Volume 53, Number 2, April-June 2018
|Page(s)||101 - 105|
|Published online||04 May 2018|
Second cancers after radiotherapy: update and recommandations
Centre de cancérologie − GIE Charlebourg, Groupe Amethyst,
La Garenne-Colombes, France
2 Amethyst Radiotherapy Centre, Rydygier Hospital, Krakow, Poland
3 Institut Gustave-Roussy, 94600 Villejuif, France
4 École du Val-de-Grâce, French Military Health Academy, 75005 Paris, France
* Corresponding author: firstname.lastname@example.org
Accepted: 11 April 2018
While radio-induced cancers are well known since the first years of the xxth century, they did not represent a major concern for radiation oncologists for many decades. With better and better results of modern radiotherapy and prolonged follow-up of patients, secondary radio-induced cancers should now be systematically taken into account when irradiating patients. The analysis of the available literature allows to stress a few main points; (1) cancer patients are at a higher risk for developing secondary cancers than the general population, radiotherapy being only responsible for a (small) proportion of those second malignancies; (2) the clinical data emphasize the role of age, with children being much more susceptible to the carcinogenic effect of ionizing radiation than adults; (3) most radio-induced cancers occur in or close to the high-dose treatment volume; (4) the relative risk of radio-induced cancer appears to be different for different organs; (5) the relative risks of radio-induced cancers tend to be lower in the medical cohort studies than in the Japanese A-Bomb survivor studies; (6) several cofactors (genetic, lifestyle…) account for the risk of secondary and radiation-induced cancer. The exact shape of the dose/effect (carcinogenesis) curve is still debated, particularly for the high doses of radiotherapy, with a direct impact on risk calculations, which can be very different if using different radiobiological models. In spite of some uncertainties, a few main recommendations could be proposed to reduce as much as possible the risk of radio-induced cancer after radiotherapy: (1) adapting the irradiation technique; (2) reducing the target volumes; (3) adapting to patient’s age; (4) adapting to specific organs; (5) and optimizing the imaging dose. In conclusion, even if radio-induced cancers are rare, they must be kept in mind each time a radiotherapy is proposed in 2018.
Key words: radio-induced cancer / radiotherapy / carcinogenesis / radiosensivity
© EDP Sciences 2018
Current usage metrics show cumulative count of Article Views (full-text article views including HTML views, PDF and ePub downloads, according to the available data) and Abstracts Views on Vision4Press platform.
Data correspond to usage on the plateform after 2015. The current usage metrics is available 48-96 hours after online publication and is updated daily on week days.
Initial download of the metrics may take a while.