Splenic irradiation is indicated in pts with splenic involvement but renal dose must be limited to mean <10.5 Gy or keep 2/3rds of the kidney to <15 Gy
If the pelvis needs to be treated the ovaries should be relocated and the dose should be limited to <3 Gy
When treating a male, ensure on a daily basis that the scrotum is not in the pelvic field
Late Toxicity of Radiotherapy
Growth abnormalities 17
Bone and soft-tissue hypoplasia in prepubertal children
Thyroid sequela 18,19
Benign and malignant thyroid nodules
17% of children treated with RT dose <26 Gy had thyroid abnormalities compared to 78% with >26 Gy
Cardiovascular disease 20,21
Atherosclerotic heart disease
Pulmonary toxicity 22
Decrease in pulmonary function tests
Sterility/Infertility: limit dose to ovaries to 3Gy
Increase incidence of secondary cancers 23-25
Late effects study group: 30 yr cumulative incidence of SC = 26.3% in pts dx’ed before age 16
Breast cancer was most elevated solid cancer
Toxicities of higher dose RT are well documented but it is less clear what toxicities will exist with 15-25 Gy bc many toxicities are dose and volume dependent
Second solid cancer risk appears to be dose dependent with patients w/ <23 Gy mediastinal RT with lower risk of developing breast cancer 26
Improve the technique of response-adapted therapy
Incorporate functional imaging into evaluating treatment response and RT planning
Improve upon late toxicities AND determine the effects of decreased dose IFRT on late toxicities
Refine risk categories
Improve treatment regimen for high-risk disease
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