History Of Previous Irradiation Research Articles

Reconstruction of open wounds as a complication of spinal surgery with flaps: a systematic review.

OBJECT A systematic review of the available evidence on the prophylactic and therapeutic use of flaps for the coverage of complex spinal soft-tissue defects was performed to determine if the use of flaps reduces postoperative complications and improves patient outcomes. METHODS A PubMed database search was performed to identify English-language articles published between 1990 and 2014 that contained the following phrases to describe postoperative wounds ("wound," "complex back wound," "postoperative wound," "spine surgery") and intervention ("flap closure," "flap coverage," "soft tissue reconstruction," "muscle flap"). RESULTS In total, 532 articles were reviewed with 17 articles meeting the inclusion criteria of this study. The risk factors from the pooled analysis of 262 patients for the development of postoperative complex back wounds that necessitated muscle flap coverage included the involvement of instrumentation (77.6%), a previous history of radiotherapy (33.2%), smoking (20.6%), and diabetes mellitus (17.2%). In patients with instrumentation, prophylactic coverage of the wound with a well-vascularized flap was shown to result in a lower incidence of wound complications. One study showed a statistically significant decrease in complications compared with patients where prophylactic coverage was not performed (20% vs 45%). The indications for flap coverage after onset of wound complications included hardware exposure, wound infection, dehiscence, seroma, and hematoma. Flap coverage was shown to decrease the number of surgical debridements needed and also salvage hardware, with the rate of hardware removal after flap coverage ranging from 0% to 41.9% in 4 studies. CONCLUSIONS Prophylactic coverage with flaps in high-risk patients undergoing spine surgery reduces complications, while therapeutic coverage following wound complications allows the salvage of hardware in the majority of patients.

Abstract 3857: The polymorphisms of XRCC1 Arg194Trp and the XRCC1Arg399Gln affect the clinical features and the prognosis of MDS

Abstract Background: X-ray repair cross-complementing group 1 (XRCC1) is involved an important role in base excision repair (BER) system of DNA repair. Polymorphism in DNA repair genes may be modified of DNA repair capacity. However, it is unclear that the polymorphisms of XRCC1alter the clinical features of MDS patients. Our study was performed to evaluate the effect of the XRCC1Arg194Trp and the XRCC1Arg399Gln with the susceptibility and clinical features of MDS. Methods: We genotyped the polymorphisms by using polymerase chain reaction -restriction fragment-length polymorphism (PCR-RFLP) analysis in 119 patients with MDS [median 67.9 years, range 17.1-86.5 years; male/female 81/38; RCUD (n = 40), RARS (n = 6), RCMD (n = 21), MDS-U (n = 13), RAEB-1(n = 14), RAEB-2 (n = 12), others (n = 13)] and 202-health controls. Results: In the allele and genotype frequencies of the XRCC1Arg194Trp and the XRCC1Arg399Gln were not statistically significant difference in patients and the controls. However, Arg/Arg genotypes of XRCC1 194 and the XRCC1 399 were significantly associated with lower Hb. In addition, XRCC1 399 non Arg/Arg genotype was significantly associated with previous history of radiotherapy and multiple cancers. Furthermore, XRCC1Arg194Trp non Arg/Arg genotype and XRCC1Arg399Gln Arg/Arg genotype were significantly associated with poor prognosis of MDS patients. Conclusion: We found that the polymorphisms of XRCC1 may be affected the clinical features and the prognosis of MDS. Citation Format: Batchimeg Norjmaa, Takayuki Saitoh, Tetsuhiro Kasamatsu, Yusuke Minato, Noriaki Sunaga, Hirokazu Murakami. The polymorphisms of XRCC1 Arg194Trp and the XRCC1Arg399Gln affect the clinical features and the prognosis of MDS. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3857. doi:10.1158/1538-7445.AM2015-3857

One hundred supracricoid laryngectomies with cricohyoidoepiglottopexy: do we achieve better local control?

