisation, 153
Thermoplastic Shells, 153
Patient Head Shells, 154
Three Dimensional Printing, 154
Nonshell Fixation Systems, 154
Stereotactic Frames, 154
Body Immobilisation, 155
Stereotactic Ablative Body Radiation Therapy, 155
Surface-Guided Radiotherapy, 155
Volume Definitions, 155
Noncomputed Tomography Contouring
Devices, 156
Physical Simulation, 156
Computed Tomography Simulation, 157
Virtual Simulation, 157
A Typical Head and Neck Computed Tomography
Simulation Procedure, 159
Multimodality Images for Planning, 159
Portal Verification and Image-Guided
Treatments, 160
Portal Imaging, 160
Image-Guided Radiotherapy, 160
References, 161
Introduction, 162
Representation of the Patient for Treatment
Planning, 163
The Planning CT, 163
Patient Immobilisation for Treatment
Planning, 164
Motion Management in Treatment
Planning, 164
Magnetic Resonance–Based Planning, 164
Beam Modelling and Dose Calculations for External
MV Photon Beam Treatment Planning, 164
Modelling of the Source of Radiation, 165
Modelling of Dose in the Irradiated Medium, 166
Factor-Based Approaches, 169
Conclusion on Model-Based Approaches, 170
Dose Per Monitor Unit Formalism: Calculation of
Monitor Units, 170
Treatment Plan Evaluation Tools, 170
Isodose Distributions, 170
Beams Eye View, 171
Dose Volume Histograms, 171
Other Tools, 173
Treatment Planning Techniques in External MV
Photon Beam Radiotherapy, 174
Forward and Inverse Planning, 174
Forward Planning With Standard Beam
Arrangements, 174
Forward-Planned Intensity-Modulated
Radiotherapy, 180
Inverse Planning, 181
Specialised Techniques With MV Photons, 183
Electron Therapy, 185
Dose Calculations for Electron Beams, 185
Energy and Depth-Dose Characteristics, 185
Penumbra, 186
Standoff and Stand in, 186
Patient Contour Effects, 186
Heterogeneities, 187
Field Matching, 187
Specialised Techniques With Electrons, 187
Kilovoltage Photon Therapy, 188
Differences Between Kilovoltage and Electron
Therapy, 188
Proton and Heavy-Ion Therapy, 188
Quality Assurance in Treatment Planning, 189
Treatment Planning System Commissioning and
Performance Testing, 189
Plan-Specific Quality Assurance, 190
References, 191

12 Networking, Data, Image Handling and Computing
in Radiotherapy, 193
John Sage
Introduction, 193
History, 193
Benefits and Hazards of Computerisation, 193
Networking, 194
Link Layer: Physical Infrastructure, 194
Network Layer: Addressing, 194
Transport Layer: Send and Receive, 195
Application Layer: The Program, 195
Network Security, 195
DICOM, 195
DICOM Data Objects, 196
Radiotherapy Data, 197
Data Storage, 197
Image Quality, 197
Radiotherapy Data Types, 197
Data Burden, 198
Data Security, 198
Software Development, 199
Conclusion, 199
References, 199
13 Quality Control, 200
John A. Mills and Phil Sharpe
Introduction, 200
The Quality Control Required, 200
Commitment to Quality Control, 201
Safety, Position and Dose, 201
Frequency, Tolerances and Failure Trends, 201
Measurement and Uncertainty, 201
Null Hypothesis, 202
Combining Variances and Tolerances, 202
Setting a Tolerance to Achieve a Performance
Level, 202
Performance Improvement, 202
Maintenance and Catastrophes, 203
Long-Term, Short-Term and Immediate
Monitoring, 203
Immediate Monitoring, 203
Long-Term Monitoring, 203
Short-Term Monitoring, 203
The Radiotherapy Process, 203
Acquisition, 204
Analysis, 204
Delivery, 204
The Need for Patient-Specific Quality Control, 204
The Radiotherapy Technology, 204
Planning Imaging, 204
Virtual Simulation, 204
Dose Prediction, 205
Kilovoltage Machines, 205
Afterloading Brachytherapy Machines, 205
Megavoltage Machines, 205
Patient Positioning, 205
Treatment Verification, 205
CONTENTS ix
Computer Systems and Networking, 205
Measurement Equipment, 205
Practical Patient-Specific Quality Control, 206
Practical Methods, 206
Phantom-Based Measurements, 206
Dosimetric Arrays, 206
Gamma Index, 206
Independent Software Verification, 207
Secondary Treatment Planning System, 207
Patient-Specific Quality Control Implementation, 207
Getting Things in Balance, 207
Quality Control Scheduling for Megavoltage
Machines, 207
Conclusion, 208
References, 208
14 Quality Management in Radiotherapy, 209
Jill Emmerson, Karen Waite, and Helen Baines
Introduction: What is Quality?, 209
History of Quality in Radiotherapy, 210
Quality Management Systems, 210
1. Customer Focus, 210
2. Leadership, 211
3. Engagement of People, 211
4. Process Approach, 211
5. Improvement, 211
6. Evidence-Based Decision Making, 211
7. Relationship Management, 211
The ISO 9000 Standard, 212
Clause 4 Context of the Organisation, 212
Clause 5 Leadership, 213
Clause 6 Planning, 213
Clause 7 Support, 213
Clause 8 Operation, 213
Clause 9 Performance Evaluation, 214
Clause 10 Improvement, 214
The Radiotherapy Process, 214
An Integrated Approach to Quality and Other
Initiatives, 214
Quality in the National Health Service, 214
Risk Management, 214
Clinical Incidents, 216
Audit, 217
Patient-Focussed Care, 220
Implementation of New Technology and New
Techniques, 221
Conclusion, 222
References, 222
SECTION 2
15 Epidemiology of Cancer and Screening, 226
Katie Spencer, David Hole, Paul Symonds, and Eva Morris
The Cancer Problem, 226
Cancer in the United States, 226
Cancer in Europe, 227
x CONTENTS

Epidemiology of Cancer, 227 Cause of Death from Cancer, 246

Terminology, 227 Staging of Cancers, 246
Survival and Cure in Cancer, 227 TNM Classification, 246
Outcome of Palliative Care, 228 Histological Grading: Differentiation, 247
Epidemiology and The Prevention of Cancer, 228 Limitations of Grading, 248
Criteria for Causality, 228 Growth Rate of Cancers, 248
Aetiology and Screening, 228 Spontaneous Regression of Cancer, 248
Lung Cancer, 228 Classification of Neoplasms, 248
Colorectal Cancer, 230 Undifferentiated Tumours, 249
Breast, 230 Current Advances in Pathology Guiding Patient
Stomach, 232 Management, 251
Prostate, 232 Further Reading, 252
Cervix, 232
Oesophagus, 233 17 Molecular, Cellular and Tissue Effects of
Melanoma, 233 Radiotherapy, 253
Head and Neck, 233 George D.D. Jones and Paul Symonds
Lymphoma, 234 Introduction, 253
Leukaemia, 234 Ionising Radiation, Free Radical Generation,
Reducing the Risks of Developing Cancer, 235 Subcellular Radiogenic Damage, 253
Reducing Tobacco Smoking, 235 Recovery, DNA Damage Repair and Damage
Modifying Alcohol Consumption, 236 Signalling, 255
HPV Vaccination, 236 Recovery, 255
Ultraviolet Light, 236 Double-Strand Break Repair and Damage
Occupational Exposure, 236 Signalling, 255
Diet, 237 Epigenetic Radiation Signalling Mechanisms, 255
Ionising Radiation, 237 Radiation-Induced Cell Killing, 257
Pollution, 237 Tumour Hypoxia, Oxygen Effect and
Chemoprevention, 237 Reoxygenation, 257
Conclusion, 238 The Cell Cycle and Sensitivity to Irradiation, 259
Further Reading, 238 Patterns of Cell Death After Irradiation, 259
Models of Radiation Cell Survival, 260
16 Biological and Pathological Introduction, 239 Radiation Effects in Normal and Malignant
John R. Goepel and Abhik Mukherjee Tissue, 261
Introduction, 239 Acute Responses of Normal Tissue, 261
Growth: Proliferation, Differentiation and Apoptosis, Subacute Reactions of Normal Tissue, 261
239 The Effect of Radiotherapy on Tissues, 261
Growth Disorders, 239 The Tolerance of Normal Tissues, 261
Neoplasia, 240 Retreatment, 262
Benign and Malignant Neoplasms, 240 Response of Tumours to Radiation, 262
Carcinogenesis, 240 Overall Treatment Time, 262
Initiation, 240 Modification of Fractionation Patterns, 262
Promotion, 240 Other Radiation Modalities, 262
Progression, 240 Heavy Particle Radiotherapy, 262
Clinical Cancer, 241 Drug–Radiotherapy Combinations, 263
Oncogenes and Tumour Suppressor Genes, 241 Future Trends (and Pitfalls), 263
Defective apoptotic mechanisms, 241 New Technologies, 263
Blood Vessels, 241 Molecular Studies, 263
Physical Agents, 242 Further Reading, 264
Chemicals, 242
Viruses and Cancer, 243 18 Principles of Management of Patients With Cancer, 265
Immunity and Cancer, 243 Paul Symonds and Angela Duxbury
Injury and Cancer, 243 Introduction, 265
Precancerous Lesions, 243 Factors Governing Clinical Decisions, 266
Field Change, 244 Tumour Factors, 266
Natural History and Spread of Cancer, 244 Patient Factors, 267
Local Invasion, 244 Treatment Modality, 267
Metastasis, 245 Support Services, 269
Functioning Tumours, 246 Palliative Care, 270
 CONTENTS xi

