Post-radiation Patients Research Articles

Immediate Nipple Reconstruction in Skin-sparing Mastectomy with A Modified Wise-pattern Design.

This article discusses a novel approach to immediate nipple reconstruction during skin-sparing mastectomy with Wise-pattern design, a common procedure in direct-to-implant breast reconstruction. Traditionally, nipple reconstruction is performed as a second procedure, incurring additional costs and potential complications. This novel technique involves a simple modification to the Wise-pattern flap during the initial mastectomy, allowing for one-step reconstruction. The procedure includes preoperative markings of the Wise-pattern design, with a U-shaped flap added at the top angle to create the nipple position. This U-shaped flap, containing both skin and subcutaneous tissue, is then folded over itself and sutured, resulting in an inverted T-shaped incision with the reconstructed nipple at the apex. This article emphasizes the avoidance of a secondary operation for nipple reconstruction, avoiding additional costs and potential complications associated with flap loss, especially in postradiation patients. The technique was applied to five consecutive cases, with patient satisfaction reported as very high. Follow-up at 6 months showed no venous congestion or flap loss, and in patients without adjuvant radiation, the reconstructed nipple maintained almost all its initial postoperative height. Minor loss of nipple protrusion over time was comparable to traditional nipple reconstruction (eg, skate flap), and the construction of the new nipple required only an average of 10 extra minutes. Although larger-scale studies are needed for a comprehensive evaluation, the preliminary results suggest promising outcomes and encourage larger-scale safety and outcomes studies of this technique in Wise-pattern skin-sparing reconstructions.

Long-Term Follow-Up of Post Radiation Complete Sinus Opacification in Sinonasal Cancer Patients.

Treatment of sinonasal malignancies most often requires primary or postoperative radiation treatment. Post radiation sinonasal morbidity has been previously described; however, none addressed post-radiation sinus obstruction. Our objective was to investigate the long-term outcomes of post radiation complete isolated sinus opacification (CISO). A retrospective analysis of sinonasal cancer patients treated with radiation therapy during the years 2002 to 2022. Clinical, imaging and treatment data were collected from patients' medical records. Only patients with at least 12 months of follow-up and available imaging for review were included. Out of 109 patients, 37 patients were identified to meet the inclusion criteria. Mean follow-up was 58 months. 35% of patients were diagnosed with persistent post radiation CISO with a mean onset of 4 months. All these patients remained asymptomatic, and their imaging remained stable during follow-up with none developing an expanding mucocele. Ethmoid sinus tumor involvement was found to be more prevalent in the CISO group (62% vs. 25%, p-value = 0.048) as well as chemotherapy/immunotherapy (54% vs. 38%, p-value = 0.046). Multivariant analysis revealed that ethmoid sinus involvement (OR = 9.516, p-value = 0.047) and adjuvant therapy, either chemotherapy/immunotherapy (OR = 10.75, p-value = 0.036) were found to be a predictive factor for complete opacification. Our study revealed that a substantial number of post-radiation patients develop a stable and persistent CISO, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up. 4 Laryngoscope, 134:4232-4238, 2024.

MP61-10 URINARY FUNCTIONAL OUTCOMES OF RADICAL PROSTATECTOMY VS. RADIATION THERAPY FOR PROSTATE CANCER FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP)

