Late Complication Of Radiotherapy Research Articles

Increased optic nerve radiosensitivity following optic neuritis

Radiation-induced optic neuropathy (RION) is a late complication of radiotherapy, resulting in severe visual loss.1 We report a RION case following radiation therapy delivered at a dose widely considered as innocuous, occurring on a background of previous isolated optic neuritis. Increased brain sensitivity to radiation has been observed in patients with multiple sclerosis (MS),2–4 but we are not aware of previously reported cases solely involving the optic nerves (ONs). This aspect deserves consideration when defining therapeutic strategies.

Complications Associated With Postoperative Adjuvant Radiation Therapy for Advanced Rectal Cancer

Preoperative management of advanced rectal cancer often includes chemoradiotherapy, but little is known about the late complications of radiotherapy. However, these are usually serious, making determination of the characteristics of late complications after radiation therapy critical. Accordingly, we investigated the complications occurring after adjuvant pelvic radiation therapy in patients with advanced rectal cancer. We enrolled 34 consecutive patients with TNM stage III rectal cancer who had undergone curative surgery with adjuvant pelvic radiation therapy. Data on the type of complication/organ involved, the number of complications, the phase of onset, and the treatments used were reviewed. Patients who experienced gut complications or edema were less likely to have their complications resolved than those with complications due to infection. Similarly, patients with multiple complications and late-onset complications were also less likely to have their complications resolved than those with single complications and those with early-onset complications, respectively. Adjuvant radiation therapy in patients with resected advanced rectal cancer was associated with various complications, characterized by late onset and impaired resolution. Therefore, patients indicated for radiation therapy should be selected with great caution.

Growing Heterotopic Calcification in the Prevertebral Space of a Cervical Spine as a Late Complication of Irradiation: Case Report

Heterotopic calcification following head and neck irradiation has rarely been reported. It usually develops as a late complication of radiotherapy in patients with malignancies, including breast cancer, lymphoma, and genitourinary malignancies. The occurrence of heterotopic calcification in the prevertebral space of the cervical spine has not been described as a late complication of irradiation. Here, we report a case of prevertebral heterotopic calcification in a patient with history of chemotherapy and radiotherapy for tonsil cancer 21 years ago.

Pathological Fracture Of The Mandible Associated To Osteoradionecrosis With Necrotic Bone And Reconstruction Plate Exposure: Case Report

Osteoradionecrosis is a severe and devastating late complication of radiotherapy in patients with head and neck cancer. The diagnosis of Osteoradionecrosis is established by clinical and radiographic evidence of bone necrosis after irradiation. The current article reports a case of osteoradionecrosis in an irradiated patient (male; 62-year-old), which evolved into pathological fracture of the jaw, 2 years after the end of radiotherapy for oral cancer treatment. The patient was rehabilitated in other service, with reconstruction plates, without adjuvant hyperbaric oxygen therapy, progressing to a fistula formation and bone exposure. The patient was referred to our service, with an extensive bone and plate exposure, with signs of severe osteoradionecrosis. After the adequacy of the oral environment, the patient underwent surgery for necrotic bone and reconstruction plate resection, with a primary closure of the skin and intraoral mucosa. The post- operative clinical and radiographic examinations performed after 12 month showed no signal of recurrence. Pathologic fracture in conjunction with osteoradionecrosis has a relatively high treatment complication rate. The incorrect diagnosis of mandibular fracture associated with osteoradionecrosis leads to inadequate treatment, with irreversible consequences to the patient, as described in the related case.

