Localized scleroderma in breast cancer patients treated with supervoltage external beam radiation: radiation port scleroderma.
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Acquired Immunodeficiency Syndrome↗
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Results for “RADIODERMATITIS”
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Subacute radiation dermatitis from fluoroscopy during coronary artery stenting: evidence for cytotoxic lymphocyte mediated apoptosis.
A patient with fluoroscopy-induced subacute radiation dermatitis is described. Her biopsy specimen showed vacuolar change and necrotic keratinocytes with lymphocytes in direct apposition, or "satellitosis". Lymphocytes in the dermis and infiltrating the epidermis were predominantly CD8+ and a number of the lymphocytes stained for TIA-1, a cytotoxic granule protein in T-cells and natural killer cells, that appears to be involved in the induction of apoptosis. Our findings suggest cytotoxic lymphocyte mediated apoptosis is involved in the pathogenesis of subacute radiation dermatitis.
Acute Disease↗
Increased dermal angiogenesis after low-intensity laser therapy for a chronic radiation ulcer determined by a video measuring system.
Acute and chronic radiation-induced dermatitis can occur after high doses of ionizing radiation of the skin. We describe a patient with a long-lasting radiotherapy-induced ulcer that healed after low-intensity laser therapy. A video measuring system was used to determine the number of dermal vessels in the ulcer before and after laser treatment. We found a statistically significant increase in the number of dermal vessels after low-intensity laser therapy in both the central and marginal parts of the ulcer compared with its pretreatment status.
Adult↗
Choosing the optimal wound dressing for irradiated soft tissue wounds.
This article reviews the healing state of the previously irradiated wound, the tenets for optimal wound care, and the choices of wound dressings now available for its management. The goal in assisting a previously irradiated surgical wound to heal is to transform its chronic wound state into an acute wound state. This transformation encourages wound healing to proceed. Six major moisture-retentive dressing categories exist to optimize its healing. They are classified into the alginates, foams, gauzes, hydrogels, hydrocolloids, and transparent films. Optimal wound care management for previously irradiated wounds involves (1) adequately debriding and cleansing the local wound, (2) accurately assessing the wound, (3) choosing the appropriate dressing based on the wound assessment, and (4) encouraging granulation tissue formation and reepithelialization.
Aged↗
[Non-small cell lung cancer. Survival after radiotherapy and prognostic factors].
OBJECTIVE: To analyze the results of radiotherapy for non-small cell lung cancer and identify the clinical and therapeutic variables that might influence prognosis. PATIENTS AND METHODS: In a population base of 109 patients, 87 met the enrollment criteria. The patients received thoracic radiotherapy over the macroscopic tumor volume and lymph drainage areas, using conventional fractions. Systemic cytostatic therapy was also given to 61% of the patients. RESULTS: Staging was as follows: 33% (28/87) I and II, 20% (18/87) IIIA and 47% (41/87) IIIB. The mean radiotherapy dose was 66.7 Gy (95% CI, 65-67). Full clinical remission was achieved by 22% (18/87), half of whom later suffered recurrences. Partial remission was achieved by 26% (21/87). No response was observed in 52% (42/87). Statistically significant differences in actuarial survival rates were found for staging and tumor response. Mean survival for stages I and II was 29 months (95% CI, 19-39), for IIIA it was 22 (95% CI, 16-28) months, and for IIIB 16 months (95% CI, 12-20). The most common complications were cutaneous, esophageal and pulmonary, with a low incidence of grade 3 toxicity (less than 3%) and absence of grade 4. CONCLUSIONS: No differences in survival were observed for age, tumor location or histological type. Local control of the disease decisively influenced patient survival.
Antineoplastic Combined Chemotherapy Protocols↗
Full thickness skin grafts for the closure of defects in irradiation-damaged skin.
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Chronic Disease↗
Sonographic determination of cutaneous and subcutaneous fibrosis after accidental exposure to ionising radiation in the course of the Chernobyl nuclear power plant accident.
Chronic cutaneous lesions in eight of 15 survivors of the Chernobyl nuclear energy plant accident presenting with clinical features of cutaneous radiation fibrosis were examined 6 years after exposure using high-frequency ultrasound. In all patients, lesional skin was examined using both the B- and A-modes. Similar phenomena were found in all patients. The corium was increased in thickness as well as density compared to normal skin. The increase in density was seen not only in the medium strata but also particularly at the border between corium and subcutaneous tissue. Within the subcutaneous tissue proper, isles of echo-rich spots were prominent. The number and width of echo signals in the subcutaneous tissue were increased, representing the sonographic correlate of subcutaneous fibrotic trabeculae. The thickness of epidermis plus corium was increased by more than 50% and was even doubled in some cases. According to the present findings obtained from patients with very severe exposure to ionising radiation, ultrasound analysis of cutaneous and subcutaneous radiation fibrosis shows a characteristic picture. Moreover, it was demonstrated that quantitative assessment of skin thickness is possible. As the method is simple and noninvasive, repeated examinations are possible. This provides the basis for monitoring possible treatment effects and efficient follow-up in these chronically progressive clinical conditions after exposure to ionising radiation.
