<b>Because I received the following letter:</b> 
"When my wife received radiation, pelvic and a vaginal implant, we asked about side effects. We were told possible fatigue and diarrhea. That was it. No one mentioned the long term effects or the impact it would have on future surgeries for a disease that relies on surgery for control." "For my wife these side effects were radiation proctitis, an atrophied vagina, a bladder fistula after surgery. After her last surgery a colostomy was required because of a radiation-damaged colon. I have found that many list members were in the same boat. They enter treatment with little understanding of the long term impact of radiation." 

<b>AND this letter:</b>
"She is still in hospital as recovery is very slow due to the fact that the tumor was in the area of radiation. The radiation therapy was to prevent or significantly reduce the likelihood of a met in that area: I think that there is a real question about the efficacy of radiation. Looking back we wish that my wife did not agree to have it done. Not only was the surgery very difficult [to remove a recurrence in the irradiated area] but the recovery will be slow and difficult, especially in respect of the invasion of the bladder."

<b>AND I also received this letter:</b> 
"There has been very little on the list about IORT*. Not that many hospitals have it. Duke has been doing it for only about 1 year. Most of the papers refer to retroperitoneal sarcomas and conclude that it provides benefit for local control. My wife received it at my request during her last pelvic surgery a couple months when we knew clear margins would not be possible and the recurrence was exactly in the same place. The obvious benefit was that all organs could be moved aside. Still with that and the other radiation, 7 years of CT scans, bone scans, etc., I will be surprised if she does not develop leukemia if she makes it another 5 years. Bottom line, however, is that this should be investigated as a possible better alternative to external beam." *IORT is Intra Operative Radio Therapy. 

<b>Ultimate Risks of Radiotherapy? Only long-term follow-up can determine the ultimate risks of radiotherapy.</b>  One study followed 221 consecutively treated patients for 8 to 42 years after post mastectomy radiation. <b>Complications requiring in-hospital treatment were observed in 24 of 221 patients (11%).</b> There were four sarcomas of the treated chest wall, three squamous carcinomas (two in the esophagus), two angiosarcomas of the swollen arm, nine chronic ulcers, five respiratory insufficiencies, six pathologic fractures of the radiated shoulder or ribs, two fatal cardiomyopathies, one persisting leucopoenia with fatal brain abscess, and one severe neurovascular impairment of the arm. <b>In a comparable group of 394 consecutive post mastectomy patients who were not irradiated, one similar event, a myxosarcoma of an unswollen arm, was observed.</b> 
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