Pain Control, 270 Comparison of Outcome for Different Modalities in

Nausea and Vomiting, 271 the Treatment of Basal Cell Carcinomas, 296
Context of Care, 271 Melanoma, 296
Further Reading, 271 Aetiology, 296
Subtypes of Melanoma, 296
19 Chemotherapy and Hormones, 272
Diagnosis, 297
Anne L. Thomas
Melanoma TNM Staging, 297
Introduction, 272
Stage and Prognosis, 297
General Indications for Chemotherapy, 272
Management of Melanoma, 300
Development and Testing of Anticancer Agents, 272
Adjuvant Treatment for Melanoma, 301
Phase I Studies, 273
Management of Recurrent or Metastatic
Phase II Studies, 273
Melanoma, 301
Phase III Studies, 273
Side Effects of Immunotherapy, 302
Assessing Tumour Responses, 273
Role of Radiotherapy in Malignant Melanoma, 302
The Evaluation of Targeted Therapies, 273
Cutaneous Lymphomas, 303
Principles of Cytotoxic Therapy, 273
Merkel Cell Tumours, 303
Drug Resistance, 274
Skin Sarcoma, 303
Selection and Scheduling of Chemotherapy Agents,
Kaposi Sarcoma, 305
274
Skin Appendage Tumours, 305
High-Dose Chemotherapy, 274
Further Reading, 306
Route of Administration, 274
Side Effects of Chemotherapy, 275
21 Head and Neck Cancer—General Principles, 308
Classification of Cytotoxic Drugs, 275
Christopher D. Scrase
Alkylating Agents, 275
Introduction, 308
Antimetabolites, 275
Demographics, 308
Mitotic Inhibitors, 278
Aetiology, 308
Topoisomerase Inhibitors, 279
Prevention and Early Diagnosis, 310
Miscellaneous, 279
Tumour Types, 310
Hormones, 280
Presentation, 310
Targeted Therapies, 281
Investigation, 310
Epidermal Growth Factor Receptor, 282
Nutrition, 311
Signalling Through RAS-RAF-ERK (MAPK) and
Dentition, 311
PI3K-AKT, 282
Indications for Radiotherapy, 311
Vascular Endothelial Growth Factor Signalling
Definitive Radiotherapy, 311
Pathway, 282
Postoperative Radiotherapy, 311
Proteasome Inhibitors, 282
Palliative Radiotherapy, 311
Poly(ADP-Ribose) Polymerase Inhibitors, 282
Radiotherapy Planning, 312
CDK4/6 Inhibitors, 283
Immobilisation, 312
Immunotherapy, 283
Target Volumes, 312
Therapeutic Antibodies, 283
Definitive Radiotherapy, 312
Immune Checkpoint Inhibitors, 283
Postoperative Radiotherapy, 313
Further Reading, 284
Radiotherapy Technique, 313
20 Skin and Lip Cancer, 285 Conformal Radiotherapy, 313
Charles Kelly and Paul Symonds and Intensity Modulated and Image Guided
Cliff Lawrence Radiotherapy in Head and Neck Cancers, 313
Introduction, 285 Dose and Fractionation, 317
Keratinocyte Skin Tumours, 285 Definitive Radiotherapy, 317
Aetiology, 285 Postoperative Radiotherapy, 318
Basal Cell Carcinoma, 287 Chemotherapy in Head and Neck Cancer, 318
Squamous Cell Carcinoma of the Skin, 289 Concurrent Chemotherapy and Definitive
Cancer of the Lip, 289 Radiotherapy, 318
Keratoacanthoma, 289 Concurrent Chemotherapy and Postoperative
Treatment of Nonmelanoma Skin Cancer, 290 Radiotherapy, 318
Radiotherapy for Keratinocyte Skin Cancers, 292 Induction Chemotherapy, 318
Electron Beam Treatment, 293 Chemotherapy in the Palliative Setting, 318
Electron Backscatter, 293 Toxicity of Treatment, 319
Superficial X-Ray Treatment, 293 Acute Toxicity, 319
xii CONTENTS

Late Toxicity, 320 Signs and Symptoms, 339

Future Developments, 320 Diagnosis and Staging, 340
Immunotherapy, 320 Treatment, 340
Further Reading, 320 Radiation Technique, 340
Complications, 342
22 Sino-Nasal, Oral, Larynx and Pharynx Cancers, 322
Follow-up, 342
Christopher D. Scrase and Paul Symonds
Results, 342
Nasopharynx, 323
Larynx, 342
Anatomy, 323
Anatomy, 342
Incidence of Nasopharyngeal Tumours, 323
Incidence of Laryngeal Cancer, 343
Staging System for Nasopharyngeal Tumours, 324
Staging System for Laryngeal Cancer (TNM, 8th
Aetiology, Pathology and Lymphatic Spread, 324
Edition), 343
Signs and Symptoms, 324
Aetiology, Pathology and Lymphatic Spread, 344
Diagnosis and Staging, 324
Signs and Symptoms, 344
Treatment, 324
Diagnosis and Staging, 344
Radiation Technique, 325
Treatment, 345
Complications, 325
Glottic Cancers, 345
Follow-up, 325
Complications of Treatment for Early Laryngeal
Results, 326
Cancer, 345
Nose and Nasal Cavity, 326
Results of Treatment, 348
Anatomy, 326
Hypopharyngeal Carcinoma, 348
Incidence, 328
Anatomy, 348
Staging System, 328
Incidence of Hypopharyngeal Tumours, 348
Aetiology, Pathology and Lymphatic Spread, 328
Staging System of Hypopharyngeal Tumours
Signs and Symptoms, 328
(TNM, 8th Edition), 348
Diagnosis and Staging, 328
Aetiology, Pathology and Lymphatic Spread, 348
Treatment, 328
Signs and Symptoms, 348
Complications, 330
Diagnosis and Staging, 348
Results, 330
Treatment, 348
Paranasal Sinus Tumours, 330
Radiotherapy Technique, 348
Anatomy, 330
Complications, 351
Incidence of Paranasal Sinus Tumours, 330
Follow-up, 351
Staging System for Paranasal Sinus Tumours, 330
Results, 352
Aetiology, Pathology and Lymphatic Spread, 331
Further Reading, 352
Signs and Symptoms, 331
Diagnosis and Staging, 332 23 Thyroid Cancer, 353
Treatment, 332 Charles Kelly and Paul Symonds
Complications, 332 Introduction and Epidemiology, 353
Follow-up, 333 Anatomy, 353
Results, 333 Aetiological Factors, 353
Lip and Oral Cavity Carcinoma, 333 Presentation, Diagnosis and Patient Pathway, 354
Anatomy, 333 Differentiated Thyroid Cancer, 355
Incidence of Oral Cavity Carcinoma, 333 Management of Differentiated Thyroid
Staging System for Oral Cavity and Lip Carcinoma Cancer, 356
(TNM, 8th Edition), 333 Surgery, 356
Aetiology, Pathology and Lymphatic Spread, 334 Radioiodine Ablation, 357
Signs and Symptoms, 334 Thyroglobulin, 358
Diagnosis and Staging, 335 Management of Hypocalcaemia, 358
Treatment Lip Cancers, 336 Management of Locoregional Recurrence, 358
Radiotherapy Technique, 337 Metastatic Disease, 358
Radiotherapy Technique, 338 Medullary Thyroid Cancer, 358
Follow-up, 338 Anaplastic Thyroid Cancer, 359
Results of Treatment, 338 Thyroid Lymphoma, 359
Oropharyngeal Carcinoma, 338 Thyroid Sarcoma, 359
Anatomy, 338 Hurthle Cell Carcinoma, 359
Staging System of Oropharyngeal Tumours, 339 External Beam Radiotherapy for Thyroid
Aetiology, Pathology and Lymphatic Spread, 339 Cancer, 359
 CONTENTS xiii

As Adjuvant Treatment, 359 Radiation Therapy, 376

Palliative High Dose, 360 Principles of Radiation Delivery, 376
Low Dose Palliation, 360 Future Perspectives, 377
Radiotherapy for Thyroid Lymphoma, 362 Biliary Tract Cancers, 378
Follow-Up Policy for Thyroid Cancer Principles of Radiotherapy, 378
Patients, 363 Cancer of the Colon and Rectum, 378
Further Reading, 363 Epidemiology, 378
Aetiology, 378
24 Gastrointestinal Cancer, 364 Histopathology and Clinical Features, 379
Somnath Mukherjee and Maria Hawkins Pretreatment Staging Evaluations, 379
Cancer of the Oesophagus, 364 Staging Systems, 379
Epidemiology, 364 Colon Cancer—Treatment Principles, 380
Aetiology and Pathology, 365 Management of Advanced Colorectal
Risk Factors for Squamous Cell Carcinomas, 365 Cancer, 380
Risk Factors for Adenocarcinoma, 365 Third-Line Options, 380
Anatomy, 365 Rectal Cancer—Treatment Principles, 381
Clinical Manifestations, 365 Organs at Risk, 381
Diagnostic Evaluation, 365 Anal Cancer, 382
Therapy, 366 Epidemiology and Aetiology, 382
Radical Radiotherapy, 366 Anatomy, 382
Definitive Chemoradiation, 366 Histopathology, 382
Neoadjuvant Chemoradiation, 366 Clinical Features, 382
Adjuvant Radiation or Chemoradiation, 367 Treatment, 383
Palliative Radiotherapy, 367 References (Oesophagogastric), 386
Radiation Therapy Techniques, 367 References (Pancreas), 386
Chemotherapy, 369 References (hepato-biliary, colo-rectal and anal
Other Treatments, 369 cancer), 386
Oesophagogastric Junctional Tumours, 369
Summary, 369 25 Tumours of the Thorax, 388
Cancer of the Stomach, 369 Michael Snee
Anatomy, 369 Lung Cancer, 388
Epidemiology, 369 Pathology, 388
Aetiology, 369 Symptoms, 388
Pathology, 369 Diagnosis and Staging, 389
Clinical Features, 370 Systemic Treatment for Nonsmall Cell Lung
Staging, 370 Cancer, 394
Management, 370 Chemotherapy, 394
Radiation Techniques, 371 Targeted Therapy, 395
Palliative Treatments in Advanced/Metastatic Immune Therapy, 395
Gastric Cancer, 371 Small Cell Lung Cancer, 395
Summary, 371 Neuroendocrine Tumours, 396
Pancreas, 371 Mesothelioma, 396
Anatomy, 371 Symptoms, 397
Incidence and Epidemiology, 372 Diagnosis, 397
Pathology, 372 Pathology and Natural History, 397
Diagnostic Evaluation and Imaging, 372 Management, 397
Therapy, 372 Conclusion, 398
Hepatocellular Carcinoma, 375 Further Reading, 398
Epidemiology, 375 26 Breast Cancer, 399
Symptomatology, 375 Ian Kunkler
Diagnostics and Classification, 375 Anatomy, 400
General Management Principles, 375 Lymphatic Drainage, 400
Surgical Therapy, 375 Pathology, 400
Liver Transplantation, 375 Epidemiology, 400
Locoregional Treatments, 375 Aetiology, 400
Systemic Therapy and Molecularly Targeted Ductal and Lobular Carcinoma In Situ, 402
Agents, 376 Invasive Breast Cancer, 402
xiv CONTENTS

Molecular Classification of Breast Cancer, 402 Clinical Features, 434

Multidisciplinary Management of Breast Cancer, 402 Diagnosis, 434
Diagnosis, 403 Principles of Management, 434
Clinical Assessment, 403 Role of Surgery, 434
Breast Ultrasound, 403 Choice of Systemic Therapy, 434
Magnetic Resonance Imaging, 404 Hormonal Therapy, 435
Positron Emission Tomography, 404 Locoregional Therapy, 435
Obtaining a Histological Diagnosis, 404 Target Volume, 435
Staging, 404 Technique, 435
Staging Investigations, 405 Dosage and Fractionation (Radical), 435
Management of Ductal Carcinoma In Situ, 406 Locoregional Palliative Radiotherapy, 435
Role of Postoperative Radiotherapy for Ductal Technique, 435
Carcinoma In Situ, 407 Dose, 435
Prognostic and Predictive Factors for Invasive Breast Bone Metastases: Prevention and Treatment, 435
Cancer, 408 Palliative Radiotherapy for Bone Metastases, 436
Stage, 408 Palliative Surgery, 436
Age, 408 Principles of Management, 436
Tumour Size, 408 Medical Management of Advanced and Metastatic
Axillary Node Status, 408 Disease, 436
HER2/neu Status, 409 Menopausal Status and Hormone Receptor
Lymphovascular Invasion, 409 Status, 436
Prognostic Indices, 409 Sites of Metastases and Impact on Management, 437
Hormonal Receptor Status, 409 Cytotoxic Therapy, 437
Ki67, 409 Morbidity of Chemotherapy (Adjuvant and for
Molecular Subtype, 409 Metastatic Disease), 440
Gene Profiling, 409 Bone Marrow Involvement, 440
Endocrine Therapy, 409 Growth Factor Support, 441
Mastectomy or Breast Conservation, 410 Clinical Outcomes in Early and Advanced Metastatic
Management of the Axilla, 411 Breast Cancer, 441
Regional Nodal Irradiation, 411 Follow-Up, 441
Indications for Internal Mammary Irradiation, 413 Follow-Up After Breast-Conserving Therapy, 442
Postoperative Radiotherapy, 413 Follow-Up After Mastectomy, 442
Target Volume and Techniques for Locoregional Breast Cancer in Pregnancy, 442
Irradiation, 416 Breast Cancer in Males, 443
Computed Tomography Simulation, 416 Further Reading, 443
Intensity Modulated Radiotherapy, 416
Shoulder Field, 417 27 Gynaecological Cancer, 444
Neoadjuvant Therapy, 417 Christopher Kent and Paul Symonds
Adjuvant Hormonal and Cytotoxic Therapy, 425 Anatomy, 444
Rationale, 425 Incidence of Gynaecological Cancer, 444
Who Benefits?, 426 Carcinoma of Cervix, 444
Adjuvant Endocrine Therapy, 426 Causes of Cervical Neoplasia, 444
Adjuvant Tamoxifen, 427 Pathology of Cervical Cancer, 444
Aromatase Inhibitors, 427 Symptoms and Investigations of Cervical
Adjuvant Hormonal Therapy After 5 Years of Cancer, 445
Tamoxifen, 428 Treatment, 448
Toxicity of Tamoxifen, 429 Treatment of Stage II–IVa, 449
Tamoxifen Plus Chemotherapy, 429 Future Trends, 451
Adjuvant Ovarian Suppression, 429 Carcinoma of Endometrium, 452
Adjuvant/Neoadjuvant Combination Chemotherapy Pathology, 453
(Polychemotherapy), 429 Routes of Spread, 453
Neoadjuvant Chemotherapy, 429 Treatment, 453
Postoperative Adjuvant Chemotherapy, 430 Postoperative Radiotherapy, 453
HER2 Positive Breast Cancer, 430 Future Trends, 454
Triple Negative Breast Cancer, 434 Sarcomas of the Uterus, 454
Adjuvant Chemotherapy in Older Patients, 434 Cancer of the Ovary, 454
Management of Locally Advanced Breast Cancer, 434 Aetiology, 454
 CONTENTS xv