You have accessJournal of UrologyCME1 Apr 2023MP61-10 URINARY FUNCTIONAL OUTCOMES OF RADICAL PROSTATECTOMY VS. RADIATION THERAPY FOR PROSTATE CANCER FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP) Alex Piroozi, Austen Slade, RJ Caras, T. Max Shelton, Udit Vyas, Katrina Collins, Omar Ishaq, Mohamed Elsaqa, Corey Able, Ronald Boris, Marawan M. El tayeb, Marcelino Rivera, and James Lingeman Alex PirooziAlex Piroozi More articles by this author , Austen SladeAusten Slade More articles by this author , RJ CarasRJ Caras More articles by this author , T. Max SheltonT. Max Shelton More articles by this author , Udit VyasUdit Vyas More articles by this author , Katrina CollinsKatrina Collins More articles by this author , Omar IshaqOmar Ishaq More articles by this author , Mohamed ElsaqaMohamed Elsaqa More articles by this author , Corey AbleCorey Able More articles by this author , Ronald BorisRonald Boris More articles by this author , Marawan M. El tayebMarawan M. El tayeb More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , and James LingemanJames Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003319.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer is a well-documented finding in Holmium Laser Enucleation of the Prostate (HoLEP); however, there is little data on the outcomes of patients who underwent HoLEP followed by definitive therapy for subsequent prostate cancer diagnosis. We sought to compare the urinary functional outcomes after undergoing radical prostatectomy or external beam radiation for prostate cancer following HoLEP. METHODS: All patients from 2010 to 2021 at Indiana University and Baylor Scott and White Hospitals who underwent radiation or prostatectomy for treatment of prostate cancer after HoLEP were included. We performed a retrospective analysis of their urinary function with greater than 1-year post-treatment American Urological Association Symptom Index (AUA), Quality of Life (QOL), and incontinence follow up. Incontinence was defined as patient reported leakage of any urine. RESULTS: There were 33 radical prostatectomy and 36 radiation patients who met the inclusion criteria. There was no statistical significance between the mean AUA scores of greater than 1-year post-prostatectomy patients (7.69) and post-radiation patients (8.08) (p=0.8175). Similarly, there was no statistical significance between the QOL scores of greater than 1-year post-prostatectomy patients (1.96) and post-radiation patients (2.00) (p=0.9175). There is a statistically significant decrease in complaints of incontinence in greater than 1-year post-radiation patients (28%) compared to post-prostatectomy patients (73.3%) (p=0.0017). There was also a significant difference between mean age of the prostatectomy group (66.4 years) and the radiation group (75.3 years) (p<0.001). There was no significant difference in BMI, pre-HoLEP prostate size, pre-HoLEP AUA score, or pre-HoLEP QOL score between the groups. CONCLUSIONS: Radical prostatectomy and radiation provide similar AUA and QOL symptom scores for prostate cancer patients who previously underwent HoLEP, with radiation associated with decreased incidence of incontinence. Patients specifically concerned with the risk of incontinence following prostate cancer treatment may consider the increased risk from a prostatectomy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e856 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alex Piroozi More articles by this author Austen Slade More articles by this author RJ Caras More articles by this author T. Max Shelton More articles by this author Udit Vyas More articles by this author Katrina Collins More articles by this author Omar Ishaq More articles by this author Mohamed Elsaqa More articles by this author Corey Able More articles by this author Ronald Boris More articles by this author Marawan M. El tayeb More articles by this author Marcelino Rivera More articles by this author James Lingeman More articles by this author Expand All Advertisement PDF downloadLoading ...

Аутотрансплантация почки как метод лечения дефектов мочеточника

The treatment of ureteral strictures is one of the most difficult problems of current urology. In recent years, an increase in post-radiation patients who have an iatrogenic ureteral damage during surgical procedures on the pelvic and abdominal organs is seen. We describe two cases in which a long ureteral stricture was diagnosed. The etiology of the strictures was associated with urolithiasis. After the removal of ureteral stones, long ureteral stricture developed in both patients. A nephrostomy tube was initially put. Considering the prolonged length of the stricture with a formation of obliteration, several treatment options were discussed, including nephrectomy. Nevertheless, due to the young age and the good functional state of the renal parenchyma, the decision was made about renal autotransplant, which was associated with a lower surgical risk. However, this procedure requires a high degree of training of the surgical team with appropriate experience.

The lexicon of PET/CT reports in prostate patients: Evaluating confidence.

