1/26. arteritis and brachial plexus neuropathy as delayed complications of radiation therapy.radiation-induced arteritis of large vessels and brachial plexus neuropathy are uncommon delayed complications of local radiation therapy. We describe a 66-year-old woman with right arm discomfort, weakness, and acrocyanosis that developed 21 years after local radiation for breast adenocarcinoma. Arteriography revealed arteritis, with ulcerated plaque formation at the subclavian-axillary artery junction, consistent with radiation-induced disease, and diffuse irregularity of the axillary artery. electromyography showed a chronic brachial plexopathy. The patient's acrocyanosis, thought to be due to digital embolization from her vascular disease, improved with antiplatelet therapy. The concurrent combination of radiation-induced arteritis and brachial plexopathy is uncommon but should be considered in patients presenting with upper extremity pain or weakness after radiation therapy.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
2/26. Long-term expression of fibrogenic cytokines in radiation-induced damage to the internal anal sphincter.BACKGROUND: There is accumulating evidence, both quantitative and qualitative, that pelvic irradiation affects anorectal function. However, the molecular mechanisms responsible for radiation-induced damage to the anal sphincter remain unclear. AIM: To determine the expression of transforming growth factor-beta 1 (TGF-beta 1) and its downstream effector connective tissue growth factor (CTGF) in the anal sphincter of a patient irradiated for prostate cancer. PATIENT: A 82 year-old patient developed a rectal adenocarcinoma and underwent an abdomino-perineal resection (APR), four years after receiving pelvic irradiation for prostate carcinoma. methods: Tissue sections of the anal sphincter were processed for histology. Immunostaining for TGF-beta 1 and CTGF were performed. RESULTS: CTGF and TGF-beta 1 immunoreactivity was detected in the irradiated anal sphincter, and was absent in controls. Immunoreactivity for both cytokines predominated in the internal sphincter. CTGF and TGF-beta 1 were preferentially detected in endothelial cells, myofibroblasts and fibroblasts; in addition, there was strong immunoreactivity for TGF-beta 1, but not for CTGF in smooth muscle cells of the anal canal. CONCLUSION: Four years after pelvic irradiation, radiation-induced damage appeared to affect predominantly the smooth muscle layer of the anal canal. The molecular mechanisms responsible for radiation-induced fibrosis to these tissues involve prolonged activation of TGF-beta 1 and its downstream effector CTGF.- - - - - - - - - - ranking = 3.5keywords = radiation-induced (Clic here for more details about this article) |
3/26. Gamma knife radiosurgery for metastatic tumours in the brain stem.BACKGROUND: Stereotactic radiosurgery has become important in the treatment of metastatic brain tumours and is often the first choice modality for eloquent or deep locations such as the brain stem. This study evaluated the efficacy of gamma knife radiosurgery (GKS) for the treatment of brain stem metastases. methods: The medical records of 25 patients with 31 tumours, 11 men and 14 women aged 42 to 78 years (mean 57.1 years), who underwent GKS for metastatic tumours in the brain stem were retrospectively reviewed. The results of GKS were evaluated according to the change in tumour size on neuro-imaging. FINDINGS: The most common location of the primary malignancy was the lung followed by the breast. adenocarcinoma was found in 19 patients (24 lesions). No case of squamous cell carcinoma was found. The mean calculated tumour volume was 2.1 cm(3) and the mean prescription dose to the tumour margin was 13.0 Gy. Mean duration of neuro-imaging follow up was 5.2 months and the overall tumour control rate was 77.4%. There was a significant correlation between the marginal dose delivered and the effect on neuro-imaging. New radiation-induced injury in the surrounding brain occurred in only 2 patients. INTERPRETATION: GKS for brain stem metastases using a marginal dose of 15 Gy or less is effective and relatively safe. Accurate targeting of the tumour and safe dose planning are essential to obtain satisfactory results with GKS for brain stem metastases.- - - - - - - - - - ranking = 0.5keywords = radiation-induced (Clic here for more details about this article) |
4/26. Intra- and postoperative radiation therapy for an alpha-fetoprotein-producing pancreatic carcinoma.We describe an alpha-fetoprotein (AFP)-producing pancreatic cancer irradiated intra- and postoperatively. A 64-year-old man with a hypoechic lesion in the pancreatic head and body was referred to us. On admission, his serum AFP level was markedly elevated (441 ng/ml). Computed tomography showed a 65 x 35 mm diameter tumor in the pancreatic head and body. The tumor periphery was enhanced with contrast medium. angiography revealed faint tumor staining. After laparotomy, curative resection was impossible, because several arteries were embedded in the metastatic lymph nodes. Core needle biopsy was performed. The tumor was irradiated intraoperatively (25 Gy; area, 8 cm(2)). The diagnosis was moderately to poorly differentiated pancreatic adenocarcinoma. Immunohistochemical staining revealed AFP-positive cytoplasm in some cancer cells. The tumor shrunk significantly (longest axis, from 65 to 30 mm) after postoperative external beam radiation therapy (total, 40 Gy). The serum AFP level fell dramatically (from 441 to 2.5 ng/ml). However, distal gastrectomy for postradiation gastric ulceration was required. The patient did well without tumor regrowth or signs of liver or lymph node metastases 1 year 10 months after his first operation. In conclusion, we treated a rare AFP-producing pancreatic cancer with radiotherapy, which was effective. However, care is needed to avoid external beam radiation-induced gastrointestinal ulceration.