Pathology, 454 Penis, 476

Method of Spread, 454 Pathology, 476
Clinical Features, 454 Clinical Features, 476
Investigations and Staging, 454 Staging, 476
Treatment, 455 Treatment, 477
Chemotherapy, 455 Results of Treatment, 478
Radiotherapy, 455 Further Reading, 478
Future Trends, 456
29 Lymphoma and Disease of Bone Marrow, 479
Rare Tumours of the Ovary, 456
Matthew Ahearne and Lesley Speed
Sex-Cord Tumours, 456
Introduction, 479
Germ-Cell Tumours, 456
Aetiology and Epidemiology, 479
Tumours of the Vagina and Vulva, 456
Pathological Characteristics, 480
Further Reading, 457
Clinical Features, 481
Diagnosis and Staging, 481
28 Cancer of Kidney, Bladder, Prostate, Testis, Urethra
and Penis, 458 Clinical Prognostic Factors, 481
Treatment, 481
Aravindhan Sundaramurthy and Duncan B. McLaren
Multiple Myeloma, 483
Kidney, 458
Pathology, 483
Anatomy, 458
Clinical Features, 483
Pathology, 458
Diagnosis, 484
Clinical Features, 459
Prognostic Factors, 484
Investigation and Staging, 459
Treatment, 484
Treatment, 460
Results of Treatment, 461 Leukaemia, 484
Acute Leukaemia, 484
Bladder, 461
Chronic Myeloid Leukaemia, 485
Anatomy, 461
Chronic Lymphocytic Leukaemia, 485
Pathology, 461
Myeloproliferative Disorders, 485
Aetiology, 461
Haemopoietic Stem Cell Transplantation, 486
Epidemiology, 461
Radiotherapy Doses, Techniques and
Macroscopic Appearance, 461
Toxicities, 486
Microscopic Appearance, 461
Clinical Features, 462 Hodgkin’s Lymphoma, 486
Non-Hodgkin’s Lymphoma, 486
Investigation and Staging, 462
Treatment Techniques, 487
Treatment, 462
Extra-Nodal Sites, 487
Results of Treatment, 465
Leukaemia, 491
Prostate, 465
Myeloma, 491
Anatomy, 465
Mycosis Fungoides, 492
Pathology, 465
Chemotherapy Regimens and Toxicities, 492
Hormonal Sensitivity, 466
Prostate-Specific Antigen and Screening, 466 Hodgkin’s Lymphoma, 493
Non-Hodgkin’s Lymphoma, 493
Clinical Features, 466
Mantle Cell, 493
Diagnosis and Staging, 466
Diffuse Large B Cell, T-Cell-Rich, B Cell,
Treatment, 467
Follicular Grade 3b (and for T-Cell
Testis, 471
Lymphomas), 493
Anatomy, 471
Myeloma, 493
Pathology, 472
Acute Myeloid Leukaemia, 494
Tumour Markers, 472
Clinical Features, 472 Further Reading, 494
Diagnosis and Staging, 473 30 Tumours of the Central Nervous System, 495
Treatment, 474 Pinelopi Gkogkou, Sarah J. Jefferies, and Neil G. Burnet
Testicular Lymphoma, 476 Introduction, 496
Dose and Energy, 476 Tumour Types, 496
Results of Treatment, 476 Anatomy of the Central Nervous System, 496
Urethra, 476 Anatomy of the Brain, 496
Female Urethra, 476 Anatomy of the Cerebrospinal Fluid Pathways and
Treatment, 476 Hydrocephalus, 497
Results of Treatment, 476 Anatomy of the Skull and Meninges, 498
xvi CONTENTS

Clinical Features—Presentation of Brain Tumours, 499 Treatment, 516

Specific Focal Neurological Deficit, 499 Spinal Cord Tumours—Primary, 517
Epileptic Seizure, 499 Pathology and Clinical Features, 517
Raised Intracranial Pressure, 499 Treatment—Radical, 517
Nonspecific Symptoms, 499 Treatment—Palliative, 517
Principles of Management, 499 Cerebral Metastases, 518
Diagnosis—A Combination of History, Imaging and Clinical Features and Management Principles, 518
Pathology, 499 Patients With Multiple Brain Metastasis, 518
Performance Status in the Treatment Decision, 499 Patients With One to Three Brain Metastasis, 518
Principles of Neurosurgery, 499 Treatment, 519
Principles of Radiotherapy Planning for Central Hypofractionated Radiotherapy, 519
Nervous System Tumours, 500 Stereotactic Radiosurgery, 519
Planning Volumes, 501 Spinal Cord Compression, 519
Normal Tissue Tolerance to Radiotherapy, 501 Pathology and Clinical Features, 519
Principles of Steroid Therapy, 502 Management Principles, 519
Principles of Additional Supportive Care, 502 Steroids, 520
Driving After a Diagnosis of Central Nervous System Surgery and Radiotherapy, 520
Tumour, 502 External Beam Radiotherapy, 520
Individual Tumour Types, 502 Stereotactic Body Radiation Therapy, 520
High-Grade Gliomas, 502 Further Reading, 520
Pathology and Clinical Features, 502
31 Eye and Orbit, 524
Treatment, 503
Tom Roques and Adrian Harnett
Radical Treatment, 504
Anatomy, 524
Palliative Treatment, 505
Principles of Radiotherapy to the Eye, 524
Elderly Patients, 505
Radiation and Ocular Morbidity, 525
Low-Grade Gliomas, 506
The Lens, 525
Pathology and Clinical Features, 506
The Sclera and Retina, 525
Radical Treatment, 507
The Cornea and Lacrimal Apparatus, 525
Ependymoma (Intracranial), 507
The Optic Nerves and Chiasm, 526
Pathology and Clinical Features, 507
Benign Conditions, 526
Treatment, 508
Thyroid Eye Disease, 526
Central Nervous System Lymphoma, 508
Orbital Pseudotumour, 527
Pathology and Clinical Features, 508
Malignant Tumours, 527
Management Principles, 509
Primary Malignant Tumours, 527
Radical Treatment—Full Dose Radiotherapy, 509
Skin Cancers Involving the Eyelid, 527
Localised Unifocal Disease, 509
Lacrimal Gland and Nasolacrimal Duct
Palliative Radiotherapy, 509
Cancer, 528
Elderly Population, 509
Tumours Arising From Adjacent Structures, 528
Germinoma, 509
Lymphoma, 528
Clinical Features and Management Principles, 509
Ocular Melanoma, 529
Treatment, 510
Retinoblastoma, 530
Medulloblastoma, 510
Metastases, 531
Meningioma, 510
Further Reading, 531
Pathology and Clinical Features, 510
Treatment, 510 32 Sarcomas, 532
Pituitary Tumours and Craniopharyngioma, 512 Thankamma V. Ajithkumar
Pituitary Tumours, 512 Soft Tissue Sarcomas, 532
Pathology and Clinical Features, 512 Pathology, 532
Treatment, 512 Clinical Features, 533
Craniopharyngioma, 513 Diagnosis and Staging, 533
Pathology and Clinical Features, 513 Management, 535
Treatment, 513 Chemotherapy, 536
Vestibular Schwannoma, 514 Retroperitoneal Sarcomas, 536
Pathology and Clinical Features, 514 Radiotherapy Technique, 537
Treatment, 515 Radiotherapy Side Effects, 538
Chordomas and Low-Grade Chordosarcomas, 516 Proton Therapy, 538
Pathology and Clinical Features, 516 Results of Treatment, 539

Bone Tumours, 539
Osteosarcoma (Osteogenic Sarcoma), 539
Pathology, 539
Clinical Features, 539
Diagnosis and Staging Investigations, 540
Treatment, 540
Results of Treatment, 541
Ewing Sarcoma, 541
Pathology, 541
Clinical Features, 541
Diagnosis and Staging, 541
Treatment, 541
Radiotherapy Side Effects, 543
Results of Treatment, 543
Chondrosarcoma, 543
Clinical Features, 543
Diagnosis and Investigation, 543
Treatment, 543
Radiotherapy, 543
Chemotherapy, 543
Results of Treatment, 543
Undifferentiated Pleomorphic Sarcoma of Bone, 543
Secondary Tumours in Bone, 544
Clinical Features and Investigation, 544
Treatment, 544
Pathological Fracture, 545
Further Reading, 545
33 Principles of Paediatric Oncology, 546
Roger E. Taylor
Introduction, 546
Toxicity of Radiotherapy for Children, 547
Acute Morbidity, 547
Subacute Effects, 547
Long-Term Effects, 547
Tolerance of Critical Organs to Radiotherapy, 548
Chemotherapy/Radiotherapy Interactions, 548
Radiotherapy Quality Assurance, 548
Leukaemia, 548
Total Body Irradiation, 549
Hodgkin Lymphoma, 550
Non-Hodgkin Lymphoma, 550
Neuroblastoma, 550
Metaiodobenzylguanidine Therapy for
Neuroblastoma, 551
Wilms Tumour (Nephroblastoma), 551
Rhabdomyosarcoma, 551
Ewing Sarcoma/Peripheral Primitive
Neuroectodermal Tumour, 554
Osteosarcoma, 554
Central Nervous System Tumours, 555
Long-Term Effects of Radiotherapy for Central
Nervous System Tumours, 555
Chemotherapy for Central Nervous System
Tumours, 555
Low-Grade Astrocytoma, 555
High-Grade Astrocytoma, 557
Brainstem Glioma, 557
CONTENTS xvii
Ependymoma, 558
Embryonal Tumours, 558
Intracranial Germ Cell Tumours, 559
Craniopharyngioma, 564
Proton Therapy for Paediatric Tumours, 565
Conclusions, 565
Further Reading, 565
34 Care of Patients During Radiotherapy, 566
Lorraine Webster and Angela Duxbury
Introduction, 566
Assessment of Individual Patient and Carer Needs, 566
Skin Reactions, 567
Nutrition, 568
Nausea, Vomiting and Diarrhoea, 569
Fatigue, 569
Psychosocial Issues, 569
Communication, 570
Information, 571
Consent, 572
Spiritual Needs, 572
Complementary Therapies, 572
The Impact on Staff, 573
Further Reading, 573
35 Medical Complications of Malignant Disease, 575
Robert Coleman and Harriet S. Walter
Effusions Secondary to Malignant Disease, 575
Pleural Effusions, 575
Pericardial Effusions, 576
Peritoneal Effusions (Ascites), 576
Venous Thrombosis, 576
Metabolic and Endocrine Manifestations of
Malignancy, 577
Hypercalcaemia, 577
Inappropriate Secretion of Antidiuretic Hormone,
577
Other Endocrine Manifestations of Malignancy, 577
Hyperuricaemia and Tumour Lysis Syndrome, 577
Infection, 577
Paraneoplastic Syndromes, 578
Neurological, 578
Hypertrophic Pulmonary Osteoarthropathy, 578
Other Paraneoplastic Syndromes, 578
Further Reading, 578
36 Proton Beam Therapy, 579
Jenny Gains, Laura Beaton, Richard A. Amos, and Ricky A. Sharma
Introduction, 579
Physics and Technology of Proton Beam Therapy, 579
Physical Characteristics of Proton Beams, 579
Proton Therapy Systems Overview, 580
Passively Scattered Proton Beams, 580
Active Proton Pencil Beam Scanning, 581
Sources of Physical and Biological Uncertainties, 581
Treatment Planning and Delivery, 582
Proton Beam Therapy in Children, Teenagers and
Young Adults, 582
Low-Grade Astrocytoma, 583
xviii CONTENTS