Supracricoid laryngectomy with cricohyoidoepiglottopexy has been known to be able to cope with tumor excisions with minimal margins. Extended resection may result in a limited margin and may impair the prognosis. We conducted a clinicopathologic analysis of local recurrence in supracricoid laryngectomy with cricohyoidoepiglottopexy patients. Between 1997 and 2013, 100 patients with glottic cancers underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. The clinicopathologic findings were evaluated. We also analyzed: (i) cancer-specific and overall survival rates, (ii) the correlation between locoregional recurrence and overall survival, (iii) T staging and larynx preservation rates and (iv) previous radiation history and larynx preservation rates. Local recurrence was recognized in eight of the 100 patients (8%); all were initially staged as T3 or T4. Recurrence was identified in the submucosal regions of the ipsilateral arytenoid and/or infraglottis. Six patients were salvaged by completion total laryngectomy except two. Cancer-specific survival at 5 years was 93%; overall survival at 5 years was 89%. There was no significant difference between overall survival and locoregional recurrence. There was a significant difference between larynx preservation in T1-2 and T3-4 patients. There was no significant difference between larynx preservation and the previous radiation therapy status. Our experience convinced us of the clinical potential of supracricoid laryngectomy with cricohyoidoepiglottopexy as one of the effective options for functional larynx preservation. Supracricoid laryngectomy with cricohyoidoepiglottopexy is the most suitable for unfavorable T2 and T3a cases and is applicable for appropriately selected radiation-failed patients. Thorough pre-operative evaluation, proper surgical techniques and careful follow-up are prerequisites for the success of supracricoid laryngectomy with cricohyoidoepiglottopexy.

Robotic Stereotactic Body Radiation Therapy in Patients With Recurrent or Metastatic Abdominopelvic Tumors: A Single Institute Experience.

The aim of this study was to evaluate the efficacy and toxicity of robotic CyberKnife (Accuray Incorporated, Sunnyvale, California)-based stereotactic body radiation therapy (SBRT) in patients with recurrent or metastatic abdominopelvic tumors. A total of 69 patients treated between May 2008 and January 2011 were evaluated retrospectively. Indication for SBRT was persistent disease in 3 (4%) patients, local recurrence in 29 (42%) patients, regional recurrence in 13 (19%) patients, and oligometastatic disease in 24 (35%) patients. Forty-two (61%) patients were previously irradiated to the same region and 27 (39%) patients were treated for the first time. The median age was 59 years (range, 24-86 years). There were 31 (45%) male and 38 (55%) female patients. The median total dose was 30 Gy (range, 15-60 Gy) delivered with a median 3 fractions (range, 2-5 fractions). The tumor response to treatment was assessed by computed tomography, magnetic resonance imaging, or positron emission tomography. At the 12-month (range, 2-44 months) median follow-up, local control was 65% and median overall survival (OS) was 20 months. A larger gross tumor volume (≥ 67 cm(3)) was significantly correlated with worse 1-year OS (81% vs 48%, P = .03). The patients with local recurrence occurring <11 months had a significantly shorter 1-year local control rate than patients with ≥ 11 months (31% vs 91%, P < .001). Grade 3-4 acute and late toxicities were seen in 7% and 15% of patients, respectively. The patients with previous radiotherapy history had significantly higher rate of acute toxicity (19% vs 0%, P = .019). Late toxicity was significantly higher in pelvic tumors than in abdominal tumors (3% vs 28%, P = .004). The SBRT seems to be feasible and resulted in good treatment outcomes in patients with recurrent or metastatic abdominopelvic tumors.

A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer

ABSTRACT Background Papillary thyroid carcinoma is the commonest thyroid cancer. Patients usually present with thyroid nodule and rarely with hyperthyroidism such that 2009 ATA guidelines recommended that cytological evaluation is not necessary in patients with hyperfunctioning nodules as they rarely harbor malignancy. We report a case of an unusual presentation of metastatic papillary thyroid carcinoma in a young patient. Case presentation A 17-year-old girl, presented to our hospital with 3 days of fever, cough and hemoptysis. Chest X-ray showed extensive miliary nodules and was treated for presumed miliary tuberculosis. Biochemical investigations revealed a hyperthyroid state (fT4 55.7 TSH &lt; 0.02), with negative antibodies (TRAB and TSI). Radioisotope scan showed increased uptake on right lobe. She underwent bronchoscopy and biopsy which revealed metastatic papillary thyroid carcinoma. Clinical examination revealed a small goiter with palpable cervical node at level III on the left. There were no clinical signs of Graves’ disease and she had no history of previous radiation or family history of endocrine disease. Ultrasound revealed multiple hypodense thyroid nodules with microcalcification and increased vascularity. Ultrasound of the neck showed the presence of abnormal lymphadenopathy. She underwent total thyroidectomy, bilateral central neck dissection and left lateral modified neck dissection. Histology showed 1.3 cm papillary thyroid carcinoma involving the left lobe and multifocal papillary thyroid microcarcinomas involving both lobes. Ten out of 27 nodes were involved. She was BRAF mutation positive. She recovered well postoperatively and was rendered hypothyroid. She underwent radioiodine ablation which showed no more disease in the neck but unfortunately there was no uptake in the lung metastases. Conclusion Metastatic papillary thyroid cancer developing in a young patient with hyperthyroidism is extremely rare and suggests a more aggressive behavior as confirmed by BRAF mutation. How to cite this article Hu JSL, Parameswaran R. A Case of Miliary Nodules, Hemoptysis and Hot Thyroid Cancer: Unusual Presentation of Papillary Thyroid Cancer. World J Endoc Surg 2015;7(3):72-75.

