Monday, 23 November 2015

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

McKeown SR, Hatfield P, Prestwich RJD, Shaffer RE, Taylor RE. Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation. Br J Radiol 2015; 88: 20150405.

Dr Shaffer has recently had a paper published which related to one of the most common concerns and questions regarding the use of radiotherapy to treat Ledderhose and Dupuytren's. The question being that should I use radiotherapy, something which technically increases my risk of cancer, on something which is not going to kill me? To answer this effectively we need to know what is the risk of radiation induced cancer following this treatment. 

For those not of a scientific background I have covered it before but basically radiation causes DNA damage which can cause mutations if not repaired quickly and correction and mutations can lead to cancer. In normal cells that are not replicated out of control e.g. the majority of cells in the hands and feet the damage will be repaired before any damage is done and therefore the risk should be minimal (those are my thoughts and not facts, that is hopefully below). So onto the paper. 

To get it out of the way the summary is: 
"Overall, the evidence suggests that the risks of cancer following RT for benign disease for currently advised protocols are small, especially in older patients."

As a side note I thought that the predominant age group for Ledderhose as 20-40 years old is interesting. Is that the age of patients being treated with radiotherapy or patients in general? Just assumed from all the surveys and general discussions that the age groups were the same as Dupuytren's, despite feeling there was a slight shift towards a younger and more gender equal demographic. I see that this references the DD book, I will have to try and remember to dig that out and take a look.

The paper is very technical and discusses lots of different information, I think for these conditions the key point is the above, that the risk is low. It is the extremity of the body that is being treated rather than areas that are high in proliferative tissue and the biggest risk is in skin cancer. 

I personally have never heard of anyone having cancer in their foot nor having cancer in their hand or foot post radiotherapy for Dupuytren's or Ledderhose and I agree fully with the article in that other treatments for most conditions will present side effects and the minimal risk of cancer can be deemed worse because of the fear associated with cancer even though the risk is minimal. 

Everyone is different and a personal approach needs to be taken, radiotherapy is not for everyone with these conditions and it is also not a cure, there is a small increased risk of cancer and this needs to be acknowledged and investigated as per this paper. I personally (you should do your own research and this is just my opinion) feel that in this case the potentially risk is tiny compared to the potentially rewards and I am in the younger age group for these conditions and therefore, in theory, one of the higher risk candidates to develop cancer.