Late Complication Of Radiotherapy Research Articles

Long-term effects of radiation therapy in outpatient practice

Moscow multidisciplinary clinical center «Kommunarka», Moscow, Russia SUMMARY Radiation therapy is one of the main methods of treating malignant neoplasms. Along with high efficiency, radiation therapy leads to complications in the early and late period. General practitioners and therapists are insufficiently familiar with long-term radiation-induced complications. The article presents data on the pathogenesis, clinical manifestations, diagnosis and treatment of radiation lesions of the bone system, lungs, myocardium, gastrointestinal tract, genitourinary system, hematopoiesis system, as well as chronic pain syndrome. The symptoms of late complications of radiation therapy are nonspecific and similar to the symptoms of somatic diseases. Knowledge of the clinical manifestations of radiation-induced complications in the long term allows timely diagnosis and treatment.

Early Postoperative Complications after Pelvic Exenteration

Background. Radiation therapy is an integral part of the treatment of most malignant neoplasms of the pelvic organs, which in 25–30% of cases can cause the development of late radiation complications; in addition, 2–8% of patients have severe complications with an outcome in fistulas of various localization. Also, tumors of this localization are prone to local-regional recurrence, which can be combined with late radiation injuries. One of the most radical, and, often, the only method of treating this extremely severe and prognostically unfavorable pathology is to perform evisceration of the pelvic organs; however, its implementation against the background of radiation damage to normal tissues, leading to a significant decrease in the reparative potential, inevitably leads to a high risk of postoperative complications.
 Methods. A retrospective analysis of early postoperative complications on the Clavien–Dindo scale was carried out in 136 patients after pelvic evisceration performed at the A.F. Tsyba MRSC in 2019–2021. All patients in the perioperative period underwent complex conservative therapy, including nutritional support.
 Results. Pelvic evisceration was performed due to the progression of the underlying disease in 57% of cases, in 29% — due to the development of severe late radiation injuries with an outcome in the fistula, in 14% — due to a combination of local recurrence of the underlying disease with radiation complications). Complications of grade I on the Clavien–Dindo scale were noted in 50%; II — in 20.5%; III — in 3.6%; grade IV — in 3%. There were no cases of postoperative mortality.
 Conclusions. Conducting active preoperative preparation of patients aimed at correcting anemia, dysproteinemia, pain syndrome, etc.; as well as modifying surgical techniques and improving the management tactics of postoperative patients can minimize the risk of postoperative complications in patients after pelvic evisceration.

Pelvic insufficiency fractures and pelvic bone metastases after neoadjuvant (chemo)radiotherapy for rectal cancer

Background: Pelvic insufficiency fractures (PIFs) are a late complication of radiotherapy for pelvic malignancies. We evaluated the incidence, radiologic findings, clinical course, and outcome of PIFs in patients treated with neoadjuvant (chemo)radiotherapy ((C)RT) for rectal cancer. Material and methods: Data of patients diagnosed with rectal cancer from a large teaching hospital treated from 2002 to 2012 were extracted from the Dutch Cancer Registry. All hospital records were reviewed for the diagnosis of PIFs or pelvic bone metastases. An expert radiologist reassessed all imaging procedures of the lower back, abdomen, and pelvis. Results: A total of 513 rectal cancer patients were identified of whom 300 patients (58.5%) were treated with neoadjuvant (C)RT (long- vs. short-course radiotherapy: 91 patients [17.7%] vs. 209 [40.7%], respectively). Twelve PIFs were diagnosed initially according to hospital records and imaging reports of all 513 patients. These 12 patients were treated with neoadjuvant (C)RT. After reassessment of all pelvic imaging procedures done in this patient group (432 patients (84.2%)), 20 additional PIFs were detected in patients treated with neoadjuvant (C)RT, resulting in a 10.7% PIF rate in irradiated patients. One PIF was detected in the group of patients not treated with neoadjuvant (C)RT for rectal cancer. This patient had palliative radiotherapy for prostate cancer and is left out of the analysis. Median follow-up time of 32 PIF patients was 49 months. Median time between start of neoadjuvant (C)RT and diagnosis of PIF was 17 months (IQR 9–28). Overall median survival for patients with PIF was 63.5 months (IQR 44–120). Conclusion: PIFs are a relatively common late complication of neoadjuvant (C)RT for rectal cancer but are often missed or misdiagnosed as pelvic bone metastases. The differentiation of PIFs from pelvic bone metastases is important because of a different treatment and disease outcome.