Ependymoma, 583 Central Nervous System Tumours, 586

Medulloblastoma, 583 Intraocular Melanoma, 586
Craniopharyngioma, 583 Gastrointestinal Malignancies, 586
Retinoblastoma, 583 Prostate Cancer, 586
Rhabdomyosarcoma, 584 Lung Cancer, 586
Ewing Sarcoma, 584 Other Cancers and Role of Proton Beam Therapy in
Other Paediatric Tumours, 584 Retreatment, 586
Proton Beam Therapy for Adult Cancers, 584 Conclusions and Future Directions, 586
Chordoma and Chondrosarcomas, 585 Further Reading, 587
Paraspinal Tumours and Sarcomas, 585
Nasal Cavity and Paranasal Sinuses, 586 Index, 589
 CONTRIBUTORS
The editor(s) would like to acknowledge and offer grateful thanks for the input of all previous editions’ contributors, without whom this new edition
would not have been possible.

Matthew Ahearne, MBChB, MD, MRCP, Neil G. Burnet, MA, MB BChir, MD, Pinelopi Gkogkou, MD, MSc, MA, PhD
FRCPath FRCS, FRCR Oncology Department
Department of Haematology Professor Norfolk and Norwich University Hospital,
University Hospitals of Leicester NHS Trust, Manchester Cancer Research Centre Norwich,
Leicester, University of Manchester and Christie UK
UK Hospital NHS Foundation Trust,
Manchester, John R. Goepel, MB, ChB, FRCpath
Thankamma V. Ajithkumar, MBBS, MD, UK Clinical Associate Professor and Honorary
FRCR, FRCP, MBA Consultant Histopathologist
Consultant Clinical Oncologist Robert Coleman, MD, FRCP, FRCPE University of Nottingham and Nottingham
Department of oncology Yorkshire Cancer Research Professor of University Hospitals NHS Trust,
Cambridge University Hospitals, Medical Oncology Royal Hallamshire Hospital
Cambridge, Weston Park Hospital, Sheffield,
UK Sheffield, UK
UK
Matthew Aldridge, MSc, PhD Adrian Harnett, MBBS, MRCP, FRCR
Radiotherapy Physics/Nuclear Medicine Mike Dunn, BSc, MSc Department of Clinical Oncology
University College London Hospital, Retired Head of Radiation Protection Norfolk and Norwich University Hospital,
London, Medical Physics Department Norwich,
UK University Hospitals of Leicester NHS Trust, UK
Leicester,
Richard A. Amos, BSc(Hons), MSc, UK Maria Hawkins, MD, FRCR, MRCP
CPhys, CSci, FIPEM MRC group leader
Associate Professor of Proton Therapy Angela Duxbury, FCR, TDCR, MSc Department of Oncology
Medical Physics and Biomedical Emeritus Professor of Therapeutic Oxford Institute of Radiation Oncology,
Engineering Radiography Oxford,
University College London, Sheffield Hallam University UK
London, Sheffield,
UK UK Paul Hinton, BSc, MSc, CPhys, CSci,
MInstP, MIPEM
Maria Mania Aspradakis, PhD Jill Emmerson, DCR (T), HDCR (T) Medical Physics - Nuclear Medicine
Head of Radiotherapy Physics QA Radiographer Royal Surrey County Hospital,
Department of Radiation Oncology Arden Cancer Centre Guildford,
unden,
Kantonsspital Graub€ UHCW NHS Trust, Surrey,
Chur, Coventry, UK
SWZ UK
David Hole, PhD (deceased)
Helen Baines, BSc(Hons), MSc Claire Fletcher, MSc, MIPEM Late Professor of Epidemiology and
Radiotherapy Physicist Principal Clinical Scientist, Biostatistics
Medical Physics and Engineering Radiotherapy Physics, University of Glasgow,
St James’s University Hospital, UHCW NHS Trust Glasgow,
Leeds, Coventry, Scotland
UK UK
Shakardokht Jafari, PhD
Laura Beaton, MBBS, BSc, MRCP, FRCR Jenny Gains, MBBS, MRCP, FRCR, MD Medical Physics Clinical Scientist,
Clinical Research Fellow Consultant Clinical Oncologist Associate Tutor and Visiting Reasearch
Research Department of Oncology Department of Radiotherapy Fellow,
University College London Cancer Institute, University College London Hospitals NHS University of Surrey,
London, Foundation Trust, Guildford,
UK London, UK
UK

