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Radiation-Related Second Primary Cancers: Clinical Perspectives

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ALERT - Adverse Late Effects of Cancer Treatment

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

Radiation therapy (RT) is a major treatment used in the curative management of many cancer types. As survival rates for many forms of cancer continue to improve, there is increasing clinical attention being directed toward the risk of delayed radiation-induced second cancer (SC). Survivors of Hodgkin lymphoma, leukemia, cervix cancer, and breast cancer treated with RT have been shown, to varying degrees, to experience increased risks of SC. Important improvements in the analysis of risk can aid clinical interpretation: in particular, emphasis on the cumulative incidence of SC, and appropriate adjustment for competing causes of death can provide more clinically meaningful insight into the burden of SC than descriptions of the relative risk. The nature of the dose-risk relationship for normal tissues exposed to intermediate and high dose is uncertain, although there are emerging data that the risk may increase with increasing dose above 10 Gy. A better understanding of the risk associated with doses in this range will be an important component of developing RT treatments that limit the risk of SC and also for understanding the potential risk associated with newer treatments, such as intensity modulated radiation therapy (IMRT). Further research is required to better understand how the interaction of RT and chemotherapy or biologic agents may affect SC risk, and to identify the genetic contributors to the development of SC.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, 610 University Ave, Toronto, ON, M5G 2M9, Canada

    David C. Hodgson

  2. Department of Radiation Oncology, Harvard Medical School, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, 75 Francis street L2, Boston, MA, 02115, USA

    Andrea Ng

  3. Department of Radiation Oncology, University of Rochester, James P. Wilmot Cancer Center, 265 Crittenden Boulevard; CU 420318, Rochester, NY, 14642-0318, USA

    Lois B. Travis

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  1. David C. Hodgson
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  2. Andrea Ng
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  3. Lois B. Travis
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Correspondence to David C. Hodgson .

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Editors and Affiliations

  1. Dept. Radiation Oncology, University of Rochester Medical Center James P. Wilmot Cancer Ctr., Rochester, New York, USA

    Philip Rubin

  2. Department of Radiation Oncology, University of Rochester Medical Center James P. Wilmot Cancer Ctr., Rochester, New York, USA

    Louis S. Constine

  3. Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina, USA

    Lawrence B. Marks

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Hodgson, D.C., Ng, A., Travis, L.B. (2014). Radiation-Related Second Primary Cancers: Clinical Perspectives. In: Rubin, P., Constine, L., Marks, L. (eds) ALERT - Adverse Late Effects of Cancer Treatment. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-72314-1_16

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