Guidelines for Complications of Cancer Treatment Vol VIII Part B

attributed to use of cisplatin based chemotherapy andradiotherapy; and tumor of contralateral testis due tounderlying predisposition. In a cohort study by Travis et al.,relative risk of SMN was 2.0, 1.8 and 2.9 with RT alone, CTalone and combined CT & RT respectively (11).Breast Cancer: Breast cancer patients are at a high risk ofcontralateral breast cancer due to underlying predispositionfactors, radiotherapy associated lung cancer and sarcomas,chemotherapy induced leukemias , tamoxifen inducedendometrial cancers and various genetic cancer syndromes.Risk of contralateral breast cancer is two to five folds in patientwith breast cancer but role of RT in this risk is not clear. RTon the other hand is clearly linked to lung carcinomas (1.5 to3 times risk), sarcomas and esophageal cancers. With the useof IMRT and accelerated partial breast irradiation (APBI),the risk of RT associated SMN is likely to decrease (12, 13, 14).Prostate Cancer: Patient with prostate cancer are at increasedrisk of bladder, colorectal, lung carcinoma and sarcomas. SMNcould be due to radiation carcinogenesis, vigilant screening,incidental finding on investigation done for RT complicationsor due to base line high level due to genetic/environmentalfactors. The RR for bladder carcinoma after RT for carcinomaprostate is variable (between 1-1.5) with a latency period of5-10 years. RR of bladder cancer is reportedly higher afterpost-prostatectomy RT probably due to irradiation of morebladder volume. There is also modest increase in risk of rectalcancer after RT with RR varying between 1.2-1.5. Patientstreated with brachytherapy have been reported to have lowerincidence of secondary bladder and rectal cancers comparedto external beam RT (1.6 vs. 5.8%; p=0.0623). With theincreasing use of IMRT and seed brachytherapy, incidence ofSMN is again likely to change in course of time (15, 16, 17).Cervical Cancer: Patients with cervical cancer are at increasedrisk of SMN due to shared infectious aetiology (eg. cancer287