Adult↗
Synchronicity of nociceptive and non-nociceptive adjacent neurons in the spinal dorsal horn of the rat: stimulus-induced plasticity.
Current knowledge of spinal processing of sensory information is largely based on single-cell recordings; however, temporal correlation of multiple cell discharges may play an important role in sensory encoding, and single electrode recordings of several neurons may provide insights into the functions of a neuronal network. The technique was applied to the lumbar spinal dorsal horn of pentobarbital-anaesthetized rats during background activity, steady-state noxious heat stimulation (48 degrees C, 100 s), cold block spinalization or radiant heat-induced inflammation of the skin, and the recordings were evaluated by means of auto-correlation, autospectral and cross-correlation analysis. Background patterns obtained by these three methods were extremely stable in time. Autocorrelation with short lag peaks was observed in 72.2% of neurons (n = 223). Background correlated discharges were found in 83.6% of the neuron pairs (n = 134). Cross-correlation with a central peak, suggestive of common input to the recorded cells, was the most common pattern observed in almost all laminae and was associated with high incidence (91.8%) of overlapping receptive fields and with neurons with initial peak autocorrelation pattern. Cross-correlations with central trough were associated with increase autocorrelation patterns. Bilateral peaks in cross-correlation, suggestive of reverberating circuitry, were observed only for pairs of neurons located in laminae IV and V and were associated with rhythmic discharges in one or in both simultaneously-recorded neurons. Lagged peaks or troughs were observed in 4.6% and 2.2% of neuronal pairs, respectively. Long-lasting skin heating induced qualitative changes (pattern changes) in the cross-correlation of 21.6% of the neuron pairs and quantitative changes in 85.7% of them. During skin inflammation qualitative changes in the cross-correlation pattern were observed in 30.8% of the neuron pairs, and quantitative changes (strength and/or synchronization time) in about 57.7% of them. Spinalization induced quantitative changes in cross-correlation in the vast majority of neuron pairs. The results of the present study suggest that discharges of neighbouring spinal dorsal horn neurons are strongly synchronized probably by propriospinal and primary afferent sources. The existence of functional reverberating circuitry was also evidenced. Finally, the functional synchronicity in the spinal dorsal horn presents stimulus-induced plasticity which consists mainly of changes on the strength and/or time of the synchronization and rarely of activation of new connectivities.
Animals↗
TGF-beta1 and radiation fibrosis: a master switch and a specific therapeutic target?
Radiation fibrosis is a frequent sequel of therapeutic or accidental radiation overexposure in normal human tissues. One of the main fundamental problems yet unsolved in fibrotic tissues is the origin of the chronic activation of myofibroblasts within these tissues. It has been postulated that this chronic activation results from a continuous production of activating factors. In this context, fibrosis could be defined as a wound where continuous signals for tissue repair are emitted. Cytokines and growth factors probably play a central role in this process. Among them, transforming growth factor-beta1 (TGF-beta1) is considered as a master switch for the fibrotic program. This review discusses recent evidence on the critical role played by TGF-beta in the initiation, development, and persistence of radiation fibrosis. It summarizes the results concerning this factor after irradiation of various tissues and cells, with an emphasis on superficial fibrosis, including skin and subcutaneous tissues. Finally, recent data concerning the treatment of established fibrotic disorders of various etiology are presented, as well as the possible mechanisms involved in fibrosis regression, which show that the TGF-beta pathway may constitute a specific target for antifibrotic agents.
Animals↗
Influence of dose-rate on inflammatory damage and adhesion molecule expression after abdominal radiation in the rat.
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Animals↗
The acute effects of postoperative radiation therapy on the transverse rectus abdominis myocutaneous flap used in immediate breast reconstruction.