Pelvic Extirpative Surgery for the "End-Stage Irradiated Bladder".

Men with prostate cancer have the daunting task of selecting from multiple modalities of treatment. The long-term effects of radiation therapy are only now being recognized. For both patients and surgeons, the end-stage irradiated bladder poses numerous problems and challenges. Specifically, irradiated bladders with urosymphyseal fistula, radiation cystitis, and rectourethral fistula are challenging to manage and treat. This review outlines the presentation, workup, and management including cystectomy for these three devastating late complications of radiation therapy. There are special considerations when performing benign cystectomy that are not typically considered during oncologic cystectomy. We discuss an overview of the current literature regarding the "end-stage bladder" resulting from radiation therapy and the important considerations that must be acknowledged when managing these patients. It is shown that many of the less invasive and conservative options ultimately lead to cystectomy. Indeed, our review concludes that cystectomy with urinary diversion is a safe and viable option in select irradiated patients with the goal to improve quality of life.

Comparison of salvage high dose-rate brachytherapy and external beam radiotherapy for treatment of prostate cancer local recurrence after radical prostatectomy

Aim. To compare clinical efficacy of salvage high dose-rate brachytherapy (HDR-BT) and external beam radiotherapy (EBR) in treatment of local recurrence of prostate cancer after radical prostatectomy (RP).Materials and methods. Between January 2017 and December 2020, 60 patients with local recurrence of prostate cancer after RP were treated at the Russian Scientific Center of Roentgenology and Radiology. Two groups were identified: group 1 included 30 patients who underwent salvage external beam radiation therapy (EBRT) according to the classical fractionation regimen; in group 2, within the framework of the scientific protocol, 30 patients underwent 2 fractions of salvage HDR-BT with single boost dose of 15 Gy for total boost dose of 30 Gy. All patients in group 2 underwent pelvic multiparametric magnetic resonance imaging and positron emission tomography-computed tomography with prostatespecific membrane antigen ligands. In the 2nd group, transrectal biopsy of the prostate bed was also performed. Overall and biochemical recurrence-free survival, as well as the profile of early and late radiation complications, were analyzed.Results. Mean age of the patients at the time of salvage radiation therapy was 67.5 years (95 % confidence interval 66.1–69). Median time before development of biochemical relapse after RP was 24 months (interquartile range 13–46 months). Median follow-up period for all patients was 45 months (interquartile range 36–63 months). There were no dropouts in this study. The overall survival rate was 100 % in both groups. Comparative analysis of prostate specific antigen (PSA)-specific recurrence-free survival showed a clear trend toward an increase in the brachytherapy group; however, with the number of observations, statistically significant differences could not be achieved (p = 0.075). Salvage EBRT is more toxic than salvage HDR-BT. Comparative assessment of radiation adverse effects revealed higher frequency of early genitourinary toxicity of grade I and intestinal toxicity of grades I and II in the salvage EBRT group than in the salvage brachytherapy group, as well as late gastrointestinal toxicity of grade I and II.Conclusion. Salvage HDR-BT with 15 Gy × 2 fractions with total boost dose of up to 30 Gy was proved to be a promising treatment for local recurrence of prostate cancer after RP with an acceptable toxicity profile. There was also a trend towards increased PSA-specific recurrence-free survival in the salvage brachytherapy group compared with the salvage EBRT group.

Dosiomics-Based Prediction of Radiation-Induced Valvulopathy after Childhood Cancer.

