Side Effects Of Radiation Treatment Research Articles

Analysis of the Cancer Imaging Archive for Patterns of Locoregional Failure in Relation to the Mucous Membranes among Patients with Head and Neck Squamous Cell Carcinoma: Potential Organ at Risk that can be Spared?

Radiation-induced oral mucositis (RIOM), a painful inflammation and ulceration of the mucous membranes (MM), occurs as a common and severe side effect of radiation treatment (RT) for head and neck cancers. It worsens significant quality of life leading to treatment interruption or cancellation. In RIOM, radiation injury of the MM basal epithelial cells may be one of the critical pathophysiological mechanisms. However, it is unclear if advanced radiation treatments could spare MM, without compromise on tumor control. The purpose of this study is to determine whether the MM that do not overlap with the prescription target volumes are a common site of locoregional recurrence in head and neck cancers. A de-identified data collection of 215 head and neck cancer patients stored within The Cancer Imaging Archive was downloaded for analysis. Imaging series both before and after RT were downloaded, as well as RT structures and RT dosimetric data. Diagnostic CECT and/or PET/CT and/or MRI scans documenting the initial evidence of recurrence were co-registered with corresponding original planning CTs. Radiologically evident recurrent gross disease (rGTV) was manually contoured, as well as the MM (defined as an approximately 3mm thick wall of mucosa tissue lining the oral cavity and pharynx and excluding any overlap with the radiation prescription targets). Contoured MM structures were cross-referenced with the sites of recurrence by examining the overlap of the MM volumes with the rGTV volumes. A total of 40 patients had documented evidence of recurrence; 38 of which had images available for analysis. Overall, 23 (60.5%) were oropharynx cancer. Of the 38 recurrences, 35 (92%) were locoregional: 23 with only local (60.5%) recurrences, 9 with only regional (23.7%) recurrences and 3 (7.9%) with both local and regional recurrences. One patient (2.6%) had distant recurrence, one patient had both regional and distant recurrences concomitantly, and one patient had local, regional and distant recurrences simultaneously. Overall, 30 patients (78.9%) had recurrences located exclusively within prescription PTV volumes/isodose lines. Four patients (10.5%) had recurrences located outside prescription PTV volumes/isodose lines, four patients (10.5%) had recurrences located both within and outside prescription PTV volumes/isodose lines (i.e., 2 sites of concomitant recurrence). Importantly, 0 patients (0%) had recurrences located in the contoured MM (excluding any overlap with the radiation prescription targets). Based on this retrospective series, the MM (excluding the areas of overlap with radiation prescription targets) are a rare location of locoregional recurrence. Hence, sparing the MM using radiation advanced dosimetry techniques could be a reasonable approach to reducing the incidence/severity of radiation-induced oral mucositis, without compromising tumor control. However, this requires further prospective investigation.

Impact of radiation dose on patient-reported acute taste alteration in a prospective observational study cohort in head and neck squamous cell cancer (HNSCC)

PurposeTaste alteration (TA) is a frequent acute side effect of radiation treatment in HNSCC patients. Principal aim of our study was to investigate dosimetric parameters in relation to patient-assessed taste impairment in a prospective cohort treated with intensity-modulated radiotherapy.MethodsAll patients with locally advanced HNSCC and amenable to radical treatment were included. Chemotherapy-induced taste alteration scale (CITAS), EORTC QLQ-C30 and QLQ-HN43 questionnaires at baseline (T0), 3 weeks (T1) and 3 months (T2) after radiotherapy conclusion were used to assess taste impairment. Base of tongue, submandibular glands (SG), parotid glands (PG) and taste buds, along with anterior and medium third of the tongue, were considered as organs at risk and thus delineated according to consensus guidelines. The mean dose to the above-mentioned structures was correlated with patient-reported outcomes.ResultsBetween September 2019 and November 2020, 33 patients were recruited, 31 of which analyzed. 71% had oropharyngeal carcinoma, mostly HPV-related (60%). All were treated with tomotherapy. 77.4% had concurrent cisplatin. Mean scores of general taste alterations, global health status and dry mouth and sticky saliva were assessed. The mean doses to the anterior third, medium third and base of the tongue were 23.85, 35.50 and 47.67 Gy, respectively. Taste buds received 32.72 Gy; right and left parotid 25 and 23 Gy; right and left submandibular glands 47.8 and 39.4 Gy. At univariate analysis, dysgeusia correlated with SG mean dose (95% CI 0–0.02 p = 0.05) and PG mean dose (95% CI 0–0.02 p = 0.05); dry mouth with mean dose to anterior (95% CI 0.03–1.47 p = 0.04) and medium third (95% CI 0.02–0.93 p = 0.04) of the tongue, to taste buds (95% CI 0.06–0.96 p = 0.03) and to SGs (95% CI 0.06–0.63 p = 0.02); pain mouth with mean dose to taste buds (95% CI 0–0.02 p = 0.04), to SGs (95% CI 0–0.03 p = 0.03) and to base tongue (95% CI 0–0.02 p = 0.02).ConclusionsOur analysis supports the influence of dose distribution on the development of TA in HNSCC patients. The contribution of dose to taste buds and tongue subvolumes remains unclear and worthy of further investigation.