Incus Necrosis After Irradiation

Osteoradionecrosis (ORN) of the temporal bone is a rare, late complication of radiotherapy to the temporal bone region for head and neck or skull base tumours. ORN can occur as a localized or a diffuse type, according to the extension of the affected temporal bone. It can lead to otitis externa, otitis media, aseptic labyrinthitis and may lead to serious intracranial complications. Hearing loss may be conductive, sensorineural, or mixed. A few case studies report of previously irradiated patients presenting with conductive hearing loss presumably caused by ORN of the ossicular chain. In only one case report of diffuse ORN, ORN of the ossicles was histologically proven, leading to the conclusion that ossicular chain involvement as the sole entity of ORN would not exist. However, the presented case report disputes this. A 13-year-old boy presenting with a unilateral mixed hearing loss as the sole otological complaint, 10 years after radiotherapy for an anaplastic ependymoma. Middle ear inspection revealed ORN of the incus which was confirmed by histological investigation. ORN of the ossicular chain as a late complication can occur as an isolated entity and may present as conductive hearing loss predominantly in the low frequencies. Middle ear inspection and ossicular chain reconstruction should be attempted, bearing in mind the risk of iatrogenic lacerations of a thin tympanic membrane and possibly a delayed wound healing.

Clinical and Treatment Factors Associated With Vaginal Stenosis After Definitive Chemoradiation for Anal Cancer

Although VS (vaginal shortening and/or decreased width) is a known long-term toxicity after pelvic radiation therapy (RT) for gynecologic cancer, few studies have evaluated its incidence after definitive chemoRT for anal cancer. We retrospectively reviewed the clinical and treatment characteristics of women treated for anal cancer to identify factors associated with VS. Ninety-six consecutive women who received definitive chemoRT for anal squamous cell carcinoma between 2005 and 2012 comprised the study cohort. NCI CTCAE v. 4 was used to score for VS based on the medical record description of dyspareunia, vaginal dryness or difficult pelvic exam. Other clinical factors examined included age, race, body mass index (BMI), menopausal status, smoking, tumor size/lymph node status (AJCC 7th edition), immunocompromised status, and treatment with abdominoperineal resection (APR). The exact Wilcoxon-Mann-Whitney and Jonckheere Terpstra tests were used to assess VS risk factors. Median age was 60.4 years (range, 19-97). Patient characteristics included: 26% non-White; 14% pre-menopausal; 9% immunocompromised; and 51% with current or prior tobacco use. Stage distribution included 17% T1, 39.5 % T2, 26.5% T3, and 17% T4 tumors; 43% were node positive. Ninety-eight percent received dose-painted IMRT to a median primary tumor dose of 50.4 Gy (range, 41.4 Gy-60 Gy). Chemotherapy included: 83% concurrent mitomycin-C and 5-fluorouracil (5FU), 7% cisplatin and 5FU, 6% 5FU, and 2% capecitabine. APR was performed in 13% for recurrence or late toxicity. With a median follow-up of 2.5 years, 68 women (71%) had some degree of VS and 29% were without sufficient clinical information to assess VS. VS grade distribution was 38% grade 1, 25% grade 2 and 37% grade 3. For women with adequate VS assessment, only younger age (p = 0.016) and higher RT dose (p = 0.05) were predictors of worsening grade of VS on univariate analysis. Seventy-two percent of those with VS reported using measures to prevent it (38% vaginal dilator and 37% intercourse). Women without sufficient information to assess VS had cancers with worse prognostic features, including larger tumors (5 cm vs 3 cm, p < 0.005) and lymph node positivity (63% vs 34%, p = 0.009), had lower median BMI (23 vs 26, p = 0.047), and were more likely to require an APR (25% vs 7.4%, p = 0.04). Vaginal stenosis is a common late complication of radiation therapy in patients treated definitively with chemoradiation for anal cancer, even with IMRT. Younger age and higher prescribed dose are associated with an increased incidence of VS. Measures to prevent stenosis appeared ineffective although compliance may play an important role. We are currently evaluating dosimetric parameters, such as vaginal wall dose, which may contribute to VS.

Epiglottic Fibrosis as a Late Complication of Radiotherapy for Nasopharyngeal Carcinoma

Epiglottic Fibrosis as a Late Complication of Radiotherapy for Nasopharyngeal Carcinoma

Cyclosporine 0.05% ophthalmic emulsion for the treatment of radiation‐associated dry eye in children

Dry eye disease is a well-known late complication of radiation therapy and is often difficult to treat. We evaluated the usefulness of cyclosporine 0.05% ophthalmic emulsion for the treatment of radiation-associated dry eye in children. Eleven children received cyclosporine 0.05% emulsion twice daily after failure of conventional therapy. After 6 months, dry eye manifestations improved in three children (27.3%). The remaining eight children showed no improvement with cyclosporine 0.05% ophthalmic emulsion. These results suggest that twice-daily cyclosporine 0.05% ophthalmic emulsion has limited use in children with refractory radiation-associated chronic dry eye.