PURPOSE: To analyze the acute effects of postoperative radiation therapy on the transverse rectus abdominis myocutaneous (TRAM) flap reconstruction following modified radical mastectomy for breast cancer. METHODS AND MATERIALS: Twenty-five consecutive patients were treated with postoperative radiation therapy after TRAM flap reconstruction between 1985 and 1999. The radiation records for these patients were retrospectively reviewed. Information regarding treatment techniques, timing, and dose was obtained and correlated with the extent of erythema, desquamation, and the need for treatment break. RESULTS: The median age was 48 years. The median dose of chest wall radiation was 5040 cGy. Additional boost doses were delivered in 13 patients. Twelve patients (48%) developed mild erythema in the treatment field during the course of treatment and 13 patients (52%) developed moderate (40%) or brisk (12%) erythema. Only 10 patients (40%) developed any kind of desquamation; 5 patients (20%) developed dry desquamation and another 5 patients (20%) developed moist desquamation. No patients required a break in the course of treatment because of acute side effects. None of the parameters evaluated (the use of chemotherapy prior to radiation, the interval between surgery and radiation, smoking, prior incidence of fat necrosis, the use of bolus during radiation, and the use of a boost) were predictive of an increased incidence of either the extent of erythema or the development of desquamation in the treatment field. CONCLUSION: Postmastectomy radiation for TRAM flap reconstruction is well tolerated and is not associated with an increased incidence of acute side effects. Radiation technique and the use of preradiation chemotherapy do not appear to be correlated with an increased incidence of acute side effects.
Adult↗
Blood hemoglobin level may affect radiosensitivity-preliminary results on acutely reacting normal tissues.
PURPOSE: To evaluate the influence of blood hemoglobin concentration on the radiosensitivity of acutely reacting normal tissues. METHODS AND MATERIALS: Weekly scores (EORTC/RTOG criteria) for acute reactions of skin and mucosa are available for 60 patients with cancer of the head and neck undergoing a standard conventional radiotherapy. The prognostic significance of blood hemoglobin levels on the development of acute reactions is studied by multivariate analysis (Cox Proportional Hazards Model). Further, the incidence and the time to development of these reactions is looked at in cohorts of patients with different mean blood hemoglobin concentrations during radiotherapy. Patients are therefore classified into a "severely anemic group" (hemoglobin < 11.0 g/100 mL), and into a cohort with a blood hemoglobin value equal or above 11.0 g/100 mL. RESULTS: Normal tissue scoring and monitoring of blood hemoglobin levels allows for a detailed analysis of possible correlations. A decrease in the mean blood hemoglobin value of 1 g/100 mL predicts a reduced risk to develop a skin reaction of Grade 2 or 3 (RR = 0.9; p = 0.08; RR = 0.8; p = 0.26, respectively) or a mucosa reaction of Grade 3 (RR = 0.8; p = 0.16), independent from the radiation dose, the treatment time and from previous surgery within the radiation volume (multivariate analysis). Likewise, patients with severe anemia develop grade 3 mucositis or dermatitis less often (0%; 13%) as compared to those with blood hemoglobin concentrations equal or above 11.0 g/100 mL (21%; 19%). Skin and mucosa reactions further tend to occur later in the course of radiation. The observations are not statistically significant and possible reasons will be discussed. CONCLUSIONS: A decreased blood hemoglobin concentration may-perhaps by an impaired tissue oxygenation-reduce the radiosensitivity of normal tissue such as skin and mucosa. However, the data is preliminary and needs further confirmation.
Adult↗
Radiotherapy optimization in early-stage Dupuytren's contracture: first results of a randomized clinical study.
PURPOSE: Radiotherapy (RT) can prevent progression of Dupuytren's contracture (DC). It is unknown whether there is a dose response and which dose is sufficient. Herein, the 1-year results of a prospective randomized trial are presented which compared two different RT dose concepts with each other. METHODS: 129 patients (67 males; 62 females) were entered in this study: 69 had bilateral and 60 uni-lateral involvement of DC accounting for 198 irradiated hands. According to Tubiana's classification, 73 hands had Stage N (nodules/cords, no extension deficit = flexion deformity), 61 had Stage N/I (< or = 10 degrees deficit), 59 had Stage I (11-45 degrees deficit), and 5 had Stage II (46-90 degrees deficit) DC. Prophylactic RT was randomly delivered; in Group A, 63 patients (95 hands) received 10 x 3 Gy (total dose, 30 Gy) in 2 series (5 x 3Gy) separated by 8 weeks; in Group B, 66 patients (103 hands) received 7 x 3 Gy (total dose, 21 Gy) in 1 series within 2 weeks. Orthovoltage RT (120 kV) was applied using standard cones and individual shielding of uninvolved areas of the palm. Relevant patient and disease parameters were equally distributed in both