Survey of experiences and barriers to dental care post–head and neck cancer in OraRad study participants

Dental care after head and neck cancer (HNC) treatment is crucial to maintaining oral health and preventing/treating oral complications. This survey investigated the experiences and barriers to dental care post-radiation therapy (RT). Participants of the Clinical Registry of Dental Outcomes in patients with head and neck cancer (OraRad) were surveyed at approximately 4 years post-RT. Participants completed a 20-question survey which assessed perceptions of dental care and education, barriers to receiving care, and ongoing physical symptoms post-RT. One hundred fifty-three of the 505 available OraRad participants completed the survey. Almost all of the respondents (n=141; 92%) either strongly agreed or agreed that they understand the effects of cancer and its treatment on the teeth, mouth, and jaws. The majority (n=119; 80%) strongly agreed or agreed that their dentist provided them with information on how to keep teeth, mouth, and jaws healthy after treatment. Most participants reported dry mouth (n=114; 75%). Other sequelae were problems swallowing (n=57; 38%), dental caries (n=33; 22%), and difficulty keeping their mouth open during dental procedures (n=26; 17%). The OraRad respondents reported few barriers to dental care post-HNC treatment. Patients continue to suffer oral/maxillofacial side effects of radiation treatment, most notably xerostomia.

Strahlentherapeutische Behandlung von Leukämien

HintergrundLymphoide Zellen weisen eine hohe Strahlensensitivität auf, sodass die Strahlentherapie eine sinnvolle Ergänzung der Systemtherapie bei Leukämien darstellt. Vor allem als konditionierende Behandlung vor allogener Stammzelltransplantation ist die Radiotherapie in Form einer Ganzkörperbestrahlung etabliert.Ziel der ArbeitDie vorliegende Arbeit ermöglicht einen Überblick über Durchführung und Nebenwirkungen der strahlentherapeutischen Behandlung bei Leukämien. Hierbei werden insbesondere die (Langzeit‑)Nebenwirkungen nach Ganzkörperbestrahlung dargestellt.Material und MethodenEs erfolgte eine selektive Literaturrecherche über die Datenbank PubMed zur Radiotherapie von Leukämien und zu Ganzkörperbestrahlungen mit Fokus auf Nebenwirkungen sowie technische und konzeptionelle Neuerungen.ErgebnisseDie Ganzkörperbestrahlung ist eine effektive Therapie zur Konditionierung vor allogener Stammzelltransplantation und weist ein diverses, aber beherrschbares, Toxizitätsspektrum mit endokrinen, kardiopulmonalen, okulären, nephrologischen und neurologischen Langzeitnebenwirkungen sowie Sekundärneoplasien auf. Zusätzlich kann eine Radiotherapie in Niedrigdosis effektiv zur Behandlung myeloider Sarkome (Chlorome) angewendet werden.SchlussfolgerungDie Vielfalt der Nebenwirkungen nach Ganzkörperbestrahlung erfordert eine interdisziplinäre und langfristige Nachsorgebetreuung durch internistische Onkolog*innen/Transplantationsmediziner*innen und Radioonkolog*innen. Technische Entwicklungen der Strahlentherapie können in Zukunft eine selektive Adressierung des Knochenmarks sowie der lymphatischen Organe realisieren. Aktuell sind diese noch nicht in der klinischen Routine etabliert und werden im Rahmen klinischer Studien evaluiert.