Valvular Heart Disease (VHD) is a known late complication of radiotherapy for childhood cancer (CC), and identifying high-risk survivors correctly remains a challenge. This paper focuses on the distribution of the radiation dose absorbed by heart tissues. We propose that a dosiomics signature could provide insight into the spatial characteristics of the heart dose associated with a VHD, beyond the already-established risk induced by high doses. We analyzed data from the 7670 survivors of the French Childhood Cancer Survivors' Study (FCCSS), 3902 of whom were treated with radiotherapy. In all, 63 (1.6%) survivors that had been treated with radiotherapy experienced a VHD, and 57 of them had heterogeneous heart doses. From the heart-dose distribution of each survivor, we extracted 93 first-order and spatial dosiomics features. We trained random forest algorithms adapted for imbalanced classification and evaluated their predictive performance compared to the performance of standard mean heart dose (MHD)-based models. Sensitivity analyses were also conducted for sub-populations of survivors with spatially heterogeneous heart doses. Our results suggest that MHD and dosiomics-based models performed equally well globally in our cohort and that, when considering the sub-population having received a spatially heterogeneous dose distribution, the predictive capability of the models is significantly improved by the use of the dosiomics features. If these findings are further validated, the dosiomics signature may be incorporated into machine learning algorithms for radiation-induced VHD risk assessment and, in turn, into the personalized refinement of follow-up guidelines.

Overview of late complications of radiation therapy in uveal melanoma

Overview of late complications of radiation therapy in uveal melanoma

Radiotherapy-associated sensorineural hearing loss in pediatric oncology patients.

During the radiotherapeutic treatment of pediatric oncology patients, they would be at a latent risk of developing ionizing radiation-induced ototoxicity when the cochlea or auditory nerve is located within the radiation field. Sensorineural hearing loss (SNHL) is an irreversible late complication of radiotherapy, and its incidence depends on various factors such as the patient's hearing sensitivity, total radiation dose to the cochlea, radiotherapy fractionation regimen, age and chemoradiation. Importantly, this complication exhibits serious challenges to adult survivors of childhood cancer, as it has been linked to impairments in academic achievement, psychosocial development, independent living skills, and employment in the survivor population. Therefore, early detection and proper management can alleviate academic, speech, language, social, and psychological morbidity arising from hearing deficits. In the present review, we have addressed issues such as underlying mechanisms of radiation-induced SNHL, audiometric findings of pediatric cancer patients treated with radiotherapy, and management and protection measures against radiation-induced ototoxicity.

Choroidal metastasis: Radiation and bevacizumab at presentation.

To reveal early intervention outcomes for patients describing with choroidal metastasis. A retrospective interventional case series on 27 eyes of 22 patients treated for choroidal metastasis with external beam radiation therapy (EBRT) With and without intravitreal injections. The prescribed radiation dose was a mean and median 30 Gy (range of 30-40 Gy in 180-200 cGy daily fractions). Outcome measures included change in tumor thickness, subretinal fluid, visual acuity, radiation oculopathy, and survival. Decreased vision was the most common presenting symptom (n = 20/27, 74%). Pre-treatment vision for subfoveal lesions was a mean 20/400, median 20/200, and range 20/40 to hand motions (HM). Pre-treatment vision for extrafoveal tumors were a mean 20/40, median 20/25, range 20/20 to counting fingers (CF) which improved to a mean 20/32, median 20/20, range 20/12.5 to 20/200. Local control, with ultrasonographic height regression (44.5%; mean: 2.7-1.5 mm), was observed in all eyes at mean follow-up of 16 months (range: 1-72 months). Intravitreal anti-vascular endothelial growth factor (anti-VEGF) was given in nine cases (n = 9/27, 33%) to slow the growth of the metastasis and suppress their exudative detachments and to treat radiation maculopathy in 10 cases (n = 10/27, 37%). Late radiation complications included keratoconjunctivitis sicca in four cases (n = 4/27, 15%), exposure keratopathy in two cases (n = 2/27, 7%), and radiation retinopathy in 10 cases (n = 10/27, 37%). Of the 23 phakic eyes, four (n = 4, 17%) developed cataract. Radiation therapy with or without intravitreal anti-VEGF injections was a safe and effective treatment for choroidal metastasis. It was associated with local tumor control, reduction of secondary retinal detachments, and vision preservation.