232 Background: Pet/CT scans are increasingly used to evaluate prostate cancer patients with biochemical failure following surgery or radiation therapy for localized prostate cancer. We assessed the language used in report impressions to characterize the reader's confidence for lesions in various anatomic sites. Methods: Between 2015 and 2021, 419 fluciclovine PET/CT scan reports were identified in our institutional outcomes database. Thirteen phrases routinely used in the report impression section by radiologists at least once to characterize a lesion of interest were identified. The phrases were categorized in the following confidence categories: Definitive (positive, negative), Likely (consistent with, most likely, favors, probable), and Unsure (suspicious for, concerning for, non-specific, conspicuous, compatible with, borderline, unknown). The final analysis set included 353 reports where the prescan PSA value was known within the prior 90 days of the scan. Descriptive statistics, stratified by prescan PSA value, were used to characterize this language for the following anatomic regions: bone, regional lymph nodes, prostate fossa, prostate gland/seminal vesicles, other soft tissue. Results: Overall, definitive language was used between 34.6% to 87.1% of the time, depending on the anatomic context (table). The intact prostate was the least likely site to use definitive language (34.6%), whereas bone was most likely (87.1%). Intact prostates in post-radiation patients had the most uncertainty to the persistence of disease (42.3% unsure, 23.1% likely). The highest degree of definitive certainty occurred in impressions of persons with PSA &lt;0.5 (89.2%), whereas the least definitive certainty was in patients with PSA &gt;1 (66.2%). Overall, definitive, likely and unsure findings were reported in 68.6, 9.7%, and 21.7% of scans. Conclusions: Fluciclovine PET/CT scans routinely result in equivocal findings, which vary by anatomic site of interest and prescan PSA level. The language utilized in these reports has not been standardized. Future work aims to create a clear confidence level lexicon standard to assist radiologists and providers in reporting standardization.[Table: see text]

PD22-12 COMPARISON OF OUTCOMES AFTER PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT IN POST-RADIATION PATIENTS WITH AND WITHOUT HYPERBARIC OXYGEN THERAPY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-12 COMPARISON OF OUTCOMES AFTER PRIMARY ARTIFICIAL URINARY SPHINCTER PLACEMENT IN POST-RADIATION PATIENTS WITH AND WITHOUT HYPERBARIC OXYGEN THERAPY Samantha Nealon, Joseph Balbona, and Lucas Wiegand Samantha NealonSamantha Nealon More articles by this author , Joseph BalbonaJoseph Balbona More articles by this author , and Lucas WiegandLucas Wiegand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior radiation therapy is a well-documented risk factor for postoperative complications after artificial urinary sphincter (AUS) placement. Hyperbaric oxygen therapy (HBOT) has been shown to improve tissue quality in patients with prior radiation. However, no previous study has investigated the role of HBOT in reducing complications following AUS surgery in patients with pelvic radiation. METHODS: Patients identified had a radiation history and underwent primary AUS insertion by a single surgeon August 2015 - March 2019. Demographics, comorbidities, continence, and postoperative complications were analyzed. Surgical outcomes in patients who had received HBOT prior to AUS insertion were compared to those who had not. RESULTS: 31 patients underwent AUS placement. 10 patients (median age 73.4) underwent HBOT while 21 patients (median age 69.3) did not receive HBOT. More patients in the non-HBOT group received EBRT (94.7%), compared to the HBOT group in which 55.6% received EBRT while the remaining received either EBRT plus brachytherapy or brachytherapy alone (p=0.03). Average time since radiation therapy was 9.3 years in the HBOT group and 7.6 years in the non-HBOT group. Average follow up was not significantly different between groups (p=0.5). Pads per day preoperatively were 6.6 and 7.2 in the HBOT and non-HBOT groups. Postoperative pads per day were 1.0 and 2.2 in the HBOT and non-HBOT groups. Preoperative and postoperative pads per day were not statistically different between the two groups. No statistically significant difference was seen in postoperative complications between the HBOT and non-HBOT groups (50% vs. 57.1%, p<0.70). Patients treated with HBOT had an overall lower rate of erosions and revisions than patients without HBOT, however neither difference reached significance (p=0.52 and p=0.31, respectively). CONCLUSIONS: HBOT has been shown to improve post-radiation tissue damage. In our current series, rates of AUS erosion were lower in patients treated with HBOT prior to AUS placement, but this did not reach statistical significance. While our study was not powered to be statistically significant, these results indicate that an additional higher-powered study is needed to determine whether HBOT can prevent complications related to AUS placement. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e384-e385 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samantha Nealon More articles by this author Joseph Balbona More articles by this author Lucas Wiegand More articles by this author Expand All Advertisement Loading ...