Radiotherapy for the treatment of leukemia

HintergrundLymphoide Zellen weisen eine hohe Strahlensensitivität auf, sodass die Strahlentherapie eine sinnvolle Ergänzung der Systemtherapie bei Leukämien darstellt. Vor allem als konditionierende Behandlung vor allogener Stammzelltransplantation ist die Radiotherapie in Form einer Ganzkörperbestrahlung etabliert.Ziel der ArbeitDie vorliegende Arbeit ermöglicht einen Überblick über Durchführung und Nebenwirkungen der strahlentherapeutischen Behandlung bei Leukämien. Hierbei werden insbesondere die (Langzeit‑)Nebenwirkungen nach Ganzkörperbestrahlung dargestellt.Material und MethodenEs erfolgte eine selektive Literaturrecherche über die Datenbank PubMed zur Radiotherapie von Leukämien und zu Ganzkörperbestrahlungen mit Fokus auf Nebenwirkungen sowie technische und konzeptionelle Neuerungen.ErgebnisseDie Ganzkörperbestrahlung ist eine effektive Therapie zur Konditionierung vor allogener Stammzelltransplantation und weist ein diverses, aber beherrschbares, Toxizitätsspektrum mit endokrinen, kardiopulmonalen, okulären, nephrologischen und neurologischen Langzeitnebenwirkungen sowie Sekundärneoplasien auf. Zusätzlich kann eine Radiotherapie in Niedrigdosis effektiv zur Behandlung myeloider Sarkome (Chlorome) angewendet werden.SchlussfolgerungDie Vielfalt der Nebenwirkungen nach Ganzkörperbestrahlung erfordert eine interdisziplinäre und langfristige Nachsorgebetreuung durch internistische Onkolog*innen/Transplantationsmediziner*innen und Radioonkolog*innen. Technische Entwicklungen der Strahlentherapie können in Zukunft eine selektive Adressierung des Knochenmarks sowie der lymphatischen Organe realisieren. Aktuell sind diese noch nicht in der klinischen Routine etabliert und werden im Rahmen klinischer Studien evaluiert.

Late side effects of radiation treatment for head and neck cancer.

Patients undergoing radiation therapy for head and neck cancer (HNC) experience significant early and long-term side effects. The likelihood and severity of complications depends on a number of factors, including the total dose of radiation delivered, over what time it was delivered and what parts of the head and neck received radiation. Late side effects include: permanent loss of saliva; osteoradionecrosis; radiation recall myositis, pharyngoesophageal stenosis; dental caries; oral cavity necrosis; fibrosis; impaired wound healing; skin changes and skin cancer; lymphedema; hypothyroidism, hyperparathyroidism, lightheadedness, dizziness and headaches; secondary cancer; and eye, ear, neurological and neck structures damage. Patients who undergo radiotherapy for nasopharyngeal carcinoma tend to suffer from chronic sinusitis. These side effects present difficult challenges to the patients and their caregivers and require life-long strategies to alleviate their deleterious effect on basic life functions and on the quality of life. This review presents these side effects and their management.

Abstract B23: The role of bone marrow transplantation in patients with Fanconi anemia and head and neck squamous cell carcinoma receiving radiotherapy: An examination of the International Fanconi Anemia (IFAR) Registry