Radiation induced cystitis prophylactics and treatment with hydrogel compositions in rectal cancer patients: a retrospective study

INTRODUCTION: The incidence of rectal cancer in different countries tends to increase over the past 10 years. In the Russian Federation, the incidence of rectal cancer accounts for about 4.5% of the total oncological incidence, where stage III–IV is 25.9% and 23%, respectively. In the light of current trends, national clinical guidelines from different countries recommend starting the treatment of locally advanced rectal cancer with radiation or chemoradiotherapy. Radiation therapy is usually accompanied by radiation reactions and complications. For the last 10–15 years, hydrogel compositions have been included in the treatment of radiation reactions along with basic drugs.OBJECTIVE: To study the effect of the use of hydrogel compositions for the prevention and treatment of radiation reactions during irradiation of patients with rectal cancer.MATERIALS AND METHODS: The study included 257 patients, including 146 men and 111 women aged 27 to 88 years, the median was 59 years old, who lived in St. Petersburg, the Leningrad Region and in other regions of the Russian Federation, who received radiation therapy since 2013 to 2019 for rectal cancer. The severity of radiation reactions was assessed by the current RTOG/EORTC. Basic drug therapy, including non-steroidal anti-inflammatory drugs, antispasmodics, hemostatic agents, oil mixtures, etc., was used in 47% of patients. In the course of radiation therapy, 35 patients were prescribed hydrogel-based composite preparations with derinat, dioxidine and lidocaine.Statistics: Data processing was carried out using the Excel spreadsheet editor, as well as the Statistica 10 for Windows statistical data processing software package.RESULTS: Radiation proctitis was registered in 81 (31.5%), dermatitis in 50 (19.5%), cystitis in 45 (17.5%), enterocolitis, enteritis or colitis in 28 (10.9%), hematological toxicity in 8 (3.1%), vaginitis in 8 (3.1%), other in 7 (2.7%) patients. Taking into account that the bladder is the most frequently irradiated organ in cases where the target tumor is localized in adjacent organs of the small pelvis, as well as the lack of prevention and treatment standards (golden standard), radiation cystitis, which poisons the lives of apparently healthy patients, was carried out study of the effect of hydrogel compositions in the appointment of these drugs before, during and after the end of radiation therapy compared with the control. In the study group, a later onset of cystitis was noted (with SD from 20 to 34 Gy), the frequency of cystitis was 9% (p<0.05), the severity did not exceed 1 degree. In the control group, radiation reactions occurred when SD reached 14 to 27 Gy. RIC grade 1 was diagnosed in 10.3%, grade 2 in 8.8%, grade 3 in 5.9%. The overall frequency of RIC in the control group was 25%. Thus, the frequency of RIC in the control group significantly exceeded that in the main group. Further observations showed that patients, diagnosed with rectal cancer, who received hydrogel compositions suffered from overall incidence of late radiotherapy complications 2 times lower — 8.2% vs. 17.2%, respectively (p<0.05).DISCUSSION: The impact of radiation reactions and complications on the quality of life of rectal cancer patients is actively discussed in the Russian Federation and abroad. At the same time, the incidence of rectal cancer in the world is growing, as well as the need for radiation therapy. Radiation cystitis is a recognized complication of radiation therapy of the pelvic organs. The frequency of RIC, according to various authors, ranges from 23 to 80%. Hydrogel compositions are one of the proven effective means of combating radiation damage.CONCLUSION: the presence of radiation reactions during pre/postoperative radiation therapy for rectal cancer significantly contributes to a decrease in the five-year survival rate of patients. The frequency of radiation cystitis significantly decreases against the background of the appointment of hydrogel compositions before, during and after radiation therapy.

Late Radiation-Induced Carotid Artery Stenosis and Stroke in Pediatric Patient Treated With Proton Radiation Therapy for Skull-Base Chordoma

Radiation vasculopathy is a well-recognized late complication of radiation therapy. We present a case of a stroke 29 years after high-dose proton radiation therapy for skull-base chordoma due to occlusion of bilateral internal carotid arteries.

Vertebral artery sparing volumetric modulated arc therapy in nasopharyngeal carcinoma.