Analysis of Hypothyroidism Development in Post-Radiotherapy Nasopharyngeal Cancer Patients using Survival Trees

Radiotherapy is one of the treatments for nasopharyngeal cancer (NPC). However, this treatment might produce an unfavorable effect on the thyroid gland, which eventually results in less production of thyroid hormone. This is condition is known as hypothyroidism. The development of hypothyroidism in each patient with post-radiative NPC differs according to several factors. This study aims to analyze the rate of development of hypothyroidism in post-radiated NPC patients. This aim is achieved by identifying subgroups of patients with different hazard rates of developing hypothyroidism, and further identify factors explaining hypothyroidism in each subgroup. Data on ninety-seven NPC post-radiation patients taken from one of the hospitals in Jakarta were analyzed. Survival tree with the relative risk tree algorithm was proposed to analyze the data. We identified three subgroups of patients with relatively slow, medium, and fast developing of hypothyroidism. For the slow subgroup, 26% of the patients developed hypothyroidism at 150+ weeks post-radiation, while it only took less than 30 weeks for those in fast-growing subgroup; and 70 until 130 weeks for the medium subgroup. We also found that sweat production and Zulewski’s total score were the important factors in explaining the development rate of hypothyroidism.

Swallowing Patterns in the HNC Population: Timing of Penetration-Aspiration Events and Residue.

This study described swallowing patterns in a large head/neck cancer (HNC) cohort. In a retrospective review of data from a randomized controlled trial, we studied timing of penetration events as they related to aspiration and oral/pharyngeal residue. Retrospective review of a multicenter randomized controlled trial. In total, 168 patients who were >3 months postradiation received baseline modified barium swallow evaluations. Retrospective analyses of data from these exams were studied, including Penetration-Aspiration Scale (PAS) scores and timing of these events (before, during, or after the swallow), as well as percentage of oral and pharyngeal residue. Aspiration occurred more frequently after than before or during the swallow (P < .05). There were significantly more events of penetration that led to aspiration after the swallow (n = 260) when compared to events before (n = 6) or after (n = 81) the swallow. There was more pharyngeal (16%-25%) than oral residue (5%-20%). Weak correlations were found between thin liquid, nectar-thick liquid, pudding residue, and PAS scores, with varying significance (pharyngeal residue/PAS rs: .26*, .35*, .07*; oral residue/PAS rs: .21*, .16, .3; *P < .05). The predominant pattern for this sample of postradiation patients with HNC with dysphagia was aspiration that occurred after the swallow, rather than before or during the swallow. The aspiration was directly caused by penetration events that occurred during the swallow, resulting in aspiration as the airway reopened. Patients demonstrated more pharyngeal residue than oral residue, but a weak relationship was found between residue and penetration/aspiration events. These results guide clinicians in targeting appropriate swallowing interventions.

Abstract A20: Dysgeusia may play a role in negatively affecting mood and anxiety in post-radiation head and neck patients

Abstract Introduction: Anxiety and depression are well-documented comorbid conditions that many patients with head and neck cancer experience. Furthermore, radiation therapy for many head and neck cancers is associated with significant morbidity. Dysgeusia, in particular, is almost universally experienced with total taste loss occurring in up to 73% of individuals radiated for head and neck cancers. Prior studies have demonstrated a significant correlation between decreased quality of life and dysgeusia. In this retrospective study, we wish to further characterize the association between taste disturbance and patient-reported anxiety and mood. With better understanding of this relationship, we may be able to effectively intervene in improving the quality of life for head and neck patients. Methods: Forty-nine patients at The University of Vermont Medical Center who completed radiation therapy for head and neck cancer completed the University of Washington Quality of Life (QOL) Questionnaire at scheduled follow-up visits. Surveys were reviewed retrospectively for QOL measures, specifically patient-reported anxiety, mood, and taste. Results: Taste scores were the lowest at follow-up weeks 0-3 and more than tripled by the last follow-up, at 48 weeks (p&amp;gt;0.0001). The trend in taste improvement was most rapid during the first few weeks after radiation, but leveled off after 12 weeks. Mood and anxiety similarly improved across weeks after radiation when compared against taste. Conclusion: Our data suggest a correlation between taste disturbance, mood, and anxiety in patients after head and neck radiation. This suggests that targeting treatments to improve patients’ sense of taste post-radiation may improve their psychiatric well-being. Citation Format: Thomas Arnell, Quinn Self, Sharon Li, Carl Nelson. Dysgeusia may play a role in negatively affecting mood and anxiety in post-radiation head and neck patients [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A20.

Prospective evaluation of 18F-DCFPyL PET/CT in biochemically recurrent prostate cancer: Analysis of lesion localization and distribution.

