Second Tumors after Oncologic Treatment

Abstract

Radiotherapy results in a small but significant increase in tumor incidence, i.e., in secondary tumors. This is only relevant, if tumor cure is achieved with the first treatment. Collection of data on second tumors requires lifelong follow-up and/or a consequent documentation in cancer registries. The improvement in survival rates by successful radiotherapy clearly outweighs the reduction of survival by the induction of second tumors. Moreover, latent times for second neoplasms range from years to decades, while the survival after ineffective treatment is substantially shorter. Hence, the administration of ionizing radiation (in the case of clinically proven indications) is justified. Radiotherapy would even be warranted, if the incidence of second tumors were clearly higher than currently estimated, based on the difference in survival times for second tumors versus recurrences.

Treatment planning system and dose delivery accuracy in extracranial stereotactic radiotherapy using Elekta body frame

“…There is good agreement between the results obtained in this study and several publications [1][2][3]6].…”

Biologische Mechanismen der Strahlenwirkung

“…werden. Die Zeit bis zu deren klinischer Manifestation kann mitunter ebenfalls mehrere Jahrzehnte betragen [10,15,23,24]. Betreffen diese Mutationen Keimzellen, können genetisch bedingte Verände-rungen bei den Nachkommen auftreten; sog.…”

“…der Manifestation eines Sekundärtumors zu bedenken [23], wie Geschlecht und Alter bei Exposition, genetische Disposition, Expositionsmuster und betroffene Gewebe, zusätzliche Behandlungen (Chemo-, Hormontherapie) oder das Fortbestehen ätiologischer Faktoren. Hinzu kommt, dass nach einer Strahlentherapie chronische Gewebeveränderun-gen eintreten können, die einen präkan-zerogenen Prozess darstellen, wie etwa chronische Darm-und Harnblasenveränderungen nach der Strahlentherapie von Prostatatumoren [10].…”

ABVD vs. radiotherapy in early stage Hodgkin’s lymphoma

“…Since the treatment modalities have significantly changed over the years and the outdated STNRT is replaced by highly precise involved field or involved noderadiotherapy, this study has to be read and interpreted with caution. Moreover, there should be awareness that the higher cure rates justify the use of RT since most second cancers are developing much later than the (prevented) local recurrences [10].…”

“…Although for AML and MDS, there is a generally accepted link to the use (and dose) of DNA-destabilizing agents (e.g., alkylators or doxorubicin) [7], NHL is thought to be more related to the underlying immunosuppression rather than the drugs [8]. An increased risk of secondary solid tumors (mainly secondary breast and lung cancers) is attributable to both chemotherapy and radiotherapy [9,10]. Where age at exposure, radiation dose and field size play an important role in defining the excess risk, a similar dose-response relationship is also recognized for secondary lung cancer with the use of alkylators [11,12].…”