In this Pediatric Normal Tissue Effects in the Clinic (PENTEC) vision paper, challenges and opportunities in the assessment of subsequent neoplasms (SNs) from radiation therapy (RT) are presented and discussed in the context of technology advancement. The paper discusses the current knowledge of SN risks associated with historic, contemporary, and future RT technologies. Opportunities for research and SN mitigation strategies in pediatric patients with cancer are reviewed. Present experience with radiation carcinogenesis is from populations exposed during widely different scenarios. Knowledge gaps exist within clinical cohorts and follow-up; dose-response and volume effects; dose-rate and fractionation effects; radiation quality and proton/particle therapy; age considerations; susceptibility of specific tissues; and risks related to genetic predisposition. The biological mechanisms associated with local and patient-level risks are largely unknown. Future cancer care is expected to involve several available RT technologies, necessitating evidence and strategies to assess the performance of competing treatments. It is essential to maximize the utilization of existing follow-up while planning for prospective data collection, including standardized registration of individual treatment information with linkage across patient databases.

中文翻译：

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放射治疗技术的进步和儿童癌症幸存者后续肿瘤的缓解

在这份儿科正常组织临床影响 (PENTEC) 愿景论文中，在技术进步的背景下提出并讨论了评估放射治疗 (RT) 引起的后续肿瘤 (SN) 的挑战和机遇。本文讨论了与历史、当代和未来 RT 技术相关的 SN 风险的当前知识。回顾了儿科癌症患者的研究机会和 SN 缓解策略。目前关于辐射致癌的经验来自于在不同情况下受到辐射的人群。临床队列和随访中存在知识差距；剂量反应和体积效应；剂量率和分次效应；辐射质量和质子/粒子治疗；年龄考虑；特定组织的敏感性；以及与遗传倾向相关的风险。与局部和患者层面风险相关的生物学机制在很大程度上尚不清楚。未来的癌症治疗预计将涉及多种可用的 RT 技术，因此需要证据和策略来评估竞争治疗的效果。在规划前瞻性数据收集的同时，最大限度地利用现有的随访至关重要，包括通过患者数据库的链接对个人治疗信息进行标准化登记。