Late-onset radiation-induced optic neuropathy after radiotherapy for nasopharyngeal carcinoma

Radiation-induced optic neuropathy (RION) is a rare but devastating late complication of radiotherapy, usually manifesting months to years after cancer treatment of the head and neck, resulting in rapidly progressive blindness in one or both eyes. The incidence of radiation-induced complications following radiotherapy, especially RION, is correlated with survival time of patients. Nasopharyngeal carcinoma (NPC), the most common type of cancer in southern China, has been primarily treated with radiotherapy, with associated neural injuries. To our knowledge, there are few reports of RION among patients with NPC who have undergone radiotherapy. To study this further, we reviewed nine patients with NPC and RION after radiotherapy and examined the clinical manifestations of RION, characteristics of the ophthalmologic examination, MRI results and the treatments used. Of the nine patients with RION, the most frequent clinical presentation was a decline of vision with visual field defects in one or both eyes. Ophthalmologic examinations showed flame hemorrhages in the retina, optic nerve atrophy and cotton wool spots. T1-weighted enhanced MRI showed enhancement of the optic nerve and optic chiasm in six patients. Treatment with corticosteroids, anticoagulation and hyperbaric oxygen (HBO) treatment did not reduce visual loss or blindness in patients.

Radiation therapy complications in patients with primary invasive vaginal carcinoma

The aim of the study was to estimate acute and late complications of radiation therapy in primary invasive vaginal carcinoma (PIVC) patients. The analysis was performed for the group of 152 PIVC patients given radical radiotherapy in the Krakow Branch of Centre of Oncology during the 1967-2005 period. Twenty five (16.5%) patients in I stage with primary tumour of the thickness not larger than 0.5 cm were treated with intracavitary brachytherapy alone, for 120 (78.9%) patients (stages I-IVA) intracavitary brachytherapy was combined with external radiation therapy; and 7 (4.6%) patients in stage IVA were given only external radiotherapy In total, 145 (95.4%) patients were treated with intracavitary LDR brachyterapy by means of Ra-226 or afterloaded Cs-137 sources, and 127 (83.5%) received external radiation therapy using Co-60 and linac 10MV or 6MV photon beams. Early radiotherapy tolerance was good in the investigated group; 146 (96.1%) patients completed full planned radiation therapy treatment. Late complications of radiation therapy were observed in 21 (13.8%) patients: 3 (2%) patients reported mild complications, 12 (7.9%) moderate complications, and 6 (3.9%) severe complications. Severe complications of radiation therapy in the investigated group included: recto-vaginal fistula (5 patients) and vesico-vaginal fistula (1 patient). None of the patients in the group died of radiation therapy complications. Early tolerance of radiotherapy in PIVC patients is generally good. Late radiation therapy complications, particularly the severe, are rare and can be efficiently managed with conservative therapy or surgical treatment.

Gamma Knife and Chemoradiotherapy Applied Nasopharyngeal Cancer Patient Observed Radiation-Induced Optic Neuropathy and Retinopathy: A Case Report

Introduction: Radiotherapy is treatment for nasopharyngeal carcinoma, and concurrent chemoradiotherapy has been shown to prolong survival. Radiation-induced is a dramatic late complication of radiation therapy for tumors involving structures in the vicinity of the visual pathway. The association between dose and radiation retinopathy is well established. Case presentation: The patient was a 48-year-old turkish man. A case history of bilateral radiation-induced optic neuropathy and retinopathy, 105 months after combined treatment by chemotherapy, conformal radiotherapy and 62 months after gamma knife for a nasopharyngeal carcinoma. Conclusion: We recommend that all patients undergoing radiotherapy, which is likely to result in retinal irradiation, be warned of risk of radiation retinopthy of the dose applied.