5556 Background: 18F-DCFPyL, a promising PET agent targeting prostate specific membrane antigen (PSMA), is prospectively evaluated in a single academic center for detecting recurrent lesions in prostate cancer patients with biochemical recurrence (BCR). Methods: We prospectively enrolled 150 men (51-91 years old, mean ± SD: 70.3±7.5) with biochemical recurrence (PSA median 2.38 ng/mL, range 0.12 to 698.4) after primary definitive treatment with prostatectomy (65%), radiotherapy (35%) or both (19%). The 18F-DCFPyL positive lesions compatible with prostate cancer were evaluated by two independent readers. Impact of 18F-DCFPyL PET/CT on patient management was recorded from clinical chart review. Results: 18F-DCFPyL PET/CT had an overall positivity rate of 83% (125 scans), which increased with higher prostate specific antigen (PSA) levels (ng/mL): 63% (PSA &lt; 0.5), 75% (0.5≤PSA &lt; 1), 91% (1≤PSA &lt; 2), 95% (2≤PSA &lt; 5) and 98% (PSA≥5), respectively. In the cohort who underwent prostatectomy, 18F-DCFPyL PET/CT had higher positivity rate in patients with shorter PSA doubling time (PSAdt) (94% in PSAdt 0-3 months vs. 53% in PSAdt &gt; 12 months, P&lt; 0.01). No difference of 18F-DCFPyL positivity rate was observed in post-radiation patients with different PSAdt, nor were there differences between patients with low grade (Gleason 6) or higher-grade prostate cancer (Gleason 7-10). 20 patients (13%) had lesions in the prostate bed only and 41 patients (27%) had oligometastatic disease (1-3 lesions), making them candidates for locally targeted therapy. We identified a total of 1455 18F-DCFPyL positive lesions, including 51 lesions in the prostate bed, 271 pelvic and 463 extra-pelvic lymph nodes, approximately 585 osseous lesions, including 5 patients with diffuse osseous metastases, and 85 lesions in other organs (most commonly in the lungs). 91 out of 150 patients (61%) had change in treatment after 18F-DCFPyL PET and, most noticeably, 48 of these patients (32% total) had lesions only localized on 18F-DCFPyL PET/CT despite negative conventional imaging. Conclusions: 18F-DCFPyL PET/CT holds great potential to be a “one-stop shop” diagnostic tool in the work-up of BCR prostate cancer, with high (61%) impact on the management of these patients. Clinical trial information: NCT03501940 .

18F-DCFPyL PET/CT Imaging in Patients with Biochemically Recurrent Prostate Cancer After Primary Local Therapy

Our objective was to investigate the lesion detection rate of 18F-DCFPyL PET/CT, a prostate-specific membrane antigen (PSMA)-targeted PET agent, in patients with biochemically relapsed prostate cancer after primary local therapy. Methods: This was a prospective institutional review board-approved study of 90 patients with documented biochemical recurrence (median prostate-specific antigen [PSA], 2.5 ng/mL; range, 0.21-35.5 ng/mL) and negative results on conventional imaging after primary local therapies, including radical prostatectomy (n = 38), radiation (n = 27), or a combination of the two (n = 25). Patients on androgen deprivation therapy were excluded. Patients underwent whole-body 18F-DCFPyL PET/CT (299.9 ± 15.5 MBq) at 2 h after injection. The PSMA PET lesion detection rate was correlated with PSA, PSA kinetics, and original primary tumor grade. Results: Seventy patients (77.8%) showed positive PSMA PET results, with a total of 287 lesions identified: 37 prostate bed foci, 208 lesions in lymph nodes, and 42 in distant sites in bones or organs, Eleven patients had negative results, and 9 patients showed indeterminate lesions, which were considered negative in this study. The detection rates were 47.6% (n = 10/21), 50% (n = 5/10), 88.9% (n = 8/9), and 94% (n = 47/50) for PSA levels of >0.2 to <0.5, 0.5 to <1.0, 1 to <2.0, and ≥2.0 ng/mL, respectively. In postsurgical patients, PSA, PSA doubling time, and PSA velocity correlated with PET results, but the same was not true for postradiation patients. These parameters also correlated with the extent of disease on PET (intrapelvic vs. extrapelvic). There was no significant difference in the rate of positive scans between patients with higher-grade and lower-grade primary tumors (Gleason score of ≥4 + 3 vs. <3 + 4). Tumor recurrence was histology-confirmed in 40% (28/70) of patients. On a per-patient basis, positive predictive value was 93.3% (95% confidence interval, 77.6%-99.2%) by histopathologic validation and 96.2% (95% confidence interval, 86.3%-99.7%) by the combination of histology and imaging/clinical follow-up. Conclusion: 18F-DCFPyL PET/CT imaging offers high detection rates in biochemically recurrent prostate cancer patients and is positive in about 50% of patients with a PSA level of less than 0.5 ng/mL, which could substantially impact clinical management. In postsurgical patients, 18F-DCFPyL PET/CT correlates with PSA, PSA doubling time, and PSA velocity, suggesting it may have prognostic value. 18F-DCFPyL PET/CT is highly promising for localizing sites of recurrent prostate cancer.