Vascular stenosis is a late radiation complication that develops in long-term survivors of nasopharyngeal carcinoma. Vertebral arteries (VAs) are major vessels responsible for posterior circulation. In this study, we evaluated the feasibility of VA-sparing volumetric modulated arc therapy (VMAT) techniques. A total of 20 patients with nasopharyngeal carcinoma treated by a TrueBeam linear accelerator were enrolled in this study. The original VMAT plan was designed without the contouring of VAs as organs at risk (OARs). The same image set of the original VMAT plan was used to contour the VAs for each patient. A new VA-sparing VMAT plan was developed by avoiding VAs as OARs. Finally, a paired t-test was used to compare the dosimetric differences. The VA-sparing VMAT plan had similar target coverage and dose to those of other OARs. The VA-sparing plan yielded a significantly low VA dose from 53 to 40 Gy, with V35Gy changing from 97% to 56%, V50Gy changing from 67% to 35%, and V63Gy changing from 15% to approximately 7%-10% (p < 0.001 for all comparisons). VAs should be correctly identified as OARs. Photon VMAT with VA sparing can help substantially decrease the VA dose.

Case report: radiation-induced lumbosacral plexopathy – a very late complication of radiotherapy for cervical cancer

BackgroundLumbosacral plexopathy caused by radiotherapy is a rare but severe consequence of cancer treatment. This condition often leads to varying degrees of sensory and motor impairment. Neurological complications, which are typically permanent, manifest a long period after irradiation.Case presentationWe describe a case of progressive lower extremity weakness and sensory impairment in a woman who had been effectively treated with radiotherapy for cervical cancer with development 36 years after irradiation. The electrophysiological assessment revealed a subacute bilateral axonal lesion of the lumbosacral plexus. None of the clinical manifestations, serology, cerebrospinal fluid or imaging data discovered an explanation other than radiation-induced lumbosacral plexopathy (RILP).ConclusionsThis case demonstrates that RILP may emerge more than 30 years after the radiotherapy.

A Case of Multiple Radiation-related Complications during Long-term Follow-up after Sacral Ulcer Surgery

We report the clinical course of a patient who developed a sacral radiation ulcer 19 years after treatment for cervical cancer. The patient's postoperative course after a free latissimus dorsi muscle flap transfer was favorable, but various late radiation complications, including rectal perforation, a rectal fistula, sacral necrosis, a rectointestinal fistula, and sacroiliac joint osteomyelitis, occurred within 11 years. Plastic surgeons who treat such ulcers need to know that patients may develop other serious radiation-related complications. Being aware of these complications will allow appropriate measures to be taken and aid decisions regarding future surgical strategies. More careful assessment of sacral necrosis and bone resection may have ameliorated some of the complications. When encountering similar patients, we believe that careful magnetic resonance imagery (MRI) and intraoperative evaluation are warranted, as sacral necrosis may be detectable in some patients.

ODP290 A Rare Case of Hypopituitarism Secondary to Radiation Therapy for Nasopharyngeal Carcinoma

