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1/4. Unusual postirradiation sarcoma of chest wall.

    This paper reports a sarcoma of the chest wall following postoperative radiation therapy for breast carcinoma. A total of 9346 rads was delivered at a 2-cm tissue depth from two treatment courses separated by a five-year interval. The sarcoma appeared 16 years following the initial radiation course. The existence of two mesenchymal elements in the lesion led to the final diagnosis of malignant mesenchymoma. Criteria for evaluating a possible radiation-induced malignancy are discussed.
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ranking = 1
keywords = radiation-induced
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2/4. radiation-induced fibrosarcoma following treatment for breast cancer.

    A patient with radiation-induced fibrosarcoma following mastectomy and postoperative radiation for bilateral breast carcinoma is described. Only six such cases have been reported in the literature. In this patient erosion of the axillary artery produced massive hemorrhage, and emergency transthoracic ligation of the subclavian artery caused gangrene of the extremity and empyema and sepsis. Interscapulothoracic amputation not only was life-saving but offered the patient a reasonable chance for long-term survival. Only aggressive surgical management can salvage a patient with radiation-induced sarcoma.
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ranking = 2
keywords = radiation-induced
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3/4. Adenosquamous carcinoma of the floor of the mouth and lower alveolus: a radiation-induced lesion?

    A case of adenosquamous carcinoma of the floor of the mouth and alveolus that occurred following radiation therapy is described. The possible role of radiation in the etiology of this lesion is discussed, and the complex histopathologic features of this neoplasm are emphasized.
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ranking = 4
keywords = radiation-induced
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4/4. Dorsal root entry zone lesions in the treatment of pain related to radiation-induced brachial plexopathy.

    radiation-induced brachial plexopathy (RBP) is a rare (1-2% of irradiated patients) but serious disorder associated with supramaximal irradiation of the brachial plexus. Nerve compression by radiation-induced fibrosis in the absence of tumor recurrence is the hypothesized mechanism of RBP. It appears as severe pain in up to 20% of cases. Current medical and surgical therapies are ineffective in obtaining long-term pain control. Dorsal root entry zone (DREZ) lesions represent a potential therapy for the pain associated with RBP. The records of two patients with RBP with severe pain successfully treated with DREZ lesions are reviewed. Each received supramaximal radiation to the brachial plexus following resection of the malignancy and had pain within the irradiated area approximately 1 year following radiation without evidence of tumor recurrence by either computed tomography or magnetic resonance imaging. electromyography patterns consistent with RBP were detected within the irradiated area in both patients. pain was in the C8-T1 distribution and described as sharp and burning. Both patients failed to obtain pain relief with prior medical and/or surgical procedures. Histologic sections of nerves were taken at surgery and confirmed the diagnosis of radiation-induced injury. Within the immediate postoperative period both patients experienced excellent pain relief and continue to be pain free at 29-48-month follow-up observation. The DREZ lesions provide a safe and effective therapy for the pain associated with RBP.
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ranking = 6
keywords = radiation-induced
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