Some cases of severe normal tissue toxicity can be anticipated with ablated fractionated radiation with appropriate long-term follow-up

Seminars in Radiation Oncology
Christopher Dolinsky, Eli Glatstein

Abstract

As new technologies have allowed physicians to both better image and characterize malignant disease as well as deliver radiation dose with high precision and accuracy, there has been a resurgence in interest in hypofractionated or even single-fraction radiation therapy schemas. Late-reacting tissues have a low alpha/beta ratio (compared with early reacting tissues) and are therefore more sensitive to increments in fraction size. When we hypofractionate, we may lose some of the biological advantages associated with fractionation while we may simultaneously increase our risk of damaging late-responding normal tissues. The ideal 4 R's for tumor cells are exactly opposite those 4 R's ideally desired for normal tissues, and this represents the major dilemma to the practicing radiation oncologist. The long-term safety profile for modern hypofractionated radiation schemes will depend on the area and volume treated, the total dose delivered, and the level of baseline function observed before initiating radiation therapy. These issues are raised in the context of hypofractionation for central nervous system malignancies, lung cancers, pelvic malignancies, head and neck cancers, and breast cancers. If we are careful when choosing the sit...Continue Reading

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Citations

May 28, 2014·Cancer radiothérapie : journal de la Société française de radiothérapie oncologique·D N AntoniF Mornex
Aug 24, 2013·Cancer radiothérapie : journal de la Société française de radiothérapie oncologique·J-M CossetF Eschwège
Nov 3, 2009·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·L H JensenUNKNOWN Danish Colorectal Cancer Group
Mar 24, 2011·Basic & Clinical Pharmacology & Toxicology·Fiorella PetronzelliRita De Santis
Sep 7, 2014·Cancer radiothérapie : journal de la Société française de radiothérapie oncologique·G CréhangeH T Chung
Apr 29, 2015·The Breast Journal·Nadine HousriBruce G Haffty
Mar 26, 2013·International Journal of Radiation Oncology, Biology, Physics·Orit Kaidar-PersonGilles Créhange

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