A Literature Review of Late Complications of Radiation Therapy for Head and Neck Cancers: Incidence and Dose Response

A Literature Review of Late Complications of Radiation Therapy for Head and Neck Cancers: Incidence and Dose Response

下咽頭癌化学放射線療法後に化膿性脊椎炎から硬膜外膿瘍を発症した1例

Osteomyelitis is one of the most severe late complications of radiation therapy. The condition can arise from osteoradionecrosis and can be fatal if it occurrs in vertebrae. A 71-year-old woman, who had undergone chemoradiotherapy for hypopharyngeal cancer 6 months previously, presented with severe neck pain. An MRI examination revealed pyogenic spondylitis and an epidural abscess of the neck. Neurological disturbance in the extremities developed despite the administration of antibiotics for 5 days. Drainage and a laminectomy were performed to control the infection and to relieve spinal cord compression. The patient had no postoperative complications at 15 months after surgery. Previous case reports of osteomyelitis and epidural abscess following radiation therapy for head and neck cancer with surgical treatment tended to have a good clinical course. Severe neck pain and a limitation in the range of motion of the neck are considered to be serious clinical features of osteomyelitis. Since infection in the necrotic mucosa leads to pyogenic spondylitis, a repeated cultivation survey of the mucosa is nessesary for adequate antibiotics therapy. For osteomyelitis and epidural abscess following radiation therapy, immediate specific surgical treatment of the involved region is strongly suggested if antibiotics are not effective or spinal cord compression develops.

Radiation-induced enteropathy: Molecular basis of pentoxifylline–vitamin E anti-fibrotic effect involved TGF-β1 cascade inhibition

BackgroundRadiation-induced fibrosis is a serious late complication of radiotherapy. Pentoxifylline–vitamin E has proven effective and safe in clinical trials in the treatment of fibrosis, while the molecular mechanism of its activity is yet unexplored. MethodsTen patients suffering from radiation-induced enteropathy were treated with pentoxifylline–vitamin E combination with SOMA score as the primary endpoint. In parallel, primary smooth muscle cells isolated from intestinal samples isolated from humans with radiation enteropathy were incubated with pentoxifylline, trolox (vit. E hydrophilic analogous) or their combination. Activation of the TGF-β1/Smad and Rho/ROCK pathways was subsequently investigated using Q-RT-PCR, gene reporter, Western-blot, ELISA and immunohistochemistry. ResultsPentoxifylline–vitamin E combination induces regression of symptoms (SOMA) by −41% and −80% at 6 and 18months. In vitro, pentoxifylline and trolox synergize to inhibit TGF-β1 protein and mRNA expression. This inhibitory action is mediated at the transcriptional level and leads to subsequent inhibition of TGF-β1/Smad targets (Col Iα1, FN1, PAI-1, CTGF), while it has no effect on the Rho/ROCK pathway. ConclusionsThe anti-fibrotic effect of combined pentoxifylline–vitamin E is at least in part mediated by inhibition of the TGF-β1 cascade. It strengthens previous clinical data showing pentoxifylline–vitamin E synergy and supports its use as a first-line treatment of radiation-induced fibrosis.

