Cases reported "Radiation Injuries"

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1/72. radiation-induced localized scleroderma in breast cancer patients.

    radiation-induced scleroderma in breast cancer patients appears to occur in approximately one out of every 500 patients. We report four cases that developed within 3 months of conservative breast surgery and postoperative radiation treatment. The reaction was contained entirely within the treatment field and demonstrated the typical features of this condition where the breast becomes erythematous, violaceous, indurated, retracted, and progressively pigmented. The breast tends to soften and become more comfortable over 1-4 years; however, significant induration, retraction and pigmentary changes remain. There appears to be no predictive factors. radiation-induced scleroderma must be differentiated from cellulitis and recurrent breast cancer.
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2/72. breast cancer invasion into the chest wall with resection and reconstruction.

    Despite the advent of limited resections and radiation therapy in the treatment of breast cancer, a substantial number of women experience recurrence or persistent disease that invades the skin, soft tissues, and musculoskeletal layers of the chest wall. This problem, which can compromise local control of the tumor, can also involve pleura, lung tissue, and mediastinal structures. This article will cover some of the pertinent clinical decisions related to these lesions, their prognosis, and management by chest wall resection and reconstruction.
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3/72. Subcutaneous calcification as a late effect of orthovoltage chest wall irradiation.

    Adjuvant radiotherapy to the breast or chest wall is given to some patients with breast cancer, to reduce the risk of local recurrence. It is known to be associated with various late sequelae, including subcutaneous fibrosis, telangiectasia and pulmonary fibrosis. Delivering radiotherapy to the chest wall and nodal drainage areas presents the technical problem of matching the glancing and anterior supraclavicular fields. Overlap between these fields will result in underlying tissues receiving a larger dose than intended; similarly, a gap results in an inadequate dose. We present the case history of a patient with subcutaneous calcification occurring as a late sequela of radiotherapy to the chest wall and anterior supraclavicular field. This has not been previously reported and is thought to have arisen from a high dose region in an area of overlap between fields.
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4/72. Pulsed dye laser treatment of telangiectasia after radiotherapy for breast carcinoma.

    Telangiectasia formed following exposure to X-ray irradiation have been reported to respond well to the pulsed dye laser system. We present the case of a 34-year-old woman with extensive post-radiotherapy skin telangiectasia of the chest wall and axilla who was treated with six sessions of pulsed dye laser treatment, with a considerable improvement in appearance. We recommend the pulsed dye laser as an option in the treatment of post-radiotherapy telangiectasia.
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5/72. Postirradiation morphea of the breast presentation of two cases and review of the literature.

    The advent of radiation therapy as a common modality in the treatment and palliation of breast cancer has led to the observation of morphea developing months to years after supervoltage radiation therapy, in and around the site of treatment. We report 2 new cases of morphea at the site of previous supervoltage radiation therapy for breast cancer. The time period between irradiation and onset of morphea in our 2 patients were an atypically long 6.5 years and 32 years, the latter being the longest reported such interval. With conservative treatment, the inflammatory component of the lesions resolved over an approximately 1-year period, leaving residual sclerosis. These patients are compared to those previously reported in the medical literature so as to summarize the range of clinical presentation and course. Recognition of postirradiation morphea is important in distinguishing it from infectious cellulitis, recurrent carcinoma, metastatic carcinoma or development of a second primary carcinoma. copyright (R) 2000 S.Karger AG, Basel
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6/72. radiation-induced heart disease.

    A 45-year old woman underwent a radical mastectomy in 1965 for carcinoma of the left breast with metastasis in the left axillar lymph nodes. Fifty per cent of the heart received 4,000 rads during post-operative x-ray therapy. Patient developed radiopneumonia and symptoms of acute pericarditis in 1967. Constrictive pericarditis developed gradually from 1972 on. A pericardiectomy was performed in June 1974 and a thickened pericardium could be removed. light and electron microscopic examination of a surgical biopsy of the left ventricular epi-myocardium revealed epicardial fibrosis, interstitial fibrosis of the myocardium and perivascular fibrosis. The diagnosis of post-radiation pericarditis was made. The myocardial involvement may be responsible for the subsequent clinical course.
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7/72. radiation injury involving the internal carotid artery. Report of two cases.

    radiation therapy is an uncommon cause of stenosis and occlusions of the cervical internal carotid artery (ICA). We describe two cases of cerebral ischemia due to ICA stenosis in patients irradiated for malignant tumors (lymphoma and breast cancer). The first patient, a 32-year-old man, presented with an episode of cerebral ischemia. Six years previously he had received irradiation therapy for a left laterocervical mass histologically diagnosed at biopsy as a Hodgkin's lymphoma. cerebral angiography on entry revealed bilateral occlusion of the cervical ICA, with a 2-cm stump at the origin of the left ICA. Despite anti-platelet aggregation therapy the ischemic attacks persisted, necessitating a stumpectomy. After vascular-repair surgery the patient had no further ischemic symptoms. The second patient, a 42-year-old woman, began to experience the sudden onset of pain in the right arm and left hemiparesis five years after surgery plus irradiation (4500 rad) for breast cancer, and three years after excision of a single cerebral metastasis. cerebral angiography obtained on admission showed occlusion of the right ICA and right subclavian arteries, both lesions necessitating thrombectomy. After surgery the right radial pulse immediately re-appeared and the hemiparesis regressed. In both patients, 2-year follow-up assessment by Doppler ultrasonography and magnetic resonance angiography (MRA) confirmed that the operated arteries remained patent. These two unusual cases underline the potential risk of irradiation-induced ischemic cerebrovascular symptoms, suggesting that patients who have received radiation therapy to the neck and mediastinum who survive for more than 5 years should undergo regular non-invasive imaging of neck vessels (Doppler ultrasonography and MRA).
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8/72. Endovascular therapeutic occlusion following bilateral carotid artery bypass for radiation-induced carotid artery blowout: case report.

    A patient with breast cancer received radiation therapy to the upper chest wall. Twenty-two years later, she presented with repeated severe bleeding through a left lower neck ulcer. She was taken to surgery for hemostasis, which was not successful because the carotid artery was surgically inaccessible. To manage for explosive carotid blowout, we performed common carotid artery ligation and endovascular coil embolization after contralateral-external-carotid to ipsilateral-common-carotid artery bypass with a polytetrafluoroethylene (PTFE) graft. The patient has experienced no ischemic events or bleeding since this treatment.
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9/72. Hyperlucent lung after radiation therapy.

    A 63-year-old woman was demonstrated to have a hyperlucent lung in a hemithorax irradiated 9 years previously for carcinoma of the breast. This is the second reported concurrence of these events.
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10/72. A newly recognized syndrome--radiation-related bronchiolitis obliterans and organizing pneumonia. A case report and literature review.

    bronchiolitis obliterans and organizing pneumonia (BOOP) is a syndrome that has been associated with a variety of underlying disorders, including infection, collagen vascular diseases and toxic fume inhalation. Rarely, however, BOOP has been associated with radiation- or chemotherapy-induced pulmonary toxicity. Over the past 3 years, several case series have reported BOOP in the unique setting of radiation in breast cancer patients. This study describes our experience with this newly recognized syndrome and a review of the English-language literature on this syndrome.
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