xix
Another random document with
no related content on Scribd:
S/7978 Carpenter, H.
L/9782 Carpenter, H. J.
G/14100 Carpenter, T. B.
L/8306 Carr, C.
G/2730 Carr, S.
G/14656 Carrack, J.
T/3518 Carter, A.
G/1548 Carter, C.
S/10973 Carter, H.
G/12901 Carter, J.
G/15566 Carter, J. H.
G/6136 Carter, J. T.
G/2478 Carter, R. H.
L/7696 Carter, T. F.
S/60 Carthew, J.
G/14161 Cartwright, F. G.
G/768 Carver, W.
G/7706 Caselton, S.
G/11131 Casey, H. T.
T/242206 Casey, R. F.
G/565 Cashman, J.
G/10499 Cassidy, J.
G/8455 Castle, F. H.
G/4004 Castle, R.
G/11317 Cath, H.
T/3116 Catlin, E.
T/20242 Catlow, W.
G/5367 Catt, A. E.
G/8894 Catt, A. H.
G/11284 Catt, J. B.
G/544 Causer, E.
G/602 Causer, J.
G/8062 Cavalier, E. S.
T/271022 Cave, E. M.
G/131 Cave, H. J.
L/9330 Chaddock, W. E. V.
G/11959 Chadwick, H.
G/14158 Chaffer, A. T.
G/9283 Chalk, H. G. W.
G/21208 Chalkley, A.
S/8730 Challis, C. J.
G/14502 Chaloner, H. B.
G/12794 Chamberlain, H. F.
G/1067 Chamberlin, H.
T/1620 Chambers, C. T.
G/21291 Champion, T. E.
G/20132 Champkins, C.
G/463 Champs, B.
G/22343 Chandler, A.
G/22426 Chandler, E. D.
G/24355 Chandler, W. H.
L/8929 Chantler, J. H.
G/11432 Chantley, A. H.
L/7647 Chapman, A. R.
G/19022 Chapman, C. F.
G/4930 Chapman, E.
G/4980 Chapman, F. J.
G/18846 Chapman, H.
G/10142 Chapman, J. P.
G/5682 Chapman, J.
L/10497 Chapman, R. W.
G/5397 Chapman, R. H.
T/240083 Chapman, V.
G/22423 Chapman, W.
G/18844 Chappell, E. G.
L/7227 Chapple, A. E.
L/6578 Charlton, F. J.
T/203521 Charlton, J. S.
G/3737 Charman, A. E.
G/5646 Charman, H. J.
G/1912 Chatterton, H. F.
G/13936 Cheadle, R. H.
G/22429 Cheeseman, C.
G/18965 Cheeseman, C. A.
T/2164 Cheeseman, G. H. S.
G/6165 Cheeseman, H. J.
G/4911 Cheeseman, P. E.
T/240214 Chenery, C.
G/18719 Cheney, C.
S/486 Cherrison, J.
G/9869 Cheshire, H.
T/2338 Chesson, W.
T/242075 Chester, E. J. P.
G/26560 Chester, F. G.
L/10145 Chevous, S. G.
G/325 Chidwick, F.
G/17659 Chinnery, T.
G/13077 Chittenden, G. A.
S/860 Chittenden, T.
T/1676 Chittenden, W.
G/15762 Chown, W. H.
G/1792 Chubb, E. F.
G/1057 Churchill, A. E.
S/10954 Churchman, L. F.
G/17661 Churchward, W.
G/9876 Clack, A. C.
G/9511 Clackett, A. E.
T/203581 Clackett, C.
G/24192 Clampin, J. H.
G/21209 Claridge, A. W. T.
S/10428 Claringbold, F. W.
G/21213 Clark, A.
T/203583 Clark, A.
L/8489 Clark, A. J.
G/12596 Clark, C.
G/1535 Clark, C.
G/5934 Clark, J. E.
S/10855 Clark, L. R.
G/24258 Clark, R. H.
G/25322 Clark, S. H.
G/12902 Clark, W. E.
T/270281 Clark, W. M.
T/241334 Clarke, A.
G/7908 Clarke, A.
S/10231 Clarke, A.
S/10981 Clarke, A. C.
G/2182 Clarke, A. W.
G/1576 Clarke, C.
L/10344 Clarke, C.
G/4364 Clarke, E. F.
G/2235 Clarke, H.
G/24264 Clarke, H. P.
L/9917 Clarke, R.
T/4440 Clarke, R. A.
G/11874 Clay, E. W.
G/18876 Claydon, T.
G/986 Clayton, F.
G/29265 Clayton, J. T. H.
G/18248 Clayton, S. G.
G/13193 Cleaver, S.
L/9962 Clegg, R. H.
G/3281 Clemence, J.
G/13866 Clements, E.
G/25499 Clements, G. C.
G/11182 Clements, H. E.
G/7863 Clephane, D.
G/26655 Clewley, J. H.
G/12795 Clifford, E.
G/6665 Clifford, J.
G/3632 Clifton, H. A.
L/10250 Clifton, J. E.
G/18210 Clinch, T. J.
G/6626 Close, W.
G/14153 Clough, T.
G/9712 Clout, H. W.
G/18993 Clubb, H. W.
T/206121 Cobain, H.
G/6286 Cock, E. J.
G/6731 Cockerill, E. A.
G/8631 Cockle, F.
G/12164 Coesheaell, L.
G/18845 Coffield, E. C.
G/4460 Cogger, H.
G/22470 Cohen, O.
S/10450 Cohsall, J.
L/10260 Cole, A. G.
G/5089 Cole, C.
T/241451 Cole, F.
L/9822 Cole, H.
G/12113 Cole, J.
G/25128 Cole, L.
G/12597 Cole, S. M.
G/730 Cole, W.
G/12016 Coleman, A. W.
G/4098 Coleman, E. J.
G/8659 Coleman, G. B.
G/12817 Coleman, H. J.
G/751 Coleman, J.
L/9832 Coleman, J. M.
G/20133 Coleman, O.
G/20236 Coleman, T.
G/25877 Coles, R.
T/240055 Coley, G.
G/2481 Coley, H.
G/1383 Collard, A. S.
L/7164 Collard, P.
G/5123 Collard, R.
G/25210 Collier, F. C.
L/9986 Collier, F. H.
G/14102 Collin, R.
G/13263 Collin, T.
G/8946 Collins, E. A.
T/203920 Collins, H. W.
S/10547 Collins, J.
L/10165 Collins, L. C.
G/7632 Collins, P. J. M.
G/1575 Collins, R. C.
G/22032 Collins, S.
G/1381 Collins, S. A.
G/14416 Collins, T.
S/10704 Collins, T. G.
G/15573 Collison, A. L. T.
G/6535 Collison, W.
G/4574 Colvin, D.
G/127 Comboy, D. P.
G/2479 Company, F.
G/8517 Conley, A.
G/7024 Connor, B.
S/10327 Cook, A. E.
S/10818 Cook, F. W.
T/1887 Cook, G. F.
S/8883 Cook, H. J.
G/720 Cook, J.
G/7821 Cook, J. A.
G/1586 Cook, J. H.
G/20826 Cook, T. G.
G/2722 Cook, W.
S/9868 Cook, W. E.
G/18716 Cooke, F. W.
G/13619 Coomber, H.
G/18728 Coomber, H.
G/1943 Coomber, R.
L/7848 Coombs, C.
G/12182 Coomer, C. A.
G/20954 Cooper, B. J.
G/1867 Cooper, F.
G/15574 Cooper, G. H.
G/15575 Cooper, G. L.
L/8968 Cooper, H. E.
L/8551 Cooper, J. H.
G/20853 Cooper, J.
G/9691 Cooper, P. B. A.
G/1705 Cooper, W. E.
G/18065 Coote, P. R.
T/204104 Cope, C.
G/3516 Cope, L. W.
G/38 Coppen, E. E.
G/5639 Coppin, W. R.
G/1582 Copping, T.
L/10127 Coppins, E. S.
T/240102 Coppins, G.
G/18691 Coppins, T.
G/29291 Corah, A.
L/9084 Corby, W. J.
G/14155 Cordarcy, S.
G/5333 Cordell, E.
G/21439 Cordell, F. C.
T/203939 Cordery, G.
L/10061 Cordier, A.
G/7271 Cordingly, W.
G/9765 Cork, A.
G/4831 Cork, J.
G/9222 Cork, W. J.
G/1956 Corke, J.
G/21042 Corney, L. A.
G/10230 Cornhill, A. J.
L/6391 Cornish, A.
G/14315 Corrall, G. L.
G/20848 Corrie, E. G.
L/8242 Corry, E. A.
G/19174 Cosens, W.
T/242688 Costa, J.
L/8881 Cotter, B.
L/7996 Cotter, W.
G/29285 Cotterill, F. A.
G/8491 Cottingham, J. A.
G/18804 Cotton, A.
G/22238 Cotton, E. H.
G/22445 Cottrell, A. E.
G/14733 Couch, J. W.
G/4606 Coughlan, J. J.
G/4478 Coulbeck, J. H.
S/10338 Court, B. J.
T/20213 Court, E.
T/240695 Court, J. S.
G/25275 Courtman, F. A. L.
T/202595 Courtney, A. G.
G/1608 Courtney, W. G.
L/6915 Cousins, F. W.
G/26717 Cousins, T.
S/849 Couzens, T. J.
G/4237 Cowdrey, R.
G/139 Cowell, A. T.
G/15577 Cowell, S.
G/8778 Cowey, T. B.
G/6353 Cowland, C. W.
G/4533 Cox, F. J.
S/10743 Cox, H.
G/1327 Cox, H.
S/10249 Cox, W. T.
G/2656 Cox, W. T.
T/206021 Crabb, F. C. G.
G/3307 Crabb, W. H.
G/6755 Crabtree, A.
G/25157 Cracknell, E. P.
G/8759 Craddock, W.
G/13078 Craker, T. R.
L/10249 Craker, W.
G/20254 Cramp, D. S.
G/9467 Cramp, J.
G/4473 Crampton, P.
G/15505 Crampton, W.
G/6778 Crawford, W.
G/14974 Crawley, G. E.
G/13207 Crawley, J.
G/9489 Crayden, H.
G/15578 Crayford, S.
G/14931 Crean, H.
T/203567 Creed, S.
G/3297 Cresdel, T. F.
G/29132 Creswell, G.
G/10227 Crick, J. W.
L/8657 Crickett, G. A.
G/5241 Crippen, S. G.
G/25314 Crisp, E. H. G.
L/10217 Crispin, J.
G/17906 Crockford, G. O.
G/22440 Crofford, G. N.
G/4677 Croft, J. S.
L/6179 Croft, W.
S/9428 Croft, W. J., M.M.
G/8388 Crofts, E. L.
L/9742 Crofts, F. W.
G/7981 Cronin, D.
G/12904 Crook, J.
G/1683 Crookes, F.
T/206185 Crooks, J.
G/14976 Crosby, E. H. S.
G/20071 Crosier, W.
T/202690 Cross, W. N.
G/6072 Crouch, C. F.
G/4838 Crouch, G.
G/12903 Crouch, H.
G/13282 Crouch, J. C.
L/8763 Croucher, A. E.
L/10663 Croucher, C.
G/4856 Croucher, E.
G/39 Croucher, F. S.
L/5391 Croucher, J. R.
G/6151 Croud, F.
S/675 Crowhurst, P.
G/22428 Crowson, W. P.
G/24895 Crummey, D.
L/9214 Crump, E. H.
G/12993 Crumpton, E. H.
L/7845 Cudlip, H. D.
G/12815 Cuff, J. W.
T/1334 Cullen, J.
G/2840 Culling, W. G.
G/4023 Culver, A. E.
G/9894 Culver, T.
G/817 Culwich, W. J.
G/6876 Cummings, T. H.
G/9844 Curl, G.
G/4413 Curness, F. G.
L/7532 Curnow, G.
G/22159 Currall, E.
G/13874 Curry, T. W.
G/20449 Curtis, J.
G/20990 Curtis, P. J.
G/12584 Curtis, W.
G/7888 Curtis, W. G.
G/6100 Curtiss, H.
G/14018 Cuttress, H.

