http://journals.tubitak.gov.tr/medical/iss...3-4-0110-11.pdf

X-rays used in radiotherapy are contaminated with secondary electrons. While deep tumors are targeted, the secondary electrons can burn the skin essentially.

http://www.jmp.org.in/temp/JMedPhys34287-4526136_123421.pdf

Still an issue today.

You may have to go through some links:

http://www.jmp.org.in/article.asp?issn=097...92;aulast=Yadav

then

http://www.jmp.org.in/downloadpdf.asp?issn...st=Yadav;type=2

So?

Where is the substantive discussion of this balancing of benefit versus harm and risk for all medical treatments, from placebos to invasive surgery?

I think it is important enough for extended discussion. The elimination of deep embedded cancers without harming surrounding tissue is very much worth developing. Not just radiation but also chemo, etc.

The secondary electron exposure can be considered similar to beta radiation exposure from radioisotopes:

http://www.bt.cdc.gov/radiation/criphysicianfactsheet.asp

My mother (God rest her soul) received X-ray radiotherapy for brain lymphoma. The doctor said a ring matching the trajectory of the treatment was plainly visible in the followup brain head scans.

The quality of life not to mention other health risks balances the immediate need for treatment. One can also take the extreme analogy of transfusion of HIV-infected blood when you are bleeding to death and there is no other blood available. Best to avoid that situation at all costs.

It is always a tragedy to take a solution that leads to another big problem further down the line.