groups. Evaluation (toxicity, efficacy) was performed at 3 and 12 months after RT. Subjective (patient's opinion) and objective parameters (palpation, measurements, and comparative photographs) were applied to assess treatment response. Minimum follow-up (FU) was 1 year. RESULTS: Acute toxicity was minimal, but slightly more pronounced in Group B. Seventy-six (38%) hands developed skin reactions CTC 1 degrees (A, 30; B, 46); and 12 (6%) had skin reactions CTC 2 degrees (A, 4; B, 8). Chronic side effects were limited to dryness, desquamation, skin atrophy, and change of sensation (LENT 1 degrees ) in 9 (5%) sites without differences between the two groups. At 3 and 12 months after RT, subjective and objective reduction of symptoms, nodules, and cords occurred in both groups (p < 0.01) with no differences between the groups: in Group A, 55 (56%) sites regressed, 35 (37%) remained stable, and 7 (7%) progressed, whereas in Group B, 55 (53%) regressed, 39 (38%) remained stable, and 9 (9%) progressed at 12 months FU (NS). Overall and mean number of nodules, cords, and skin changes decreased at 3 and 12 months. The "treatment failure" rate at 1 year was 16 of 198 (8%), but only 4 (2%) sites required hand surgery for disease progression. Seven of 60 patients with unilateral DC received prophylactic RT for the initially uninvolved, contralateral hand due to progression of DC. CONCLUSION: Both prophylactic RT concepts have been well accepted and tolerated by patients. Within the first year, they were equally effective to prevent further disease progression of DC and obtain considerable symptomatic improvement. Although 1-year results suggest similar response rates for both treatment groups, long-term FU of > 5 years has to be awaited for final assessment and recommendation of an optimized RT treatment schedule.
Adult↗
Randomized phase III study comparing Best Supportive Care to Biafine as a prophylactic agent for radiation-induced skin toxicity for women undergoing breast irradiation: Radiation Therapy Oncology Group (RTOG) 97-13.
PURPOSE: To determine if Biafine compared to Best Supportive Care (BSC) is effective in minimizing or preventing radiation-induced dermatitis in women undergoing breast irradiation. METHODS AND MATERIALS: Patients were randomized between Biafine (n = 83) vs. BSC (n = 89). The institutions identified preference for BSC at the time of randomization. A no-treatment arm was allowed (16% received no treatment). Patients were instructed to apply randomized product three times a day, but not within 4 h of their daily RT session. Application began following their first radiation treatment and continued 2 weeks postradiation. Skin dermatitis was scored weekly utilizing the RTOG and ONS (Oncology Nursing Society) skin toxicity scales, a weekly patient satisfaction and quality-of-life questionnaire. RESULTS: Using the RTOG toxicity scale there was no overall difference for maximum dermatitis during RT between Biafine and BSC (p = 0.77). There was no difference in maximum toxicity by arm or breast size. There was an interaction between breast size and toxicity, with large-breasted women exhibiting more toxicity. Large-breasted women receiving Biafine were more likely to have no toxicity 6 weeks post RT. CONCLUSION: There was no overall difference between BSC and Biafine in the prevention, time to, or duration of radiation-induced dermatitis.
Adult↗
Results of chest wall reirradiation using pulsed-dose-rate (PDR) brachytherapy molds for breast cancer local recurrences.
PURPOSE: We report in a retrospective study on the effect and toxicity of chest wall reirradiation using pulsed-dose-rate (PDR) afterloading molds. METHODS AND MATERIALS: Between 1993 and 1999, a total of 58 patients were treated. All patients presented with locally recurrent breast cancer (31 patients had concomitant distant metastases) after mastectomy and a previously completed course of radiation therapy (median, 54 Gy; range, 36-70). Indication for reirradiation was a progressive macroscopic skin recurrence in 30 cases and an incomplete surgical resection in 28 patients. Standard treatment consisted of a split course with two fractions of 20 Gy (interval, 31 days). The reference dose was prescribed to the skin surface at 5 mm distance from the source. PDR brachytherapy (37 GBq, (192)Ir) was carried out after geometric distance optimization with 0.5-1 Gy/pulse/h. The irradiated median area was 423 cm(2) (range, 100-919). The median follow-up was 18 months (range, 7-84). RESULTS: The actuarial 1-, 2- and 3-year local recurrence-free survival rates in patients treated for macroscopic disease (microscopic disease in parenthesis) were 89% (96%), 81% (85%), and 75% (71%). Local control was obtained in 24/30 (22/28) patients. Twenty-nine of the 34 patients (85%) who deceased during follow-up were locally controlled. 9/58 patients experienced Grade III acute toxicity, 35/58 patients Grade III (29/58 telangiectasia, 6/58 contracture), and 4/58 Grade IV late toxicity (RTOG/EORTC). CONCLUSION: Reirradiation of the chest wall using PDR brachytherapy molds is effective and provides a high local control rate with acceptable toxicity.
