Description and Management of Radiotherapy-Induced Long-Term Effects

Radiation therapy (RT) is involved in about 50% of cures. However, overall, after a median follow-up of 2.3 years, 3–5% of the treated patients are estimated to suffer from late toxicity that can cause potentially serious sequelae—in absence of therapeutic deviation. These toxicities are essentially cardiovascular, renal, endocrine, and musculoskeletal but also include secondary radiation-induced malignancies. The incidence of late complications continued to increase with the duration of follow-up without reaching a plateau. These late effects are characterized by a clinical latency during which intricated cellular and tissue events take place, as described in the second section. Several patient- and treatment-related cofactors are associated with late effects occurrence including individual radiosensitivity and radiosensitive syndromes. In the fourth section, we provide a clinical description of “deterministic” late effects according to organ/tissue location and radiosensitivity with a specific emphasis on pediatrics. After reviewing the stochastic late effects, we give insights into the current management of radiotherapy-induced sequelae with curative and preventive approaches.