Modified Continuous Mucosal Connell Suture for the Pharyngeal Closure After Total Laryngectomy: Zipper Suture.

ObjectivesPharyngocutaneous fistula is a serious complication after total laryngectomy, and there are some risk factors stated in the literature. The surgical suture techniques are not studied so much. The aim of this study is to evaluate the effectiveness of 'modified continuous mucosal Connell suture' on the incidence of pharyngocutaneous fistula after total laryngectomy.MethodsThis is a retrospective case series study based at a tertiary center with 31 patients who underwent total laryngectomy between July 2011 and December 2013. Pharyngocutaneous fistula formation after total laryngectomy was evaluated with the patients who underwent modified continuous mucosal Connell suture for pharyngeal repair.ResultsPharyngocutaneous fistula was observed in only one patient (3.2%) who had a history of previous radiotherapy, and it was spontaneously healed within 6 days by conservative treatment.ConclusionWe defined a new suture technique for the pharyngeal repair after total laryngectomy. This technique is a simple modification of continuous mucosal Connell suture. We named it as zipper suture. It is effective in the prevention of pharyngocutaneous fistula for pharyngeal reconstruction after total laryngectomy.

Epidemiological Study of Non-Melanoma Skin Cancers Qazvin Province, Iran

and statistical tests including t-test and chi-square tests. Results: Of the 484 patients, 294 (60.7%) were male and 190 (39.3%) were female. Most cases of carcinoma were found in basal cells (77.7%) and the rest of squamous cells. The most common sites of involvement were the head and scalp. The most frequent predisposing factors were working in the open air (70.7%), history of previous radiation for treatment of tenia capitis (26.1%), and chronic skin diseases such as burn eschar, chronic lesion, fistula and actinic keratosis (35.7%). The most prevalent Fitzpatrick skin phenotypes were II or III (75.4%). There were significant correlations between the incidence of NMSC and hookah smoking and oral contraceptive pill (OCP) consumption. Conclusions: Skin phenotypes II and III were the most common types found in the present study and this could be due to the higher frequency of these phenotypes among the study population. The lower incidence of NMSC in areas other than the neck and scalp could be associated with the importance of covering style used by the population under study. Known risk factors for the incidence of NMSC were also observed in the present study. A history of radiotherapy for treatment of tenia capitis was observed in a considerable percentage of patients, which could lead to the incidence of cancer several decades later. Further studies are needed to determine the role of hookah smoking and the use of OCP in the occurrence of NMSC.

DXA-based variables and osteoporotic fractures in Lebanese postmenopausal women

IntroductionThe aim of this study was to assess DXA-based variables (bone mineral density, bone mineral apparent density, compressive strength index of the femoral neck and trabecular bone score) in Lebanese postmenopausal women having presented a previous fracture. Materials and methodsOne thousand Lebanese postmenopausal women between 45 and 89 years participated in this study. The women were recruited by advertisements offering bone mineral density measurements at a reduced cost. Subjects with previous history of radiotherapy or chemotherapy were excluded. Informed written consent was obtained from all the participants. ResultsFemoral neck compressive strength index (FN CSI) was significantly (P<0.001) associated with the presence of fracture using a simple logistic regression (odds ratio=0.51 [0.385–0.653]). When a multivariate logistic regression analysis was performed with the presence of fracture as a dependent variable and each of age, FN BMD and FN CSI as independent variables, only FN BMD (P=0.005) and FN CSI (P=0.004) were found to be associated with the presence of fracture. ConclusionThis study suggests that FN CSI is associated with history of osteoporotic fractures in postmenopausal women. The use of FN CSI in clinical practice may help to identify patients with high risk of fracture. Level of evidenceEpidemiological study, level IV.

Sonographic appearance of thyroid glands in patients treated with intensity-modulated radiotherapy or conventional radiotherapy for nasopharyngeal carcinoma.