Adult↗
Hyperbaric oxygen therapy for late sequelae in women receiving radiation after breast-conserving surgery.
PURPOSE: Persisting symptomatology after breast-conserving surgery and radiation is frequently reported. In most cases, symptoms in the breast resolve without further treatment. In some instances, however, pain, erythema, and edema can persist for years and can impact the patient's quality of life. Hyperbaric oxygen therapy was shown to be effective as treatment for late radiation sequelae. The objective of this study was to assess the efficacy of hyperbaric oxygen therapy in symptomatic patients after breast cancer treatment. PATIENTS AND METHODS: Forty-four patients with persisting symptomatology after breast-conservation therapy were prospectively observed. Thirty-two women received hyperbaric oxygen therapy in a multiplace chamber for a median of 25 sessions (range, 7-60). One hundred percent oxygen was delivered at 240 kPa for 90-min sessions, 5 times per week. Twelve control patients received no further treatment. Changes throughout the irradiated breast tissue were scored prior to and after hyperbaric oxygen therapy using modified LENT-SOMA criteria. RESULTS: Hyperbaric oxygen therapy patients showed a significant reduction of pain, edema, and erythema scores as compared to untreated controls (p < 0.001). Fibrosis and telangiectasia, however, were not significantly affected by hyperbaric oxygen therapy. Seven of 32 women were free of symptoms after hyperbaric oxygen therapy, whereas all 12 patients in the control group had persisting complaints. CONCLUSIONS: Hyperbaric oxygen therapy should be considered as a treatment option for patients with persisting symptomatology following breast-conserving therapy.
Breast Diseases↗
Interferon-gamma in 5 patients with cutaneous radiation syndrome after radiation therapy.
BACKGROUND: Irradiation can cause acute inflammatory responses as well as chronic fibrotic alterations of the skin. Cutaneous radiation fibrosis evokes a complex of therapeutic problems. However, therapeutic options, apart from surgical approaches, are limited. PATIENTS AND METHODS: Five female patients suffering from severe cutaneous fibrosis were treated with interferon-gamma on a low-dose regimen, 3 x 100 microg/week subcutaneously for 6 months, then once per week for another 6 months. In 4 patients, skin thickness was measured with high-frequency (20 MHz) ultrasound in a clinically well-defined target skin lesion. In 1 patient, nuclear magnetic resonance imaging was performed to quantify the extent of cutaneous radiation fibrosis and to monitor the therapeutic outcome. RESULTS: All patients suffered from radiation-induced cutaneous fibrosis. Additionally, in 1 patient, a fistula, as assessed by lymph vessel scintigraphy, and in another patient a radiation ulcer was diagnosed. In all patients, reduction of radiation-induced fibrosis could be documented. Both fistula and radiation ulcer regressed completely under interferon-gamma therapy. CONCLUSION: Low-dose interferon-gamma therapy is a new and effective treatment modality for cutaneous radiation fibrosis caused by radiation therapy. The positive impact of interferon-gamma on our patients warrants randomized double-blind trials on therapy of radiation fibrosis.
Adolescent↗
Can 8-oxo-dG be used as a predictor for individual radiosensitivity?
PURPOSE: To develop predictive tests for individual radiosensitivity of tumor patients. METHODS AND MATERIALS: Acute skin reactions were clinically scored among 40 women after 46 Gy, given with 2 Gy fractions to breast and regional lymph nodes, adjuvant after surgery. The acute skin reactions were compared to the excretion of 7,8-dihydro-8-oxo-2'-deoxyguanosine (8-oxo-dG) in urine, determined by high-performance liquid chromatography (HPLC) with electrochemical detector. Specimens of urine were collected before and during postoperative radiation treatment at given intervals. We compared a group of 9 patients with the most pronounced skin reactions with another group of 8 patients with almost no skin reactions at 46 Gy. RESULTS: The level of 8-oxo-dG excreted in urine during 8 h was measured. After normalizing the excretion to irradiated volumes, dose per volume and excretion before irradiation, the 8-oxo-dG level in urine was significantly (p < 0.001) lower for the patients with pronounced skin reactions as compared to patients with minor skin reactions, at an accumulated dose of 12 Gy. In addition, the background level of 8-oxo-dG excreted before treatment started, was significantly (p = 0.043) lower for patients with minor skin reactions as compared to patients with pronounced skin reactions. The background level of 8-oxo-dG was corrected for body weight and normalized to BMI. CONCLUSION: We suggest that the excretion of 8-oxo-dG into urine of breast cancer patients is a possible marker for acute radiosensitivity.
8-Hydroxy-2'-Deoxyguanosine↗