Abstract Radiation therapy with or without chemotherapy remains a mainstay of treatment for nasopharyngeal carcinomas. Radiation can cause neurological complications such as cranial nerve palsies, and brachial plexopathy as well as non-neurological complications including endocrinopathies like primary hypothyroidism and hypopituitarism. We describe a 30-year-old male with a diagnosis of nasopharyngeal carcinoma who presented to our clinic in June 2021 with low energy level, occasional headache,light-headedness, and poor balance. He received chemo and radiation treatment in 2014 that led to the diagnosis of pituitary hormone deficiency. He also reported erectile dysfunction and decreased libido. His history is remarkable formononucleosis, asthma, and bone fracture in high school while playing football. He developed subsequent hypothyroidism in 2016 and taking Levothyroxine 100 mcg daily since 2016. The patientwas diagnosed with hypogonadism in 2018 and receiving testosterone cypionate injection every 3 weeks. Patient diagnosis of hypothyroidism and hypogonadism prompted to initiate a hypopituitarism workup which lead us to find growth hormone deficiency. Laboratory workup showed low Total Testosterone 43.1 ng/dl (normal range(NR): 264-916), FSH &amp;lt;0.3 IU/L (NR: 1.5-12.4), low IGF-1 56 ng/dl(NR: 83-246), LH &amp;lt;0.3 IU/L(NR: 1.7-8.6),TSH 0.23 uIU/ml(NR: 0.27-4.2), Prolactin Undiluted 55.6,Diluted 49.8 ng/ml(NR: 4.1-18.4), SHBG 86. 0 nmol/L(NR: 16.5-55.9), Normal Free T4 1.4 ng/dl(NR: 0.9-1.8), Free T3 2. 07 pg/ml(NR: 1.8-4.6). Thyroid Antibodies were negative. ACTH-ESO 10 pg/ml(NR: 6-48) and normal Cortisol PM were 4. 0 Ug/dl (NR: 2.7-10.5). We found that he has growth hormone deficiency. We are currently implementing growth hormone supplementation treatment. The patient has been restarted on testosterone injections. Repeated TFTs showed Free T4 0.6 ng/dl, Free T3 1.78 pg/ml and TSH 2.30 uIU/ml. Levothyroxine was increased to 125 mcg daily. This case showed the importance of considering endocrinopathies as late complications of radiation therapy fornasopharyngeal carcinomas. In a cohort study by Tuan et al, primary hypothyroidism and hypopituitarism was reported(Incident rate of 13% and 6% accordingly). Previous studies showed somatotropic axis is the most vulnerable to radiation damage and after radiation, patients developed growth hormone deficiency, adrenal insufficiency, hypogonadism, and thyroid disorders. This case is unique considering that the patient was initially diagnosed with hypothyroidism subsequently hypogonadism and growth hormone deficiency diagnosed years later. Radiation can affect pituitary function. Hypopituitarism can be a late complication of radiation therapy in patients with nasopharyngeal carcinoma. Complete pituitary workup are advised to ensure timely diagnosis and early hormone replacement therapy in these patients. Our case will be helpful to other clinicians for diagnosis and management of endocrinopathies secondary to radiation therapy. Presentation: No date and time listed

Variable presentations of radiation-associated angiosarcoma in patients treated for breast cancer

Introduction: Radiation-associated angiosarcoma is a rare and late complication of radiotherapy in breast cancer. Its incident is reported in the range of 0.03–0.3%. It carries a poor prognosis with a 5-year survival rate of 43–54%. Due to its non-specific presentation, diagnosis is often delayed. Case Report Case 1: A 60-year-old female presented six years after her breast cancer treatment with a history of bruising over the breast following trauma. Initial imaging and punch biopsy only showed inflammatory change. Her breast symptoms progressed and repeat biopsy revealed angiosarcoma. She was treated with chemotherapy followed by mastectomy. Case 2: A 60-year-old female treated for breast cancer, presented two and a half years later with subtle erythema over the breast. Imaging was normal. Punch biopsy showed angiosarcoma and she underwent mastectomy. Case 3: A 90-year-old female presented eight years after treatment for breast cancer. Her symptoms included blisters over the breast that bled at times. Punch biopsy showed angiosarcoma. There was rapid disease progression with convergence of the blisters into a large necrotic mass. She underwent a mastectomy for local control. The angiosarcoma recurred a year later and she died within three months of recurrence. Conclusion: Radiation-associated angiosarcoma is rare but carries a poor prognosis. Due to its non-specific presentation, diagnosis is often delayed. A high level of suspicion is needed in patients presenting with unusual breast symptoms and changes post-treatment.

Early and late radiation complications after application of preoperative radiation therapy in complex treatment of cancer recti

Objective. To study and assess the rates and degree of severity of early and late radiation complications in patients after application of preoperative radiation therapy in complex treatment of the patients, suffering cancer recti.&#x0D; Materials and methods. Analysis of the treatment results in 113 patients, suffering locally–advanced (сT3с–4N1–2M0) cancer recti, who have obtained preoperative oncotherapy in 2019–2022 yrs in the Department of Radiation Therapy of Zakarpattya Antitumoral Centre, was performed.&#x0D; Results. Most frequent early radiation affection was rectitis, which have occurred – in 86 (76,1%) patients of 113. Early radiation affections of the reproductive system organs were noted in 5 (4,4%) patients. Late radiation affections were registered in 9 (7,9%) patients, mostly frequent in the gut system – in 5 (4,4%) patients.&#x0D; Conclusion. Аnalysis of the complex treatment results, performed in 113 patients with cancer recti, have shown, that preoperative radiation therapy do not enhance the rate of occurrence of early radiation complications and hematological toxicity. The rate of early radiation affections was 76,1%, and of the late – 7,9%.

