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Effect: Second Primary Malignancies (SPM)

10

• SPM’s mostly in tissues >2Gy (fractionated)

– Thresholds of 0.6Gy (adult) and 0.1Gy (children

• Practical guidelines: aim for reducing volume

<3.5Gy

Tubiana, R&O 2009

• SPM incidence has reduced due to better

conformality of dose (heart, lung, breast)

Tubiana, R&O 2009

• Somewhat controversial but

clear need for

organ specific doses and distributions

K.Trott R&O 2009

(patient specific?)

Dose?

Mesbahi etal, Jpn J Radiol 2010 28:398-403

Implantable devices etc too…