- - - - - - - - - - ranking = 0.5keywords = radiation-induced (Clic here for more details about this article) |
5/26. Rectovaginal radiation fistula repair using an obturator fasciocutaneous thigh flap.BACKGROUND: Rectovaginal fistulae are a known complication of pelvic radiotherapy utilizing locally applied isotope implants. Most often, either permanent colostomy or reconstruction with a well-vascularized flap is necessary. Traditional techniques for fistula repair utilize bulky muscle flaps, disfiguring pudendal artery flaps or may require laparotomy. CASE: We describe the management of a 26-year-old woman with a large radiation-induced rectovaginal fistula. A fasciocutaneous medial thigh flap based on terminal branches of the obturator artery and vein was used without colostomy and resulted in pain-free sexual function and minimal vulva disfigurement. CONCLUSION: A medial thigh fasciocutaneous flap without muscle can be transferred into the vagina on the obturator vessels and may become the preferred method for managing large rectovaginal fistulas.- - - - - - - - - - ranking = 0.5keywords = radiation-induced (Clic here for more details about this article) |
6/26. Primary stenting of bilateral radiation-induced external iliac stenoses.radiation-induced arteritis is a described rare complication of radiotherapy, particularly in patients with cancer. We report bilateral radiation-induced arteritis leading to stenoses in the external iliac arteries, which was treated with primary percutaneous arterial stenting, and review the current literature on the topic.- - - - - - - - - - ranking = 2.5keywords = radiation-induced (Clic here for more details about this article) |
7/26. Absence of fatty replacement in radiation damaged liver: CT demonstration.Computed tomography from two patients with chronic radiation-induced hepatic damage demonstrates focal sparing within the radiation portal from otherwise diffuse fatty infiltration.- - - - - - - - - - ranking = 0.5keywords = radiation-induced (Clic here for more details about this article) |
8/26. A case of carcinoma of the rectum after radiotherapy for carcinoma of the cervix.Carcinomas are known to develop after radiation therapy for benign or malignant lesions. However, the development of primary carcinoma of the rectum following radiotherapy is relatively rare. This paper presents a case of adenocarcinoma of the rectum in which the history strongly suggested a radiation-induced carcinoma 12 years after initial radiotherapy for carcinoma of the cervix. Furthermore, it was interesting that metastatic adenocarcinoma of the skin was localized only over the pelvic and perineal area that had mild brown pigmentation from the previous irradiation. The relation between the effect of irradiation and a second primary cancer in the irradiated skin is discussed.- - - - - - - - - - ranking = 0.5keywords = radiation-induced (Clic here for more details about this article) |
9/26. Lupus-like syndrome associated with carcinoma of the breast.Two patients with locally advanced carcinoma of the breast had radiation therapy as primary treatment. Within one year, a lupus-like syndrome developed characterized by pneumonitis, pleural effusion, and positive fluorescent antinuclear antibody (FANA) reaction and lupus erythematosus (LE) preparation. pericarditis developed in one patient and leukopenia in the other. The bilateral pulmonary disease, serological abnormalities, and rapid and sustained response to administration of prednisone made the diagnosis of systemic lupus erythematosus more likely than radiation-induced disease or metastic carcinoma. radiation to normal and/or malignant tissue may have initiated an immunological response leading to a lupus-like syndrome.- - - - - - - - - - ranking = 0.5keywords = radiation-induced (Clic here for more details about this article) |
10/26. Hepatic duct stricture after radical radiation therapy for biliary cancer: recurrence or fibrosis?Two patients with biliary cancer received radical radiation therapy. After treatment, both patients experienced episodes of biliary obstruction without definite evidence of progression of the tumor. These cases emphasize the importance of including radiation-induced biliary fibrosis in the differential diagnosis of hepatic duct stricture after radical radiation therapy.- - - - - - - - - - ranking = 0.5keywords = radiation-induced (Clic here for more details about this article) |
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