Esophageal cancer developed in a radiated field: can we reduce the risk of a poor prognosis cancer?

Publicato: Maggio 23, 2017

Articoli Scientifici

Esophageal cancer developed in a radiated field: can we reduce the risk of a poor prognosis cancer?

Marina Schena 1, Angelo F. Battaglia 1, Fernando Munoz 2

Treatment options for patients with clinically localized cancer diagnosis include radiation therapy and chemotherapy. Each option is associated with side effects. Progress in cancer therapy has increased multimodality approach such as chemoradiotherapy, and patient’s life expectancy as well. However aggressive treatments and prolonged survival may cause growing concern about late effect of treatments. An important complication for patients submitted to combined approaches is the potential development of a second primary cancer (SPC). Theappearance of SPCs is considered a late radiation effect only if it fits certain predetermined criteria. Some of these criteria include the timing of SPCs development (>5 years after radiation), the origin from tissues within the irradiated fields and the different histopathological features compared to primary tumors (1,2). The process of radio-carcinogenesis is not clearly understood, and accurate risk models do not exist; the best data for radiation-induced carcinogenic risk come from A-bomb survivor studies, although these are subject to big limitations (3). Carcinogenesis risk after radiotherapy seems to be highest for tissues receiving even low doses (≤6 Gy) (4). However, there seems to be a tissues-specific dose-response relationship for radiocarcinogenesis, whit radiation-induced sarcomas developing in tissues receiving higher doses (30 to 60 Gy) and carcinomas induced in tissues receiving much lower doses (5,6). Both the integral dose to normal tissue and its dose distribution therefore influence the risk.

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