This study aimed to investigate the sonographic appearances of the thyroid glands in nasopharyngeal carcinoma (NPC) patients whose cervical lymph nodes were treated with conventional radiotherapy (RT) or intensity-modulated radiotherapy (IMRT). The post-RT sonographic appearances of the thyroid glands in NPC patients were also correlated with the thyroid function. One hundred and three NPC patients who had completed RT of cervical lymph nodes using the anterior cervical field, 30 NPC patients who had completed RT of cervical lymph nodes using IMRT, and 61 healthy subjects were included in the study. Thyroid glands were sonographically assessed for their size, echogenicity, vascularity, and internal architecture. Thyroid function tests were also performed on each subject. In comparison with the patients with abnormal thyroid function, the thyroid glands of the patients with normal thyroid function tended to be homogeneous and to have greater volume and echogenicity index (p < 0.05). Compared with those of the healthy subjects, the thyroid glands of patients previously treated with IMRT and those treated with the anterior cervical field showed significantly lower thyroid volume, lower incidence and number of nodules, and higher vascularity index (p < 0.05). The patient's history of previous RT should be taken into consideration in the sonographic examination of the thyroid gland post-RT. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:210-223, 2015.

Pectoralis major myofascial onlay and myocutaneous flaps and pharyngocutaneous fistula in salvage laryngectomy.

To review the fistula rate in irradiated patients undergoing salvage laryngectomy, compare the effect of closure type on fistula rate, and examine possible perioperative risk factors that might contribute to an increased fistula rate. Case series with chart review. We conducted a retrospective review of the University of Pittsburgh head and neck tumor registry and identified 73 patients from 1998 to 2011 who had received prior radiation before total laryngectomy or salvage laryngectomy and who had either primary closure, pectoralis major myofascial (PMMF) flap onlay, or pectoralis major myocutaneous (PMMC) flap. Fistula was more common in patients who underwent initial primary closure (45%) than in patients who had immediate PMMF onlay (10.5%). The fistula rate for patients who underwent immediate PMMC flap was 28.6%, intermediate to primary closure and PMMF flap. Several factors were evaluated for relationship to fistula, but no significant associations were identified. However, patients with fistula tended to have longer inpatient stays and may have been more likely to have a history of cardiovascular or hypoxic disease. Pharyngocutaneous fistula is a well-established complication of total laryngectomy and is especially a concern in patients with a previous history of radiation. Our retrospective review demonstrates that PMMF onlay flap appears to be more effective in reducing the rate of fistula compared to primary closure in these patients. Myocutaneous augmentation flaps, in contrast, have a fairly high fistula rate and may be better replaced with alternative closures such as free flaps. 4.

Treatment Outcomes of Transurethral Macroplastique Injection for Postprostatectomy Incontinence

PurposeWe investigated the efficacy of transurethral injection of Macroplastique bulking agent (Uroplasty) for male stress urinary incontinence (SUI) after prostate surgery.Materials and MethodsThis retrospective review included men with SUI treated by transurethral injection for symptoms resulting from prostate surgery. Patients were evaluated at 1 month and 6 months after injection by determining the number of pads used per day and changes in incontinence symptoms. Treatment success was defined as use of 1 pad or fewer per day combined with subjective symptom improvement.ResultsThe study population comprised 30 men with a mean age of 66.1±5.3 years. Of the 30 patients, 24 (80.0%) underwent prostate cancer surgery and the remaining 6 (20.0%) underwent surgery for benign prostatic hyperplasia. The preinjection pad number was 2.9±1.9 pads per day. After injection treatment, the mean follow-up period was 9.3±12.7 months and the success rate was 43% (13/30) at 1 month and 32% (6/19) at 6 months. Injection was more likely to result in a successful outcome in patients with no preinjection radiation treatment history and higher abdominal leak point pressure (ALPP) than in those with a previous history of radiation treatment and lower ALPP, although this result was not statistically significant. Acute urinary retention occurred in 5 patients (17%).ConclusionsTransurethral Macroplastique injection treatment is a relatively non-invasive treatment method for male SUI with a success rate of 43% at 1 month and 32% at 6 months. Patients with a higher ALPP and no previous history of radiation therapy may experience better treatment outcomes.

