Radiotherapy Associated Secondary Malignancies

[ghgi8]

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Hi all,
I was wondering if some of you could share some insight regarding some of the harmful effects of our treatment. I have an aunt in our family who was diagnosed with breast cancer and received radiotherapy following her lumpectomy and axillary lymph node dissection. A few years later she was found to have a sarcoma on the anterior chest wall. For this reason I feel that some in my family, naturally, may have a more amplified negative association with the career I am pursuing. I was wondering how rare such an occurrence is. I know that different tissues have different predilictions for radiation induced carcinogenesis but I have no epidemiological understanding of this issue. Some in my family are big on holistic/preventative medicine....what can I say to highlight the good intentions of radiation oncology? Are secondary malignancies grounds for malpractice suits?
Thanks in advance

 

[napoleondynamite]

The stat I always heard my attendings quote during 4th year rotations was that your risk of secondary malignancies was about 1 in 1,000 and that these normally begin appear 10-20 years after radiation. But I haven't done any research to back that up.

 

[radiaterMike]

Radiation carcinogenesis is dependent upon many factors, including age at treatment, site treated, dose/volume paramters, chemotherapy, genetic factors, etc. Second malignancy should not be grounds for a lawsuit, as it is not the result of malpractice, but rather an accepted risk of treatment. The patient is always made aware of this risk during the consent for radiation therapy. As an aside, chemotherapy can induce malignancy (chemotherapy induced leukemia for example) and in rare circumstances surgery can also induce malignancy (chest wall angiosarcoma after breast surgery).

 

[Gfunk6]

Secondary malignancies are a well-recognized (if rare) long-term side effect of radiation therapy. As radiaterMike stated, a good radiation oncologist will inform you of this prior to treatment. Assuming this was the case with the OP, I don't see grounds for malpractice.

In our journal club, we recently went over a large retrospective study published in the Red Journal.

Title: Risk of second malignancies after adjuvant radiotherapy for breast cancer: a large-scale, single-institution review.
PMID: 17379448

 

[3dtp]

Concur with the above. Risk of secondary malignancies in radiation treatment is well known and documented. However, the time course is inconsistent with a few years. Although risk of cancer is a stochastic process, the usual time course is decades past radiation treatments. The risk also decreases with age at time of administration of radiation.

"A few years" seems like a very short interval between the time of irradiation and development of a sarcoma in close proximity to radiation seems unlikely as a consequence of radiation, and I suspect reputable attorneys would politely decline this one. You may be able to scrounge a bottom dweller though.

This is not a forum for medical advice, so the above is general in nature and your specific mileage may vary.

 

[ghgi8]

Thanks for your replies. Just for clarification, I was not asking for medical-legal advice pertaining to my family but was curious about the impact such a circumstance could have on my career in the future.

 

[stephew]

there is no short answer for this. some patients have DNA repair gene faults and get subsequent 2ndaries readily. others dont. even chemo can do this (usually leukemias however). the mening data for kids who had rt for tinea capitus is interesting as they didnt have rt for a cancer.

 

[pikachu]

And couldn't you argue that RT didn't give the tinea capitis kids "cancer," per se? There is a big difference between a meningioma and an angiosarc of the chest wall. It could make sense that RT would be more likely to induce an invasive cancer in pts w/germline mutation that predisposes them to malignancy in the first instance.

 

[stephew]

And couldn't you argue that RT didn't give the tinea capitis kids "cancer," per se? There is a big difference between a meningioma and an angiosarc of the chest wall. It could make sense that RT would be more likely to induce an invasive cancer in pts w/germline mutation that predisposes them to malignancy in the first instance.

if youre talking benign mening its not cancer. but many are high grade. but the point is 2nd tumors really. and of course you could have gliomas.