Malignant Gastrocolic Fistula as a Late Complication of Radiation Therapy

Malignant gastrocolic fistula is a rare mode of presentation of gastric or colonic carcinoma [1–3]. A benign aetiology is more common, including peptic ulcer disease, particularly benign gastric ulcers which may relate to non-steroidal antiinflammatory use. Other benign causes include inflammatory bowel disease, post-PEG insertion, post-gastroenterostomy, pancreatitis, abdominal tuberculosis, trauma, perforated diverticular disease and infections including CMV, histoplasmosis, actinomycosis, amoebiasis, echinococcosis and lymphogranuloma venereum [2, 4–7]. A malignant gastrocolic fistula is most commonly found between the greater curvature of the stomach and the distal half of the transverse colon [8]. They are usually seen in the setting of large infiltrative tumours with a surrounding inflammatory reaction, and lymph node involvement is uncommon [8]. The colon rather than the stomach is the more usual site of origin. In a review of 1,500 cases of stomach cancer and 3,200 cases of colon cancer at the Lahey Clinic, 11 cases of gastrocolic fistula were reported, with 10 being of colonic origin [9]. Radiation therapy is associated with an increased risk of second cancers. Abdominal radiation therapy has been most frequently administered in the context of testicular cancer, where the overall cure rate is greater than 90 % [10]. The average age of presentation of testicular cancer is 35, and second neoplasms are uncommon but well-recognised complications where radiation therapy has been given [11–14]. Exposure to radiation may induce a broad variety of DNA damage including singleand double-stranded DNA breaks, cross-linking and damage to nucleotide bases [15]. Radiation-related genomic instability enhances the rate at which mutations and epigenetic changes are acquired in the descendants of that cell line after many generations of replication. In a cohort study of 40, 576 survivors of testicular cancer, Travis et al. reported on 2,285 second solid tumours observed where 1,619 new cancers were expected, demonstrating an elevated relative risk (ERR) as well as an excess absolute risk of developing a second neoplasm in comparison with the general population [16]. A further report of 5,142 patients treated with radiation therapy describes a 3.4fold increased risk of stomach cancer in survivors of testicular cancer and Hodgkin’s lymphoma [17]. This study found that the risk of second cancer begins approximately 10– 15 years after the original cancer diagnosis. We report herein a case of an adenocarcinoma presenting acutely as a J. Costelloe : C. O’Connell :O. Mc Cormack :N. Ravi : J. V. Reynolds Department of Surgery, St. James’s Hospital, Dublin, Ireland

Velopharyngeal and choanal stenosis after radiotherapy for nasopharyngeal carcinoma

Choanal stenosis is a well recognized late complication of radiotherapy for nasopharyngeal carcinoma. However velopharyngeal stenosis post radiotherapy for nasopharyngeal carcinoma is rare. We present here a case of bilateral choanal stenosis and velopharyngeal stenosis in a patient treated with radiotherapy for nasopharyngeal carcinoma. A 58-year-old woman presented to our otolaryngology clinic with a one year history of nasal obstruction. She was diagnosed to have nasopharyngeal carcinoma 12 years ago for which she received radiotherapy. Clinical examination revealed bilateral choanal stenosis and velopharyngeal stenosis. Treatment of choanal stenosis and velopharyngeal stenosis is challenging due to high incidence of recurrence and patients frequently require multiple procedures. The patient underwent a transnasal endoscopic excision of velopharyngeal scar tissue and widening of posterior choana using Surgitron®, mitomycin-C applied topically to the surgical wound and bilateral stenting under general anesthesia. The stents were kept for two weeks, and 3 years post operation velopharyngeal aperture and posterior choana remained patent. As illustrated in this case velopharyngeal stenosis can occur after radiotheraphy and should not be overlooked. Combine modality of transnasal endoscopic excision of velopharyngeal scar tissue, widening of choanal stenosis with Surgitron® followed by the application of mitomycin-C and stenting has been shown to be an effective option.

Use of hyperbaric oxygen therapy in management of radiation cystitis

Radiation induced tissue injury is a result of progressive endarteritis which leads to hypovascular, hypocellular and hypoxic tissues. This damage begins as soon as patient is exposed to radiation beam. Most patients experience some acute side effects and it is rare and serious event when late side effects develop. Radiation cystitis is a late complication of radiotherapy for pelvic malignancies like prostate and cervix. Although 85% of the cases resolve with conservative management, the remainder become refractory and progress to involve a more extensive area of bony and soft tissue. Hyperbaric oxygen therapy (HBOT) is used to treat various forms of chronic radiation tissue injury and is a potential primary option for management of radiation cystitis by enhancing healing in such cases by increasing vascular density and oxygen levels in irradiated tissues. We report a case of 60-year-old male with radiation cystitis who showed promising improvement and resolution of his symptoms after forty HBOT sessions.

