540 / 1245
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…