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Estimating the Risk of Radiation-Induced Malignancy Following Radiotherapy for Benign Disease

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Radiation Therapy of Benign Diseases

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

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Abstract

Throughout this textbook there are descriptions of a wide range of diseases treated typically with moderate-dose radiotherapy (MDRT; conventionally fractionated dose range 5–40 Gy, mean ~20 Gy). These regimens may provide clinical benefit in many of these situations with, for the most part, minimal acute side effects (Taylor et al. 2015). The most important deterrent against the use of MDRT is often the acknowledged, if normally very small, risk of a radiation-induced cancer (RIC) many years after treatment (McKeown et al. 2015; Mazonakis and Damilakis 2017). However, the number of patients required to estimate the risk of an expected small/very small increase in RICs, occurring many years after exposure to MDRT to a confined radiation field, is large, yet (with a few exceptions) the numbers treated for these specific indications are small. Consequently, there have been very few directly relevant trials to identify the risk of a RIC following MDRT. Indeed, due to the long latency time (LT) required, most of the studies discussed in this chapter relate to patients treated >30 years ago when RT treatment protocols were less sophisticated. The use of modern technology also modifies the extent and location of normal tissue exposure to ionizing radiation during RT (Lee et al. 2014; Liu et al. 2016). For example, the use of intensity-modulated RT (IMRT) to improve conformality may expose additional healthy tissue to low doses of radiation because of the increased number of angles used. This adds another layer of complexity to the assessment of RIC risk for current treatment approaches when comparing to data from historical cohorts (Mazonakis and Damilakis 2017).

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Authors and Affiliations

  1. Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA

    Jean L. Nakamura & Steve E. Braunstein

  2. Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland, UK

    Stephanie R. McKeown

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Correspondence to Jean L. Nakamura .

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  1. Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada

    David Roberge

  2. Department of Radiation Oncology, Stanford Medicine, Palo Alto, CA, USA

    Sarah S. Donaldson

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Nakamura, J.L., Braunstein, S.E., McKeown, S.R. (2022). Estimating the Risk of Radiation-Induced Malignancy Following Radiotherapy for Benign Disease. In: Roberge, D., Donaldson, S.S. (eds) Radiation Therapy of Benign Diseases. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2022_349

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