Outcome of Dental Implants in Patients With Previous Radiation History to the Head and Neck Area

Outcome of Dental Implants in Patients With Previous Radiation History to the Head and Neck Area

Necrotizing Metachronous Facial Ulcerations After “Stem Cell Face Lift”

A 63-year-old woman underwent face and neck lift with autologous fat transfer-called by her physician a "stem cell face lift." Fatty aspirate from her abdominal wall was enriched by hyaluronic acid, triiodothyronine, thyroxine, insulin, dimethylaminoethanol, estriol, dexamethasone, indomethacin, and fibroblast growth factor before injection into the face. At approximately 4-weeks postoperative, the patient developed facial swellings, erythema, necrotizing ulcers, and an orocutaneous fistula. New lesions continued occurring up to 16 weeks after surgery. After multiple surgical debridements and an oral course of rifampin, a decisive reduction in inflammation and healing was observed. Differential diagnosis included (1) mistaken transfer of allogeneic fat (ruled out), (2) toxic impurities in transferred material, (3) microbial contaminant(s) from multiple use liposuction cannula or tissue markers, and (4) endogenous anaerobic orofacial infection (history of previous radiation for tonsillar cancer and dental implants). The most probable etiology was mycobacterial infection. This is based on a single colony of mycobacterium isolated, histologic finding revealing granulomatous inflammation, and the favorable response to rifampin. The patient underwent subsequent autologous fat transfers, which successfully reduced some disfigurement and scarring.

Radiation Colitis: An Uncommon Cause of Hematochezia Diagnosed by Small Bowel Capsule Endoscopy

Purpose: A patient with hematochezia and anemia underwent capsule endoscopy to evaluate for small bowel source of anemia. She reported a history of abdominal radiation for uterine cancer 10 years prior to presentation. EGD was normal, and a colonoscopy revealed colitis of the ascending colon which was thought to be radiation-induced. Given her recurrent anemia and hematochezia, a small bowel capsule endoscopy was performed. Review of images revealed a normal duodenum and proximal jejenum. In the distal jejenum, however, multiple abnormalities were visualized (see images). These included lymphangiectasia, severe fibrosis, loss of vascular pattern, and punctate hemorrhage. Findings were suggestive of radiation enteritis. She was placed on iron supplementation with subsequent improvement of anemia. Injury to the GI tract can occur after radiation therapy to the abdomen. Injury is often progressive and may lead to clinical symptomatology such as diarrhea, nausea, weight loss, abdominal pain, intestinal obstruction, and perforation. Physiological changes include altered intestinal transit, reduced bile acid absorption, increased intestinal permeability, bacterial overgrowth, and lactose malabsorption. The diagnosis should be considered in the context of previous radiation history. In a patient with this clinical picture, further correlation with radiological findings (CT scan, small bowel follow through) and endoscopy (capsule endoscopy and colonoscopy) should be performed.Figure: [890] Fibrosis and punctate hemorrhage.Figure: [890] Active oozing from jejenum.

Effect of previous radiotherapy on cervical lymph node fine‐needle aspiration cytology diagnostic accuracy in head and neck cancers

It is not uncommon for head and neck surgeons to encounter patients with previous neck irradiation that require fine-needle aspiration cytology (FNAC) for assessment of neck mass. It had been observed that the diagnostic performance of FNAC appears to be poorer among patients with previous irradiation. However, to the best of our knowledge, the effect of previous irradiation on diagnostic performance of FNAC has never been studied. Retrospective study. A computer search was performed to identify all patients who had been treated under the Division of Head and Neck Surgery, Department of Surgery, Queen Mary Hospital, from January 2008 to December 2010. We retrospectively retrieved all FNAC of cervical lymphadenopathy procedures, and only cases with subsequent histologic confirmation were included. All patients with squamous cell carcinoma of the head and neck (HNSCC) were included. When compared to patients without previous irradiation, FNAC among patients with history of previous irradiation had comparable specificity (100% vs. 88%) and positive predictive value (100% vs. 89%) but significantly worse sensitivity (82% vs. 40%), negative predictive value (74% vs. 37%), and accuracy (88% vs. 54%). History of previous irradiation was found to be strongly associated with false-negative cytologic results among those with positive final histology (60% vs. 18%; P = .001). FNAC remains an important diagnostic tool in assessment of cervical nodal status in HNSCC. However, our study showed that false-negative rate is significantly higher among patients with previous neck irradiation. Negative FNAC results in this group of patients should be interpreted with caution.

