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Second Malignancies after Radiation Therapy: Update on Pathogenesis and Cross-sectional Imaging Findings
Lokesh Khanna1, Srinivasa R Prasad1, Sireesha Yedururi1
1From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (L.K., A.M.P., V.S.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P., S.Y., L.P.M.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (K.S., C.O.M.); and Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (S.H.T.).
Radiation therapy can cause aggressive second cancers, known as radiation-induced malignancies (RTIMs). Early diagnosis and management of RTIMs are crucial for cancer survivors, aided by characteristic genetic and imaging findings.
Area of Science:
- Oncology
- Radiology
- Genetics
Background:
- Second cancers are late complications of radiation therapy (RT).
- Lifestyle, environmental, and genetic factors influence second malignancy development in survivors.
- Radiation-induced malignancies (RTIMs) are aggressive, with latency periods of 5-60 years.
Purpose of the Study:
- To review the spectrum of RTIMs.
- To highlight diagnostic features, including genetic and imaging characteristics.
- To emphasize the importance of radiologist familiarity for early diagnosis and management.
Main Methods:
- Literature review of RTIMs.
- Analysis of genetic alterations in specific RTIMs (e.g., MYC amplification, H3 K27me3 loss, RET/PTC rearrangements).
- Review of characteristic imaging findings and typical locations within prior RT fields.
Main Results:
- Carcinomas and leukemias often follow low-dose RT; sarcomas occur in high-dose areas.
- Common RT-associated sarcomas include angiosarcomas and pleomorphic sarcomas.
- Specific RTIMs have distinct genetic profiles (e.g., MYC amplification in angiosarcomas) and imaging findings.
Conclusions:
- RTIMs exhibit diverse clinical, genetic, and imaging features.
- Genetic and imaging characteristics aid in accurate diagnosis and characterization.
- Radiologists' awareness of RTIMs is vital for timely diagnosis and patient management.