756 URETHROPLASTY AFTER RADIOTHERAPY A SINGLE-INSTITUTIONAL EXPERIENCE

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease II1 Apr 2012756 URETHROPLASTY AFTER RADIOTHERAPY A SINGLE-INSTITUTIONAL EXPERIENCE Khalid Sayedahmed, Björn Theodor Kaftan, Thomas Jachertz, and Roberto Olianas Khalid SayedahmedKhalid Sayedahmed Lüneburg, Germany More articles by this author , Björn Theodor KaftanBjörn Theodor Kaftan Lüneburg, Germany More articles by this author , Thomas JachertzThomas Jachertz Lüneburg, Germany More articles by this author , and Roberto OlianasRoberto Olianas Lüneburg, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.842AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES External-beam radiation and radioactive iodine-125 or palladium seeds are becoming more widespread in the treatment of localized prostate cancer. Late complications of radiation therapy may occur months or years following the completion of treatment. Reconstructive surgery after exposure to radiotherapy is known to be a challenge due to impaired blood supply and wound healing. We present our results of urethroplasty in patients with previous history of radiation therapy. METHODS Retrospective analysis of the outcome of 25 previously irradiated patients, who underwent urethroplasty. N=17 and n=8 patients underwent end-to-end and buccal mucosal graft urethroplasty, respectively. All cases were operated in the same institute by the same surgeon. Recurrence was defined as cystoscopic finding of stricture less than 17 Fr in diameter. Complication rate was the end point of this study. RESULTS Mean age of all patients was 66 years (range 54-82 years). Mean dose of radiotherapy was 84.2 Grey. Mean length of stricture was 3.5 cm (Range 1-7.5 cm). Stricture was located in bulbo-membranous urethra in 19 (76%), bulbar urethra in 4 (16 %) and in penile urethra 2 (8%) of patients. The mean follow-up of the patients was 24.2 months (range 7 - 56 months). The urethroplasty was successful without recurrence during the follow-up in 72% of cases. Recurrent stricture was managed with visual internal urethrotomy in 2 (8%) and with buccal mucosal graft in 3 (12%) of patients. Urinary diversion was required in 2 (8%) of patients. However 10 (40%) of patients developed postoperative urinary incontinence, artificial urethral sphincter was successfully implanted in 60% of them. There were no cases of new onset of erectile dysfunction after urethroplasty. 88% of patients were satisfied and reported significant improvement of quality of life. CONCLUSIONS The results of urethroplasty in patients with previous history of exposure to radiotherapy, in experienced hands, are better than expected. The high incidence of postoperative urinary incontinence has to be considered. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e309 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khalid Sayedahmed Lüneburg, Germany More articles by this author Björn Theodor Kaftan Lüneburg, Germany More articles by this author Thomas Jachertz Lüneburg, Germany More articles by this author Roberto Olianas Lüneburg, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Successful hyperbaric oxygen therapy for laryngeal radionecrosis after chemoradiotherapy for mesopharyngeal cancer: case report and literature review

Laryngeal radionecrosis is one of the most troublesome late complications of radiotherapy, because it is frequently resistant to treatment and laryngectomy is required in the worst case. Here, we report a case of laryngeal radionecrosis, successfully treated by use of hyperbaric oxygen (HBO) therapy, in which laryngectomy was avoided. A 67-year-old male received radical chemoradiotherapy (CRT) for mesopharyngeal cancer, which included radiotherapy with a total dose of 71.4 Gy/38 Fr and chemotherapy with CDDP + S-1. He developed dyspnea and throat pain 9 months after completion of CRT. Laryngoscopy revealed vocal cord impairment because of severe laryngeal edema. He was diagnosed as having laryngeal radionecrosis and initially received conservative therapy combined with antibiotics, steroids, and prostaglandins. Because his dyspnea was persistent despite this treatment, HBO therapy was administered 20 times, and resulted in complete remission of the dyspnea. HBO therapy, therefore, is regarded as an effective conservative therapeutic option for laryngeal radionecrosis.

Radiation-induced aortic occlusion.

Arterial occlusion is a late complication of radiotherapy usually seen in extracranial vessels following treatment for head and neck malignancy. Determining the etiology behind vessel occlusion can be difficult and involves consideration of several factors. We present a case of radiotherapy induced aortic occlusion and discuss the relevant clinical and imaging factors that allow the diagnosis to be made.