The relationship between muscle fibrosis and the hyoid displacement in dysphagic patients with nasopharyngeal carcinoma after radiation therapy

Objective To evaluate the relationship between muscle fibrosis and the displacement of the hyoid bone while swallowing among patients with nasopharyngeal carcinoma (NPC) after radiation therapy. Methods Twenty-six NPC patients with dysphagia were recruited. Shear wave elastography was performed to assess the fibrosis of the mylohyoid muscle. The horizontal and vertical displacement of the hyoid bone were measured based on the videofluoroscopic swallowing study, and the severity of dysphagia was determined using the penetration-aspiration scale (PAS). The correlation between the modulus value of the mylohyoid muscle and the horizontal and vertical displacement of the hyoid bone were analyzed, respectively. Receiver-operating characteristic (ROC) curve were constructed to assess the diagnostic ability of modulus value for the severity of dysphagia above grade 5 of PAS. Results For patients whose PAS was higher than grade 5, the modulus value of mylohyoid muscle was negatively correlated with the displacement of hyoid bone, while such correlation was absent for patients whose PAS grading were less than or equal to 5. Sensitivity and specificity by modulus value to detect dysphagia were 80% and 81.8%, respectively, with the best cut-off value of 14.37 kPa. Conclusion The reduction of hyoid bone displacement can be partially attributed to muscle fibrosis for post-radiation NPC patients with severe dysphagia. The modulus value measured by Shear wave elastography could be used as a supplementary way to monitor the development of dysphagia. Key words: Muscle fibrosis; Hyoid bone displacement; Nasopharyngeal Carcinoma; Dysphagia

Lipofilling effects after breast cancer surgery in post-radiation patients: an analysis of results and algorithm proposal

BackgroundLipofilling or autologous fat transfer is an established technique in plastic surgery. Herein, we describe the lipofilling effects after implant-based breast reconstruction in post-radiation patients and propose an algorithm for indication of lipofilling.MethodsForty patients with a history of breast cancer were included in this retrospective analysis. Patients had undergone either breast conserving therapy or mastectomy. Twenty-six patients underwent additional radiation therapy. Patients were assessed using a post-radiation skin scoring classification.ResultsIn total, 68 lipofilling procedures were analyzed. Scar release, skin softening, improved quality of life, and improvement of post-radiation findings are results of lipofilling with a closed filtration system. In all patients with post-surgical radiation, an improvement of tissue quality was observed. Staging revealed that lipofilling improved mean post-radiation skin scores of 2.40 ± 0.89 to 1.21 ± 0.76 (p ≤ 0.000). There was no recurrence of breast cancer in our study patients.ConclusionsThis study introduces an algorithm using lipofilling in reconstructive breast surgery and especially in post-radiation patients with low risks as well as very high acceptance in patients with various indications for this procedure. A regenerative aspect was also detectable in patients following radiation therapy and reconstruction. Lipofilling is a safe and effective procedure with a low incidence of minor complications. It is therefore a feasible method to resolve volume deficiencies and asymmetric results after oncologic breast surgery. Nevertheless, a prospective study has now been initiated focusing on the oncologic safety of lipofilling including ultrasound and radiological examinations to validate the findings of this initial study.Level of Evidence: Level IV, therapeutic study.

