1/7. radiation-induced bronchial stenosis: a new cause of platypnea-orthodeoxia.Platypnea-orthodeoxia is encountered in a variety of cardiac, pulmonary, and hepatic disorders. We report its occurrence in a 59-year-old man who had had combined external-beam and high dose-rate iridium brachytherapy for a stage I non-small-cell carcinoma of the right upper lobe 2 years earlier. The post-radiation course was complicated by a severe radiation bronchitis; the onset of platypnea-orthodeoxia signalled the development of severe bronchial stenosis that was transiently relieved, initially by dilatation, and later by stent placement, though the patient ultimately died of a pulmonary hemorrhage. The dosage of brachytherapy given, the combined external-beam therapy, and the long survival after completion of radiation therapy were likely factors in the development of bronchial stenosis. We discuss the tomographic and bronchoscopic features of radiation-induced bronchial stenosis.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
2/7. hiv complicates the management of oncological emergencies: a case involving the superior vena cava syndrome.An association exists between human immunodeficiency virus (hiv) and an increased incidence of lung cancer. superior vena cava syndrome (SVCS) is an oncological emergency seen in the presence of chest tumours. We report on an otherwise well hiv-positive male who presented with SVCS due to lung cancer. He was commenced on dexamethasone and radiotherapy with curative intent. Treatment was complicated by accelerated steroid- and radiation-induced morbidity. The patient died of disseminated aspergillosis after receiving 27 of 35 planned radiotherapy fractions. The management of SVCS in those with hiv is challenging and requires the judicious use of steroids, antifungal prophylaxis and palliative radiotherapy doses.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
3/7. The causes of dysphagia in carcinoma of the lung.Dysphagia occurs in only a small percentage of patients with lung cancer, but the frequency of this cancer means that large numbers are affected. Non-quantitative analysis of a large Scottish series of lung cancer cases indicates the following eight broad categories of dysphagia according to underlying mechanisms: mediastinal disease; cervical lymphadenopathy; brainstem lesions; gastrointestinal tract metastases; associated systemic disorders; second primaries; oropharyngeal and oesophageal infections; and radiation-induced oesophageal toxicity.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
4/7. Exacerbation, then clearance, of mutation-proven Darier's disease of the skin after radiotherapy for bronchial carcinoma: a case of radiation-induced epidermal differentiation?We investigated a radiotherapy-induced flare and subsequent clearance of skin lesions of a patient with the rare, dominantly inherited genodermatosis, Darier's disease (DD). The DD gene, ATP2A2, was recently isolated and shown to be a cation pump responsible for regulating intracellular calcium homeostasis. A severe exacerbation of Darier's skin lesions developed within the radiation field when 40 Gy of palliative thoracic external-beam radiation therapy and concurrent chemotherapy (cisplatin and hydroxyurea) were delivered for non-small cell lung cancer. The DD lesions subsequently completely cleared from irradiated skin, as they did when a subsequent course of radiation alone was given for a loco-regional tumor recurrence. The two radiation therapy-treated areas of skin remained free from lesions of the skin disorder until the patient's death from progressive lung cancer 9 months later. The nucleotide sequence of the patient's ATP2A2 gene was determined by PCR-based cycle sequencing. We identified four nucleotide sequence variants in the ATP2A2 gene in this patient. Three were probable polymorphisms and the other appeared to be a novel disease-causing mutation (R751Q), situated in the transmembrane portion of the ATP2A2 protein. This finding confirmed the clinical diagnosis. Since epidermis turns over every 3-4 weeks, total and persistent clearance of the DD lesions by chemoradiotherapy suggests that this treatment induced sustained differentiation of the DD-affected skin by an unknown mechanism. Oncologists treating malignant disease in patients with DD should anticipate temporary deterioration in DD-involved irradiated skin. radiation therapy has therapeutic potential in severe DD.- - - - - - - - - - ranking = 4keywords = radiation-induced (Clic here for more details about this article) |
5/7. Interstitial densities following radiotherapy.After admission on June 30, R.D. remained intubated, and he continued on i.v. steroids, heparin, and warfarin. Nutritional needs were met with a nasointestinal feeding tube and nutritional preparations. He was alert and oriented and communicated appropriately with family and staff via written notes. The patient and his wife wanted to try a ventilator for a period of time before considering a "No CPR" order. His chest wound continued to be open but was healing slowly. Over the next few days, R.D. became more hypoxic with increased respiratory effort and required sedation and assist-control ventilator settings. On July 1, he required more sedation to keep him comfortable, but remained alert and oriented and continued to communicate with his family. On July 3, he sat in a chair for 1.5 hours. On July 4, he developed a large right pneumothorax and a chest tube was placed. He continued to indicate that he was short of breath. The patient remained very anxious and was started on a propofol drip. Later that day, his wife had a discussion with the healthcare team; the decision was made not to resuscitate the patient. On July 5, R.D.'s agitation increased and he was started on additional propofol for sedation, vecuronium bromide to facilitate breathing, and lorazepam i.v. push for relaxation. R.D.'s oxygenation-ventilation status declined through the night. After a discussion between the family and the physician on July 6, life support was withdrawn, and R.D. died later that day. Some of the factors that may have led to R.D.'s radiation-induced pneumonitis include his prior history of smoking as well as his former occupation as a coal miner. He received 15 radiation treatments to his chest area. He also received chemotherapy, including the drug paclitaxel; this combination may have contributed to his radiation-induced pneumonitis. The pneumonitis led to his immunosuppressed condition. R.D.'s superior vena cava syndrome led to the formation of clots for which he received heparin and coumadin. He received steroids to reduce the inflammation from the mediastinoscopy site and in his lung tissues. All of these factors contributed to R.D.'s outcome.- - - - - - - - - - ranking = 2keywords = radiation-induced (Clic here for more details about this article) |
6/7. Mesothelial papillary proliferation of the pleura associated with radiation therapy: does it have a role in the pathogenesis of mesothelioma?Diffuse papillary proliferation of mesothelial cells in the pleura mimicking metastatic carcinoma was seen four weeks following radiation therapy for a Pancoast tumor. Such papillary proliferations are not observed incidentally and are envisioned to occur during asbestos-induced carcinogenesis. We postulate that similar papillary lesions may serve as a link in the pathogenesis of radiation-induced mesotheliomas.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
7/7. Severe esophageal toxicity after thoracic radiation therapy for lung cancer associated with the human immunodeficiency virus: a case report and review of the literature.This case report documents severe esophagitis and rapid esophageal stricture formation in a man infected with the human immunodeficiency virus (hiv) who was treated with standard thoracic irradiation for locally advanced non-small-cell lung cancer. Severe late esophageal toxicity is a rare complication of radiation therapy in patients who are hiv negative, but those who are hiv positive may be at increased risk. This article reviews the literature suggesting that hiv infection may lead to unusually severe radiation-induced mucosal injury. High-dose chest irradiation should be performed with caution in this group of patients.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |