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PubMedDate not supplied

High dose daily amifostine and hypofractionated intensively accelerated radiotherapy for locally advanced breast cancer. A phase I/II study and report on early and late sequellae.

Intrinsic radioresistance, tumor hypoxia and ability of cancer cells to undergo rapid repopulation during radiotherapy are associated with failure of radiotherapy. Tumors with low alpha/beta-ratio values or hypoxic tumors unable to undergo re-oxygenation, are unlikely to be eradicated with standard radiotherapy. Although the therapeutic efficacy of accelerated regimens based on low-dose per fraction may be high since they minimize the adverse role of rapid tumor repopulation, the cellular compartment with low alpha/beta-ratio values (i.e. hypoxic cells) remains a limiting factor. Accelerated hypofractionation, which may be more effective in such tumors, cannot be safely applied unless normal tissues are protected. In the present study we assessed the feasibility of hypofractionated and accelerated radiotherapy supported by cytoprotection (HypoARC) with high dose daily amifostine. Fifteen breast cancer patients with locally advanced disease entered radiation-dose escalation protocoL Twelve consecutive fractions of 3.5-4Gy (5 fractions/week) were given to the breast/chest wall, supraclavicular and axillary area, within 17 days. A high dose of amifostine, at 1,000 mg flat dose, was given 20 minutes before each radiotherapy fraction. Amifostine administration was well- tolerated with minor side-effects (vomiting in 6 out of 15 and hypotention in 2 out of 15 patients). Radiation induced acute skin toxicity was negligible (grade 3 in 1 out of 15 patients). Ten out of 15 patients survived more than 12 months and 7 out of 15 more than 18 months following HypoARC. None of these patients showed any signs of late sequellae, such as lung and myoskeletal fibrosis, or brachial plexopathy. Complete and partial responses were obtained in 11 out of 15 (73%) and in 4 out of 15 (27%) patients, respectively. High dose daily amifostine during hypofractionated radiotherapy is feasible. HypoARC regimen is well-tolerated, effective and has minimal acute and late toxicity to normal breast, chest and axillary tissues.

Adult↗
PubMed2001

Bullous pemphigoid masquerading as acute radiation dermatitis: case report.

We report the first case of bullous pemphigoid complicating radiation therapy for vulvar cancer. Shortly after completion of postoperative radiation therapy for a TIN1 vulvar carcinoma, the patient presented with a rash that started within, but continued to extend, well beyond the radiation field. A biopsy of the lesions confirmed the diagnosis of bullous pemphigoid, and she had prompt clinical resolution with systemic tetracycline and steroids.

Acute Disease↗
PubMedDate not supplied

Morhea-form basal cell carcinomas of the canthi.

Basal cell carcinoma is not a single entity, but a lesion of protean morphology. In treating basal cell carcinomas, treatment should be correlated with the histopathology of the tumor. Attention has been called to the aggressive infiltrating properties of morphea-form lesions. Morphea-form basal cell carcinomas should not be treated with radiotherapy. Surgery with frozen section control is advocated as the treatment of choice and the value of permanent sections has been stressed. Large defects should be covered with a skin graft.

Adult↗
PubMed2002

[External oblique muscle-cutaneous flap use of the in the reconstruction of large chest wall defects after mastectomy].

The use of an external oblique muscle-cutaneous flap in the reconstruction of large chest wall defects after mastectomy is described. The flap is drown as a V-Y advancement-rotation flap, laterally based, on the ipsilateral abdominal wall. The flap extends from the posterior axillary line to the linea alba, vascular supply is provided by the musculo-cutaneous perforating arteries of the intercostal vessels. Mobilization starts medially including the anterior rectus sheath, décollement continues between the external and the internal oblique muscles as far as the posterior axillary line. The abdominal wall, after flap mobilization, is reinforced by the plication of the internal oblique sheath. The flap was used in 13 patients with major anterior chest-wall defects after mastectomy. In one patient a marginal skin necrosis of about 2 cm was observed. The flap described differs from other external oblique flaps already described in several technical innovations that allow to obtain better functional and esthetic results.

Abdominal Muscles↗
PubMed1999

Management of radiation skin reactions: literature review and clinical application.

As many as 95% of patients treated with radiation therapy for cancer will experience a skin reaction. Some reactions are immediate, while others may be later (e.g., months after treatment). Therefore, nurses must be familiar with management of this side effect. This paper reviews current knowledge related to skin reactions from ionizing radiation and recommends guidelines for nursing practice.

Humans↗
PubMedDate not supplied

Radiation safety in fluoroscopy.

Fluoroscopy is an important diagnostic and interventional imaging tool that enables clinicians to view dynamic, real-time images of anatomy and function unmatched by other imaging techniques. However, operators must take into account many factors that impact the amount of radiation delivered, particularly over the course of a lengthy interventional procedure. After completing this review, readers will: Understand basic concepts of radiobiology and fluoroscopy systems. Know the typical doses and dose calculations for patients and fluoroscopic personnel. Recognize the pathology of biological effects and common radiation-induced skin injuries. Understand fluoroscopic technique factors to reduce patient exposure. Know the basic methods for controlling occupational exposure for fluoroscopic personnel.

Dose-Response Relationship, Radiation↗
PubMedDate not supplied

The cytoprotective effect of amifostine in acute radiation dermatitis: a retrospective analysis.

To study the impact of amifostine as a cytoprotective agent against acute radiation dermatitis, we reviewed 220 patient records. One hundred cancer patients, with tumors localised in the pelvis (bladder, rectum, prostatic carcinomas, or gynecological cancer), who received radiotherapy and cytoprotective treatment with intravenous infusion of amifostine (group A) were included in this study. Retrospectively, we randomly selected from a database in our hospital 120 historical controls, who received only radiotherapy without cytoprotection (group B). Mean gross dermatitis score (MGDS) was the mean value of recorded acute radiation dermatitis according to common toxicity criteria. In group A versus B patients, a significantly reduced severity of dermatitis (P < 0.001, Fisher's exact test) and significant reduction of MGDS as well as mean interruption treatment time (P < 0.001, Mann-Whitney U test) was observed. The relative risk of the outcome of the two study groups was 0.23 (95% CI: 0.15 to 0.34). The significant dermato-cytoprotective effect of amifostine noticed in our retrospective analysis warrants further investigation with randomised trials.

Adult↗
PubMed2003

[Radiation-induced skin reactions (except malignant tumors)].

The aim of this work, synthesized from personal case reports and a review of literature is to describe cutaneous complications of radiation therapy (except radiation-induced cancers): known and frequent such as radiation dermatitis or less frequent, beginning or strictly limited on irradiated skin areas: acne, infectious diseases, dyskeratosis, Grover's disease, sub-cutaneous pustulosis, cutaneous lichen, morphea, autoimmune bullous dermatosis, subacute cutaneous lupus erythematosus. Furthermore, we try to precise the physiopathogenic mechanisms of these dermatosis and we want to draw the attention on these dermatoses which sometimes need a multidisciplinary approach.

Acute Disease↗
PubMed2003

Cardiac catheterization-induced acute radiation dermatitis presenting as a fixed drug eruption.

Acute radiation dermatitis is an uncommon complication of fluoroscopic procedures. Cases secondary to cardiac catheterization are infrequently reported in the literature. The risk of developing this reaction is directly related to the skin dose of radiation, which is affected by the type of procedure, the technique used to achieve appropriate penetration, the duration of exposure, and the patient's body habitus. We report a case of acute radiation dermatitis following prolonged coronary angiography initially presenting as a fixed drug eruption.

Aged↗