G/2055 Daborn, W.
G/13653 Dadds, T. W.
G/15581 Dadson, A.
T/923 Dadswell, T.
G/6697 Dainton, A. E.
G/9187 Daisey, W. H.
T/3417 Dale, A. B.
T/202600 Dale, F. A.
G/5974 Dale, F. R.
S/168 Dale, T. E.
T/202460 Dalton, A. F.
G/3900 Dalton, N.
G/23878 Dancer, G.
G/271 Danes, A. W.
G/12973 Daniel, R. M.
G/5711 Daniells, R.
G/13004 Daniels, D. B.
G/8803 Daniels, E. T.
G/9855 Daniels, G.
G/9774 Daniels, W. S.
L/7549 Dann, F.
L/8575 Danton, A.
G/14004 Darling, A. E.
G/14077 Dart, C. G.
G/7321 Darvill, C. H.
G/29137 Davey, H.
G/15759 Davey, P.
G/20941 Davidson, W. G.
T/242455 Davies, E. A.
G/6047 Davies, G.
G/825 Davies, S.
L/7883 Davies, W.
G/20933 Davis, A. A.
G/208 Davis, C.
G/21877 Davis, E. E.
S/10702 Davis, E. E.
G/14829 Davis, G. J.
S/303 Davis, H.
T/203632 Davis, S. E.
G/8661 Davis, W. R. V.
G/3899 Davitt, J.
T/270101 Davy, H.
G/2661 Daw, A. J.
G/23870 Dawes, A.
G/3911 Dawkins, W. G.
G/7041 Dawsey, G. H.
G/13316 Dawson, C.
S/10540 Dawson, E.
S/9182 Dawson, G.
G/2389 Dawson, H.
G/1782 Day, E. J.
G/563 Day, F. H.
G/25325 Day, H.
G/6874 Deacon, F. T.
L/10488 Deadman, E.
G/25264 Deal, H. E.
S/9857 Dearman, S.
G/2075 De Beger, A. L.
G/18889 Dedman, R. A.
G/3773 Deeprose, H. J.
T/203457 Degg, R.
T/2334 De la Mare, H. R.
G/12139 Dellaway, A.
G/13079 Deller, A. L.
G/25329 Dellison, J.
G/8959 Denham, W.
G/3195 Denley, F.
T/201627 Denmee, A. L.
G/20137 Denne, C. T.
G/20109 Denne, D. G.
L/9998 Denne, P.
T/271029 Dennett, G. C. C., M.M.
L/8254 Dennis, J. W.
S/9950 Denton, A.
G/24309 Derbyshire, J.
G/14503 Derrick, W. J.
T/271152 Derrick, W. W.
T/240659 Deverson, H.
S/10935 Dewhurst, W.
G/1711 Dews, E.
G/4376 Dicker, W. L.
G/14424 Dickerson, H.
G/385 Dickson, F. G.
G/5665 Dickson, W. C.
T/20040 Diddams, W.
T/270082 Dier, F. J., M.M.
G/2163 Dillingham, S. D.
T/265012 Dillon, H.
G/4968 Divers, A. W.
G/26186 Dives, W.
G/4913 Dixon, A. C.
G/15821 Dixon, MacD.
G/13300 Dobson, C.
G/18054 Dobson, J.
G/6815 Dodds, J. W.
G/24986 Dodge, A.
G/6544 Doe, A.
T/202561 Doe, A. E.
T/201289 Dolby, L.
G/17616 Dollin, C.
T/242735 Domoney, H.
G/14247 Donaldson, A.
T/3332 Dormer, A.
S/59 Dormer, J.
G/15738 Doubleday, S. C.
G/5822 Doubleday, W.
G/4836 Doubtfire, J.
G/22491 Dove, W. H. G.
G/18734 Dowling, C. J.
G/5100 Down, F. T.
T/202160 Down, G. A.
T/25507 Down, T. G.
G/25506 Downes, W. F.
G/5235 Downs, R. W.
T/20216 Dowsett, A.
G/2728 Dowsing, H.
L/10144 D’Oyley, E.
G/2029 Draper, S. J.
G/4862 Dray, A. J.
L/10383 Dray, C. C.
G/7618 Dray, H.
L/9638 Dray, H. W.
S/585 Dray, R.
G/26658 Drayson, T. H.
L/7787 Drew, E. J.
G/15004 Druce, W.
L/8015 Drury, A. E. L.
S/9810 Drury, J. P.
G/25983 Drury, W. R.
G/8909 Dryland, G.
G/5392 Dubbins, G. W.
L/5895 Duck, F. J.
G/4620 Duckers, A.
L/8662 Duff, G.
G/24312 Duff, W.
G/829 Duffell, A. V.
G/2655 Duffield, W. C. J.
G/6906 Duffy, P.
G/11890 Duke, E. J.
G/15583 Duly, P. W.
L/5659 Dumbleton, A. J.
G/21495 Dumbrell, A. G.
G/11836 Dumbrill, S. J.
L/9144 Dunbar, S.
L/9906 Duncan, A. H.
G/9743 Dungate, H. C.
G/21190 Dungey, A. E.
L/10109 Dunk, P. J.
G/3745 Dunkley, F.
S/10264 Dunn, E. A.
G/5743 Dunn, G. A.
G/3103 Dunn, L.
G/6560 Dunn, R.
G/9626 Dunster, G.
T/3726 Dunster, J.
G/14646 Duquemin, T. H.
G/4433 Durban, E.
T/242130 Durrant, G.
G/1297 Durrant, G. W.
G/11359 Durrant, H.
G/25176 Durrant, H. G.
G/3266 Dwyer, W.
L/9940 Dyer, A. S.
G/21045 Dyer, D.
G/916 Dyer, E. G.
G/25327 Dyer, F. H.
L/10013 Dyer, H. M. A.
L/8925 Dyke, A.
G/5595 Dynan, G.
S/9718 Dyson, H. C.
G/14739 Dyson, T. H.

G/12103 Eade, H.
G/14944 Eady, E. A.
G/24231 Eagles, G. S.
G/26616 Eales, E. W.
G/15585 Ealham, W. S.
G/5238 Eason, F. E.
G/6280 East, P. J.
L/10191 East, S.
G/8083 East, S. D.
G/13114 Eastaff, W.
S/445 Easterling, F.
G/8511 Eastland, F. W.
G/103 Eastland, G. E.
L/8986 Eastwood, E.
G/9849 Eaton, J.
G/10306 Ebbs, H. S.
T/203558 Ebsworth, G.
G/11653 Eddon, J. E.
G/14820 Ede, W. J.
G/26144 Edge, A.
G/5424 Edge, C. E.
G/1599 Edgeler, W. H.
G/13965 Edinburgh, F.
G/4233 Edmonds, A.
L/8002 Edmonds, A. J.
G/14168 Edmunds, H. R.
G/8008 Edwards, A.
G/41 Edwards, G.
G/14815 Edwards, G.
L/9876 Edwards, P. A.
G/1766 Edwards, T. F.
S/7768 Edwards, W.
S/310 Edwards, W.
G/20470 Edwards, W. I.
G/3989 Edwards, W. J.
G/24745 Edwicker, A. C.
G/4880 Eggledon, A. G.
G/3215 Eggleton, J. W.
L/9679 Eggleton, W. H.
L/7729 Egleton, H.
G/17712 Elder, J. R.
G/12760 Elderfield, F.
G/3918 Eldridge, F. H.
S/9617 Eldridge, H. B.
G/22645 Element, J. W.
G/5405 Eley, H. T.
T/2418 Elgar, E. W. E.
G/25101 Elkins, A. F.
L/8626 Ellen, W. F.
G/23871 Ellen, W. T.
T/201585 Ellender, E.
T/4055 Ellender, R.
G/18939 Elliman, T. J.
L/9888 Elliott, C.
T/270263 Elliott, F.
L/7593 Elliott, F.
G/25334 Elliott, J. T.
L/9819 Elliott, W. E.
L/8136 Ellis, A.
G/18907 Ellis, C. H.
G/3977 Ellis, F. T.
G/5325 Ellis, G. C.
G/13742 Ellis, H.
T/270917 Ellis, O.
G/18916 Elsegood, J.
G/26001 Elsworth, S. C.
G/20448 Emblem, F.
G/10864 Empson, W. E.
L/9174 Emptage, C.
G/1077 Endicott, E.
G/5655 England, A. E.
G/3582 English, J.
G/4605 Epps, A. A.
L/9418 Erridge, F.
G/18679 Escott, R. S.
G/4505 Etherington, P.
G/5828 Euden, A. T.
T/3186 Euden, H. F.
G/22447 Evans, A. E.
T/203458 Evans, A. V.
L/10356 Evans, C.
L/7922 Evans, E. R.
G/6650 Evans, F.
G/13522 Evans, G. C.
G/21016 Evans, H.
L/8889 Evans, I.
G/21013 Evans, J. H.
G/24067 Evans, J. R.
G/20855 Evans, R. B.
G/4942 Evans, S.
G/6324 Eve, G.
T/241666 Evenden, C.
T/241618 Evenden, V.
G/3991 Everest, E. A.
G/263 Everson, R. H.
T/202591 Ewers, C.
L/7072 Excell, G. F.
G/9132 Excell, G. H.
G/8921 Excell, S. E.

