Lessons Learned from the Management and Prevention of Clinical Radiation Late Effects

Basic principles of radiobiology have prevailed in understanding late effects of therapeutic radiation. Decreasing the volume of normal tissue treated, decreasing dose, and decreasing the fraction size of irradiation during a course of radiotherapy all contribute to an approach to decrease radiation late effects. Radiation late effects are known to be increased by many chemotherapy drugs. Radiation oncologists continue to balance the need to treat as much tissue as possible to minimize cancer recurrence and metastasis, however to minimize the amount of tissue treated to lessen radiation side effects once patients are cured. This balance is the major concern for current generations of radiation oncologists. Total body irradiation has provided valuable information that relates to space travel and development of radiation countermeasures for nuclear reactor accidents and for survivors of fission or fusion bomb survivors.