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Risk of second cancers in the era of modern radiation therapy: does the risk/benefit analysis overcome theoretical models?

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Abstract

In the era of modern radiation therapy, the compromise between the reductions in deterministic radiation-induced toxicities through highly conformal devices may be impacting the stochastic risk of second malignancies. We reviewed the clinical literature and evolving theoretical models evaluating the impact of intensity-modulated radiation therapy (IMRT) on the risk of second cancers, as a consequence of the increase in volumes of normal tissues receiving low doses. The risk increase (if any) is not as high as theoretical models have predicted in adults. Moreover, the increase in out-of-field radiation doses with IMRT could be counterbalanced by the decrease in volumes receiving high doses. Clinical studies with short follow-up have not corroborated the hypothesis that IMRT would drastically increase the incidence of second cancers. In children, the risk of radiation-induced carcinogenesis increases from low doses and consequently the relative risk of second cancers after IMRT could be higher than in adults, justifying current developments of proton therapy with priority given to this population. Although only longer follow-up will allow a true assessment of the real impact of these modern techniques on radiation-induced carcinogenesis, a comprehensive risk-adapted strategy will help minimize the probability of second cancers.

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Acknowledgments

The authors thank Ms. Pascale Pons for her assistance in providing illustrations.

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Authors and Affiliations

  1. Radiotherapy Department, Hôpital d’Instruction des Armées du Val-de-Grâce, Paris, France

    Cyrus Chargari

  2. INSERM 1030, Molecular Radiotherapy, Gustave Roussy campus Cancer, Grand Paris, France

    Cyrus Chargari & Eric Deutsch

  3. Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA

    Karyn A. Goodman

  4. U1018 Institut National de la Santé et de la Recherche Médicale, Villejuif, France

    Ibrahima Diallo

  5. Cellular and Molecular Radiotherapy Laboratory, EMR3738, 69921, Oullins, France

    Jean-Baptiste Guy & Nicolas Magne

  6. Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France

    Jean-Baptiste Guy, Chloe Rancoule & Nicolas Magne

  7. Oncology/Radiotherapy Department, Institut Curie, 75005, Paris, France

    Jean-Marc Cosset

  8. Charlebourg-La Défense Radiotherapy Center, Amethyst Group, La Garenne-Colombes, 92250, Paris, France

    Jean-Marc Cosset

  9. Chef du Département de Radiothérapie, Directeur de la Recherche et de l’Innovation, Institut de Cancérologie Lucien Neuwirth, 108 bis, avenue Albert Raimond, BP 60008, 42270, Saint-Priest en Jarez cedex, France

    Nicolas Magne

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  1. Cyrus Chargari
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  2. Karyn A. Goodman
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Correspondence to Nicolas Magne.

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Chargari, C., Goodman, K.A., Diallo, I. et al. Risk of second cancers in the era of modern radiation therapy: does the risk/benefit analysis overcome theoretical models?. Cancer Metastasis Rev 35, 277–288 (2016). https://doi.org/10.1007/s10555-016-9616-2

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  • DOI: https://doi.org/10.1007/s10555-016-9616-2

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