G/9082 Fagg, A. G.
L/10341 Fagg, C. F.
G/4977 Fagg, F.
G/13028 Fagg, W. J.
L/10387 Fairow, C. F.
T/206054 Fairweather, W. J.
S/10765 Fallowes, F. A.
G/14507 Falshaw, A.
G/17889 Fancy, H. W.
G/13213 Fannon, J.
T/271032 Fantham, T.
G/9634 Farmer, E. F.
G/1466 Farmer, J.
G/8879 Farrance, R.
G/1598 Farrant, H.
G/11095 Farrant, W.
G/13214 Farrell, P.
G/8026 Farrell, W.
G/9687 Farrier, J. H.
G/5883 Farrier, R. H.
L/9659 Farrier, S. B.
L/7994 Farrow, E. A.
G/110 Fasham, W.
G/2423 Faulkner, W. W.
G/26312 Fearn, G. R.
G/15721 Fedarb, W. L.
G/757 Feist, A. G.
G/25999 Fellows, P. J.
G/22512 Felts, H. H.
L/7529 Fendom, W. F.
G/36631 Fenn, G.
T/202536 Fenner, H.
G/18815 Fensome, L.
G/23774 Fentiman, C. J.
T/3467 Fentiman, T. H.
G/5773 Fenton, A. E.
G/14433 Ferguson, W. J.
G/13698 Ferneley, E.
G/5903 Ferris, H. W.
G/6652 Ferry, T. H.
G/11395 Fewell, G. F.
S/6927 Fiddler, J.
S/846 Field, A. J.
G/3196 Field, C. H.
L/7997 Field, H.
L/7888 Field, J.
G/12886 Field, R.
G/5824 Fielder, H. T.
G/13347 Filmer, H.
G/25931 Filsell, A.
G/17619 Finbow, J. T.
G/23860 Finch, F.
T/204441 Finch, H. G.
G/6595 Finch, J.
G/13410 Finch, V.
L/8521 Finch, W.
G/5807 Finn, E.
S/357 Finn, J.
T/2007 Finnis, R. M.
G/15508 Finter, J. W.
L/8707 Fishenden, J. T.
L/9444 Fisher, S.
G/2781 Fisher, R. G.
G/12611 Fisher, W.
L/6265 Fisher, W. T.
G/24828 Fisk, A. H.
G/3697 Fisk, R. G. T.
L/6200 Fisken, J.
G/2574 Fison, H.
G/14757 Fitzgerald, E. P.
T/3447 Fitzgerald, J. T.
T/5107 Fitzgerald, W.
T/270274 Flack, G.
S/10674 Flanagan, J. W.
G/12908 Flatt, E. V.
G/29145 Fletcher, H.
L/9231 Flick, J. E.
G/5575 Flight, P. T., M.M.
G/12825 Flin, D. J.
G/10167 Flint, S.
G/650 Flisher, H. S.
T/242922 Flood, B. S.
G/18213 Flowerday, H. W. G.
G/1982 Flynn, F.
G/20138 Foad, R.
G/2081 Foglearde, R.
G/676 Folley, R.
L/8627 Foord, T. H.
L/5158 Foord, W.
G/13337 Foot, G. F.
T/270939 Ford, C. F.
G/4763 Fordham, J. H.
S/10561 Foreman, F.
G/8956 Foreman, H.
G/4412 Forest, A. H.
G/692 Forster, P.
G/3333 Foster, A.
G/18717 Foster, A.
T/200835 Foster, A.
L/7991 Foster, F.
T/203944 Foster, G. H.
G/5138 Foster, H. E.
G/715 Foster, H.
T/3560 Foster, H. L. H.
T/240550 Foster, W. H.
L/9287 Foster, W. J.
L/9653 Fowler, F. W.
L/9612 Fowler, G. H.
G/15594 Fowler, H. J.
G/11262 Fowler, J.
G/29144 Fowler, J. W.
S/121 Fox, C.
S/11082 Fox, F. J.
L/10589 Fox, G.
G/24187 Fox, L.
L/6148 Fox, W.
G/12509 Fox, W.
T/242923 Framingham, F. H.
G/14506 France, W. L.
G/3752 Francis, L.
L/8482 Francis, T.
L/6944 Francis, T.
L/7835 Francis, W. W.
G/25338 Frankis, J. H.
G/10288 Franklin, E.
G/2200 Franklin, G.
G/5568 Franks, A. J., M.M.
G/13291 Franks, G. E.
G/7338 Fraser, P. A.
G/23859 Freeman, A. W.
G/9234 Freemantle, S.
L/9651 Fremlin, J. H.
S/10779 French, A.
G/15596 French, O. A.
G/3269 French, W. E.
G/8943 Friend, H.
G/4966 Friend, J. R.
G/4967 Friend, J. T.
G/5664 Friend, T. A.
G/23861 Friend, V.
G/235 Friend, W. R.
L/9142 Fright, A. W.
G/11067 Frost, G. M. R.
G/14612 Frost, W.
T/242741 Fryer, J. S.
G/1546 Fulcher, A. G.
G/14774 Fulker, J. H.
G/8735 Fuller, H. R.
T/2073 Fuller, L.
G/5923 Fuller, S. W.
G/18186 Fyson, G. P.

G/2887 Gafford, P. G.
G/2387 Gage, E.
G/8884 Gage, W. J.
T/2356 Gage, W. R.
G/18244 Gain, A. R.
G/22582 Gale, E. J.
G/11894 Gale, H.
G/1511 Gale, J. A.
G/25342 Gale, J. W. T.
G/972 Gallagher, A. E.
G/13217 Gallagher, G.
G/6706 Galloway, M.
L/9112 Gambell, E.
G/15598 Gambell, R.
L/9617 Gambell, W.
G/20121 Gammon, H.
G/4721 Gannon, J.
T/1456 Gardiner, J.
G/1610 Gardiner, T.
L/7909 Gardiner, W. J.
S/123 Gardner, A. H.
G/4082 Gardner, D.
L/6918 Gardner, E.
G/8092 Gardner, W. A.
G/2713 Gardner, W. E.
G/18822 Garley, G. E.
G/12128 Garlick, H. W.
G/445 Garlinge, C. F.
G/9121 Garlinge, E. E.
T/270881 Garlinge, G.
G/5196 Garlinge, W. J., M.M.
L/10416 Garner, H.
G/18327 Gates, C.
G/2973 Gates, S.
T/3427 Gates, W. A.
G/2204 Gates, W. T.
G/13967 Gaughan, J.
L/10346 Gawler, F.
G/13937 Gee, E.
G/15602 Gee, L. F.
L/8051 Gee, W. B.
G/2180 Geere, W.
G/15509 Geering, A. R.
G/1557 Gentry, A. E.
L/9490 George, C.
G/1023 George, J.
G/746 George, T.
G/24764 Gibbard, E. J.
G/21210 Gibbons, T. W.
L/9383 Gibbs, A.
G/6552 Gibbs, C. H.
T/242005 Gibbs, D.
G/9111 Gibbs, E.
G/9559 Gibbs, E.
L/7617 Gibbs, E. A.
G/22590 Gibbs, P.
G/12887 Gibbs, R.
G/574 Gibbs, W.
G/6933 Gibson, R.
G/6508 Gibson, W. E. H.
G/4453 Giddings, S.
S/10789 Giggins, H. H.
G/2407 Gilbert, B. F.
G/19357 Gilbert, C.
G/4432 Gilbert, F. M.
G/8462 Gilbert, G.
G/5440 Gilbert, L.
G/18966 Gilbert, T.
G/5446 Gilbert, T. H.
T/4511 Gilbert, W.
G/14760 Gilbert, W.
G/22160 Gilbert, W. P.
T/2002 Gilbert, W. T.
G/3352 Gildersleeve, A.
G/1555 Giles, W.
L/9531 Giles, W. H.
L/10395 Gill, C. A.
G/9390 Gill, F. G.
G/18972 Gill, H. H.
G/1522 Gill, H.
L/6951 Gillard, J. E.