Intensity modulated radiotherapy (IMRT) for pediatric cancer patients: the advantage and fear of second malignant neoplasm

Intensity-modulated radiotherapy is used for delivering more efficient homogenous dose to the target and lowering of dose to the surrounding normal tissues. however,a second malignant neoplasm may develop after prolonged latent period. the use of modern precise radiotherapy techniques in the pediatric age group has many controversial issues in spite of its proven dosimetric distribution advantages and the considerable decrease of normal tissue complication probability (ntcp). this concern is due to many factors; mainly the exposure of a larger volume of normal tissues to low dose radiotherapy. children have more proliferating tissues compared to the adults. however,the epidemiological data did not detect an increase in the incidence of radiation-induced second malignancy. this issue is still controversial as imrt and other precise radiotherapy techniques were not widely used except recently. this may entail a thorough careful follow up for children treated with these techniques to detect any incidence increase. © 2012.