To the question of secondary cancers caused by radiation therapy, I find it fascinating that most of what we know about
the possible health effects of RT is still coming from studying survivors of atomic bomb blasts in Japan, supplemented by information from workers in jobs with radiation exposure, and lastly by patients treated with radiation therapy for cancer and other diseases.
Solid second tumors typically are not seen until at least 10-years, and some are diagnosed even more than 15-years later. Therein lies the basis for not generally recommending RT for younger patients if other treatments are available: "the younger the patient is at the time of radiation treatment, the higher the risk is of a future second cancer." (from ACS site)
In a report published last year,
One of the most difficult challenges in assessing secondary cancer risks from large epidemiologic studies is that the radiotherapy technique and technologies are perpetually changing and evolving. … With radiotherapy techniques dramatically changing the dose and volume of radiation for so many sites of radiotherapy [prostate cancer, for example], the applicability of the outcomes from the large epidemiologic studies of earlier decades utilizing outdated techniques to the modern context is unclear … Whether these newer radiotherapy technologies will necessarily reduce second cancer risks is also not clear … The unclear implications for second cancer risk of novel radiotherapy techniques despite their rapid adoption and utilization for treating patients emphasizes the critical value of dosimetric and modeling investigations.
In other words, the final assessment today is that more investigation is needed in this area to better understand the rapidly changing treatments. One study published by Grimm for the purpose of: “
To report the incidence of second bladder and colorectal cancers after prostate brachytherapy” found 15 patients (after 5-years follow-up) with a second solid tumor out of 125 patients treated with BT. (11 cases of bladder cancer, 3 colorectal cancer and 1 prostatic urethra cancer). There was no statistical differences between those treated with BT alone and those treated with BT + EBRT.
I would say it is
relatively rare.
There was a separate question regarding the risk of dying on the surgical table, which falls into the
very rare category. This situation also has a high correlation to the age of the patient (and comorbidities, which tend to accompany increasing age), and is part of the basis for the general rule of thumb that older men might be better suited for radiation therapy compared to surgery for the treatment of prostate cancer (and others).
As an additional personal observation, I was amazed at the differences in the health screening that was done 2-years ago in advance of my knee surgery compared to that done just 8-years ago for my RP. 8-years ago, I had to ask my PCP to send an email that I was in good health for upcoming surgery; but 2-years ago, I had to go to the hospital to see
their on-staff internist for a pre-surgery physical/screening. They really DON'T want you to die on the surgical table these days...
Post Edited (JackH) : 1/16/2017 12:05:12 PM (GMT-7)