Keystone Island Flap Reconstruction of Parotid Defects

Skin cancers of the face and scalp have a propensity to metastasize to the parotid group of lymph nodes. The resection of these secondary tumors and other primary tumors in the parotid region often results in defects requiring flap reconstruction. Pectoralis major flaps are reliable and free flaps are arguably the criterion standard. However, we have found keystone island flaps to be a simple and robust alternative, with low donor-site and patient morbidity. The aim of this article is to share our surgical technique, experience, and outcomes of reconstructing parotid defects with keystone island flaps. The authors retrospectively reviewed 62 patients who had 63 parotid defect reconstructions at a single institution from 2004 to 2009 (5-year period). The diseases involved were squamous cell carcinoma (52 cases), melanoma (five cases), basal cell carcinoma (four cases), and others (two cases). Nine patients presented with a previous history of radiotherapy and 33 patients required adjuvant radiotherapy. Seven patients (11 percent) suffered postoperative complications necessitating a return to the operating room. Keystone island perforator-based flaps present an alternative to free tissue transfer. From the series presented, it can be seen that reliable and reproducible results are achievable. Therapeutic, IV.

Urethral prolapse in premenopausal, healthy adult woman

Urethral prolapse is an uncommon clinical condition that is reported predominantly in children and postmenopausal women. We describe a case of a 39-year-old woman who presented at the emergency room with vaginal bleeding and pain related to Valsalva maneuver (lifting weight). She described several similar previous episodes, which started during her second pregnancy at 32 years of age. The episodes initially occurred every 6 months, but she did not seek medical assistance for 7 years, during which time symptoms became more frequent. She had no previous history of irradiation, pelvic infection, or urogenital surgery. During physical examination, a urethral prolapse was identified. Pelvic and urinary ultrasound (US) showed no other abnormality. The patient underwent cystourethroscopy and surgical excision of the urethral prolapse, with complete resolution of symptoms. Histopathology confirmed benign inflammatory urethral mucosa tissue with edema and vascular congestion.

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 ...

Salvage radiotherapy in patients with recurrent esophageal carcinoma

The feasibility and effectiveness of radiotherapy in the management of recurrent esophageal carcinoma (REC) is reported. A consecutive cohort of 54 patients with rcT1-4, rcN0-1, or cM0 recurrent esophageal carcinoma (69% squamous cell carcinoma, 31% adenocarcinoma) was treated between 1988 and 2010. The initial treatment for these patients was definitive radiochemotherapy, surgery alone, or neoadjuvant radiochemotherapy + surgical resection in 8 (15%), 33 (61%), and 13 (24%) patients, respectively. The median time to recurrence from initial treatment was 19 months (range 4-79 months). The site of the recurrence was anastomotic or local, nodal, or both in 63%, 30%, and 7% of patients, respectively. Salvage radio(chemo)therapy was carried out with a median dose of 45 Gy (range 30-68 Gy). Median follow-up time for surviving patients from the start of R(C)T was 38 months (range 10-105 months). Relief of symptoms was achieved in 19 of 28 symptomatic patients (68%). The median survival time was 12 months (95% confidence interval (CI) 7-17 months) and the median recurrence-free interval was 8 months (95% CI 4-12 months). The survival rates at 1, 2, and 3 years were 55 ± 7%, 29 ± 6%, and 19 ± 5%, respectively. The recurrence-free survival rates at 1, 2, and 3 years were 44 ± 7%, 22 ± 6%, and 15 ± 5%, respectively. A radiation dose ≥ 45 Gy and conformal RT were associated with a better prognosis. RT is feasible and effective in the management of recurrent esophageal carcinoma, especially for relief of symptoms. Toxicity is in an acceptable range. The outcome of REC is poor; however, long-term survival of patients with recurrent esophageal carcinoma after radiochemotherapy might be possible, even with a previous history of radiotherapy in the initial treatment. If re-irradiation of esophageal carcinoma is contemplated, three-dimensional conformal techniques and a minimum total dose of 45 Gy are recommended.

Malignant Fibrous Histiocytoma of the Breast: A Case Report

This paper concerns a case of Malignant Fibrous Histiocytoma (MFH) of the Breast in a 73-years-old woman. A lump was found in her right breast, measuring 1.7 cm in diameter. Surgical excision followed, and pathology revealed a highly atypical spindle cell tumor. Immunohistochemistry along the histological features, excluded the possibility of carcinoma, malignant phyllodes tumor, or another type of pure sarcoma. There was no history of previous irradiation in the region. MFH is among the rarest types of sarcoma of the breast, and most of the times behaves aggressively. Excision with wide, free-of-tumor margins is the most effective treatment, when feasible.