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not be as leukemogenic as combined modality treatment or total body irradiation—an important hypothesis worthy of testing when considering the increased number of cancer survivors after RT. Before rushing to the conclusion that RT alone is free of leukemogenic potential, it is important to address the question from the direction of a solid-tumor patient. Up until this point, oncologists studied t-MN incidence by first finding t-MN patients and then parsing their characteristics based on prior therapy (RT vs chemotherapy vs combined modality vs surgery). In these retrospective analyses, the potential for selection bias is large. In contrast, the real questions are 1) whether solid tumor patients treated with RT alone go on to develop t-MNs at a rate higher than radiation-free counterparts and 2) how post-RT t-MN pathobiology and clinical outcomes compare with those of radiation-free cohorts. Both of these questions require a forward perspective starting from the

Radiation Alone for Solid Tumors and the Questionable Development of Therapy-Related Myelodysplastic Syndromes