Neuromodulation in the Treatment of Voiding Dysfunction and Fecal Incontinence in Male and Female Cancer Survivors

Sacral neuromodulation (SNM) is a widely accepted and minimally invasive treatment for several urologic lower urinary tract pathologies and bowel dysfunction. Treatment for pelvic malignancies is associated with significant rates of urinary, sexual, and fecal dysfunction. The authors sought to determine the role SNM should play in the management of voiding and fecal dysfunction in the male and female cancer survivor patient. There is a lack of studies looking at SNM in the cancer survivor population, particularly in the setting of radiation cystitis or proctitis. Regardless, the authors feel there is a role for SNM in this population. Further studies are needed to further delineate this role and the efficacy of SNM in this challenge to treat patient population. Voiding dysfunction in the cancer survivor population including urinary urgency, frequency, and urge incontinence is very common. Similarly, fecal incontinence occurs not infrequently and is a major source of patient distress. There is great evidence for SNM via InterStim in urinary urgency, urge incontinence, non-obstructive retention, and fecal incontinence. Studies are lacking, however, in the cancer survivor population. They are non-existent in the postradiation patient population. SNM is a good treatment option for urinary urgency, urge incontinence, non-obstructive urinary retention, and fecal incontinence. More studies are needed in the cancer survivor population, particularly following radiation therapy. Regardless, the authors feel there is a role in the cancer survivor for SNM.

Endodontic management of nonrestorable teeth in patients at risk of developing osteonecrosis of the jaw: Case series

Osteoradionecrosis of the jaws is one of the most serious oral complications of head and neck cancer radiation therapy. It is a self-progressive process of bone destruction that is very difficult to treat. In this report, four patients who are susceptible to osteonecrosis of the jaw presented for endodontic management of nonrestorable teeth. The first patient had two molar teeth with necrotic pulp and was treated with nonsurgical root canal therapy (NSRCT) followed by crown amputation and hemisection. The second patient had a molar tooth that was previously treated with acute apical abscess. Crown amputation and hemisection were performed. The third patient had a molar tooth with necrotic pulp and asymptomatic apical periodontitis. NSRCT followed by occlusal reduction were completed. The fourth patient had a molar tooth with necrotic pulp and symptomatic apical periodontitis. NSRCT and crown amputation were performed. All cases had a minimum recall of 12-months. The tooth in case #1 developed a periapical pathosis, and other teeth in case #1–#3 had healing of periapical lesions. The tooth in case #4 was exfoliated. None had developed osteonecrosis. These results suggest that NSRCT is the treatment option to manage nonrestorable teeth in postradiation patients or patients taking bisphosphonate drugs to prevent osteonecrosis.

Prospective Phase II Study of the Efficacy of Transcutaneous Electrical Nerve Stimulation in Post-radiation Patients

AimsTo evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) delivered using an extra-oral device in patients with radiation-induced xerostomia. Materials and methodsThirty oral cavity and oropharyngeal cancer patients post-adjuvant (n = 26) or definitive radiotherapy (n = 4) were enrolled in this study. The TENS electrode pads were placed externally on the skin overlying the parotid glands. Unstimulated whole saliva was collected for 5 min into graduated tubes using the low forced spitting method. The TENS unit was then activated and stimulated saliva was collected for an additional 5 min. The difference between unstimulated and stimulated saliva output was measured using the paired t-test. Linear regression was used to determine factors significantly influencing the improvement in salivary output. ResultsTwenty-nine of 30 patients showed increased saliva flow during stimulation. A statistically significant improvement in saliva production (P < 0.05) during stimulation was noted. The mean unstimulated saliva flow was 0.056 ml/min and the mean stimulated saliva flow was 0.12 ml/min with a median increase of 0.06 ml/min. The interval to the application of TENS after radiotherapy significantly influenced the improvement in salivary flow. ConclusionExtra-oral application of TENS is effective in increasing the whole salivary flow in most of the post-radiated oral cavity/oropharyngeal cancer patients with xerostomia. TENS therapy may be useful as an effective supportive treatment modality in post-radiated oral cancer patients.