347. DEFINITIVE CHEMORADIOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL (DCF-RT) FOR ADVANCED CERVICAL ESOPHAGEAL CANCER

Abstract Recently, the selection rate of definitive chemoradiotherapy (CRT) as a treatment option for cervical esophageal squamous cell carcinoma (ESCC) has increased to preserve the larynx. However, many things about the regimen, irradiation field, or which is better treatment have not been determined. We have started definitive chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF-RT) for advanced cervical esophageal squamous cell carcinoma. We evaluated 20 advanced cervical ESCC patients (clinical stage II–IV, including T4b and/or M1 lymph node) in our department who received DCF-RT as the first-line treatment between December 2010 and August 2021. 16 males and 4 females. The pretreatment clinical stage included one stage II, five stage III, six stage IVa, and eight stage IVb cases (including 10 with T4b and 8 with M1 lymph node. Grade 3 or more adverse events included leucopenia (95%), neutropenia (90%), febrile neutropenia (55%). We attained CR in 17 patients (85%), SD in 2 patients, and PD in 1 patient. Of 17 patients with CR, 8 experienced recurrence and 9 continued exhibiting CR. Two patients who underwent salvage surgery. While the 2−/3-year overall survival rate was 60.2%/46.4%, the 2−/3-year recurrent-free survival rate was 51.4%/45.7%, respectively. DCF-RT for advanced cervical ESCC could be completed by the careful administration, and although a strong blood toxicity might occur, a favorable prognosis can be obtained with larynx preservation. Further observations are warranted to establish the long-term prognosis, late complications of radiotherapy, and the significance of salvage surgery.

Influence of late radiation complications on long-term survival of patients treated with irradiation of the pelvic organs

Background. Radiation therapy is one of the main treatments for locally advanced cancers of the rectum, cervix, and prostate. As a result of summing up high total doses, radiation damage occurs in patients.Aim. To determine the frequency of late radiation injuries in patients, their impact on overall survival and quality of life.Materials and methods. The study included 759 patients who received treatment in medical facilities in St. Petersburg and the Leningrad Region, of which 324 were men and 435 were women aged 27–88 years, with a diagnosis of rectal cancer – 257, cervical cancer – 327, prostate cancer – 175 patients. Irradiation was carried out on linear accelerators and brachytherapy devices. The quality of life of patients was assessed by questionnaires based on QLQ-30.Results. The overall toxicity was 35.01 % in patients with cervical cancer, 10.4 % in patients with rectal cancer and 7.6 % in patients with prostate cancer. Overall long-term 5 and 10 years survival in patients with late complications was 46.3 and 16.5 %versus66.5 and 33.4 % in patients without late complications (p= 0.001). In patients diagnosed with rectal cancer, it was significantly higher than in other groups (p&lt;0.05). 3–5 weeks after the end of radiation therapy, patients reported a significant deterioration in the quality of life.Conclusion. Late radiation damage is an important prognostic factor influencing long-term survival in patients diagnosed with cancer of the rectum, cervix and prostate. A decrease in the quality of life in patients who received irradiation of the pelvic organs 3–5 weeks after the end of radiation therapy has been proven.

Hyperbaric Oxygenation in Recurrent Rectal Bleeding in the Background of Radiation Proctitis

Radiation proctitis is a complication of radiation therapy used in the treatment of pelvic malignant tumors. The leading clinical symptom of this kind of late radiation complications is recurrent rectal bleeding, leading to the development of anemia. Despite the availability of modern drugs, conservative treatment methods remain ineffective, and minimally invasive endoscopic technologies are not applicable in all cases and can lead to the development of complications in the form of ulcers and fi stulas. About 20 years ago, the world scientifi c community recommended hyperbaric oxygenation (HBO) as a method of treating late radiation damage to the rectum. However, this technique has not been widely used. We have presented the experience of treating the successful use of HBO in the treatment of a 50-year-old patient with chronic radiation proctitis complicated by recurrent rectal bleeding. Conservative and endoscopic methods of treatment in this patient were ineffective. This clinical observation demonstrates that HBO is an effective method of treating rectal bleeding associated with radiation proctitis.