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Generally, the

benefits

of RT greatly

outweigh risks

for tumor induction!

(improvements are needed, increased survival).

Second tumor incidence far from

high dose areas

is often relatively low (non-

IMRT).

Depending on

tissue/primary tumor

,… the risk may increase, level off, or

decrease at high dose.

If probability of tumor induction levels off, or decreases for higher doses,

tumor induction

may increase for IMRT and rotational therapy

.

High energy

photon beams (>10 MV)

may result in enhanced tumor

induction due to neutron peripheral dose.

Uncertainty in epidemiological data

: even studies based on large databases

of cancer registries (~100.000 patients) may have conflicting outcome on

second cancer incidence. More/better data is needed, e.g. to predict the impact

of new techniques such as IMRT or VMAT.

49

Clinical lessons - Discussion