Post‐radiation CSF Leak of Skull Base

Objectives: (1) Describe the presence of a skull base cerebrospinal fluid (CSF) leak that occurred in a patient after receiving radiation therapy for a residual pituitary adenoma. (2) Analyze possible factors contributing to this rare occurrence. Methods: Case report with a retrospective chart review. Results: A 49-year-old African American female received 23.4 Gy in 13 fractions of definitive external beam radiotherapy for a residual nonfunctioning pituitary adenoma involving the left parasellar area for 16 days prior to developing a CSF leak. Cisternogram demonstrated a small focus of dehiscence in the right tuberculum sella, measuring 1.5 mm in diameter with a small amount of contrast present anterior to this dehiscence. This also demonstrated fluid in the right lateral aspect of the sphenoid sinus in communication with the intracranial CSF. CSF leak may occur after radiation as a tumor shrinks and leaves defects in the skull base and dura at the tumor site. Interestingly, the CSF leak in this patient occurred at a different location than that of the pituitary tumor. This suggests that radiation may weaken the skull base at sites other than tumor sites. Conclusions: CSF leak is known to occur after skull base surgery, but has not previously been reported after radiation in regions of the skull base away from previous sites of surgical manipulation. This case report identifies a middle skull base CSF leak in a post-radiation patient.

Impact of post-radiation biopsies on development of fistulae in patients with cervical cancer

ObjectiveIn the post-radiation patient, late vascular sequelae and fibrosis predispose women to poor tissue healing, such that small tissue injuries could theoretically evolve into much larger ones such as fistulae. We sought to determine if a correlation exists between invasive procedures such as post-treatment biopsies and the subsequent development of gynecologic fistulae. MethodsA retrospective review was performed evaluating all patients treated for cervical cancer at our institution between 1997 and 2010. Biopsies or pelvic surgeries were included if performed within the radiated field, and evaluated in a multivariate predictive model for development of gynecologic fistulae. ResultsOut of 325 total patients, 27 patients with fistulae were identified (8.2%). 14 fistulae (51.9%) were considered toxicity-related, 6 (22.2%) resulted from primary disease, and 7 (25.9%) were attributable to recurrent disease. Eighty-nine patients underwent an invasive procedure (55 biopsies and 34 pelvic surgeries). Recurrent and/or residual cancer was found in 28 (31.5%) specimens, and of the 61 patients who underwent an invasive procedure and were not found to have evidence of recurrent disease, 9 (14.8%) subsequently developed a fistula at a median 3.08months. An elevated dose of radiation to the rectum (OR 1.001 for dose >72Gy, p=0.0005), advancing tumor stage (OR 5.38 for stage III, OR 10.47 for stage IV, p=0.0288), and a post-radiation biopsy (OR 5.27, p=0.013) were significantly associated with fistula development. ConclusionsPerforming a biopsy in an irradiated field is associated with a relatively low yield and significantly contributes to the risk for fistula development.

152: Transcatheter aortic valve implantation in patients with Hodgkin's lymphoma

Transcatheter aortic valve implantation (TAVI) has emerged as a valuable alternative to surgical aortic valve replacement with promising results for patients with severe aortic stenosis (AS) considered as being at high or prohibitive surgical risk. Results in the high-risk subgroup of patients with post-radiation AS was unknown. From October 2006 to June 2011, among the 272 patients who underwent a TAVI at our institution, 12 had post-radiation AS due to Hodgkin's lymphoma and 260 had degenerative AS. Complications were assessed according to VARC definitions. Post-radiation AS patients were younger (61±11 vs. 83±7 years, p<0.0001), had a lower Euroscore were (9±9% vs. 25±13%, p=0.0003) but presented more frequently with porcelain aorta (60% vs. 13%, p<0.0001). TAVI results and complications are presented in the Table. In the post-radiation AS, mortality rate was not significantly different (one death due to a severe sepsis) but there was less complications especially a lower rate of major vascular complications, hospital duration was shorter and patients more frequently discharged at home. Among AS patients who underwent a TAVI, post-radiation patients experienced a lower rate of complications than patients with degenerative AS. In regard to the high mortality and morbidity of conventional surgery, our results suggest that TAVI may be an elective indication for post-radiation AS patients but deserve further confirmation in larger series.

Breast Health Education: Postradiation

This article describes a brochure developed to provide postradiation breast cancer patients with a detailed overview of posttreatment changes to detect early recurrence symptoms. The purpose of this brochure was to enhance the patient's knowledge regarding possible late radiation changes and to become proactive with health care. Topics to be highlighted include the importance of follow-up care, breast self-examination, and a sample personalized care plan. In a changing radiation oncology field, radiation oncology nurses must be aware that postradiation patient teaching as a survivor is the most important aspect of the patient's care.