Radiation-induced second malignancies

There have been significant improvements in cancer treatment in the last few decades. The use of radiation in the treatment of cancer is widespread and has increased. Up to 40% of cancer pts will receive radiotherapy as part of their management. More successful treatment has meant improved survival rates, but conversely patients are living longer and encountering more treatment-induced complications. The development of a second primary malignancy, often many years later, is one of the more sinister complications. The American National Cancer Institute published data in 2006 reporting that 'Cancer survivors constitute 3.5% of the US population' but that 'second malignancies among high risk groups now accounts for 16% of all cancer incidence. The timescale between completion of the radiotherapy and the development of a second malignancy, known as the latent period, can vary widely from as little as 5 years up to 50 years later. In this report we present three cases of radiation-induced second malignancies seen in the Palliative Care setting and then give an overview of radiation induced second malignancies, looking at the aetiology, genetics and the palliative care implications for these patients.