Abstract Introduction: Fanconi anemia (FA) patients have a high predilection for developing aggressive head and neck squamous cell carcinoma (HNSCC) at an early age. Because of their aggressive HNSCC, these patients frequently require multiple modality treatment, including radiation therapy. However, their underlying chromosomal instability makes giving radiation to these patients difficult because of increased radiation-induced complications. In order to better understand this problem, we evaluated a large population of FA patients with HNSCC who received radiation therapy for HNSCC. Hypothesis: FA patients who have undergone prior bone marrow transplant (BMT) and present with head and neck squamous cell carcinoma (HNSCC) demonstrate decreased relative risk of radiation-induced complications compared to FA patients who have not received BMT. Study Design: Retrospective Cohort Study Methods: Demographic information, genotypic data, prognostic factors, therapeutic management, and survival outcomes for FA patients enrolled in the International Fanconi Anemia Registry (IFAR) who developed HNSCC from 1981-2017 were analyzed. Results: Data were collected from the IFAR registry for n=50 patients. The mean age at time of HNSCC diagnosis was 30.5 + 9.0 years, and 36% of total patients were male. 42% of the patients received adjuvant or neoadjuvant radiotherapy for HNSCC, with the most common subsites involving the oral tongue (n=8), followed by alveolus (n=3) and supraglottis (n=2). The average dose given was 48.8 + 16.9 Gy over a 28- to 70-day period. Among patients receiving radiotherapy, 24% had received a bone marrow transplant. No patients who had a prior BMT were noted to develop pancytopenia as a radiation-related complication, while 68% of those without prior BMT developed pancytopenia from radiation. 6/16 patients who did not undergo transplant completed the full course of radiation, while 4/5 BMT patients were able to complete treatment. Both mucositis and sepsis were secondary complications more common in the non-BMT group (56% vs. 40%, and 12% vs. 0%, respectively). The relative risk of pancytopenia among patients receiving BMT and adjuvant radiation was 0.15 (95% CI 0.01-2.2); however, this was not statistically significant given the small BMT-group sample size (p=0.17). Interestingly, 80% of patients in the BMT group exhibited genetic mutations of the Fanconi complementation group C. Among patients who received a BMT and adjuvant radiotherapy, 5 patients died of XRT-related complications, while only 1 patient died from these complications in the BMT group. Conclusion: While it is well known that FA patients have a high predilection for developing aggressive HNSCC at an early age, among the patients who received preradiation bone marrow transplant the incidence of radiation-induced pancytopenia was reduced. This reduction suggests that FA patients undergoing radiotherapy for HNSCC may exhibit less adverse side effects of radiation treatment if they received a prior BMT. Citation Format: Ade Obayemi, K.R. Patel, O. Rosti, A. Smogorzewska, D. Kutler. The role of bone marrow transplantation in patients with Fanconi anemia and head and neck squamous cell carcinoma receiving radiotherapy: An examination of the International Fanconi Anemia (IFAR) Registry [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 B23.

Comparative characteristics of some haematological and biochemical indicators in II–III stages cervix cancer patients with late radiation complications in treatment dynamics

Depending on the stage of the process, tactics for the treatment of cervical cancer (СС) may include surgical treatment, radiation therapy (RT), chemotherapy, hormone therapy and a combination of these methods. The leading place in the treatment of patients with cancer is today occupied by combined RT. However, despite improvements in methodological approaches to RT, the problem of side effects of radiation treatment – early and late radiation complications (LRC) still remains to be fully resolved.
 Purpose of the study. To carry out comparative analysis of individual hematological and biochemical parameters of peripheral blood (hematocrit, fibrinogen, aspartate aminotransferase (AsAt, urea and total protein) of patients with II and III stage of CC before and after RT.
 Materials and methods. A retrospective analysis of case histories of patients with stage II–III cervical cancer was performed. The main group – 102 people: 68 patients with stage II cervical cancer and 34 patients with stage III cervical cancer with LRC. Control group: 90 people – 46 patients with stage II cervical cancer and 44 patients with stage III cervical cancer without LRC.
 Results. The study showed that in patients with СС with LRC were higher baseline (before RT) hematocrit indicators by 5,8% (p = 0,3) in patients with II stage of CC and by 11,4% (p = 0,02) in patients with III stage of СС relative to baseline indices of CC-patients without LRC and were respectively 36,2% and 35,2%. Analysis of the level of fibrinogen showed that patients with II stage of СС this indicator before RT was statistically significant (p = 0,04) higher by 10.3% in patients with LRC and was 3,2 g/L, respectively. In patients with III stage of CC with LRC, the same indicator for RT was on the contrary lower by 8,3% (p = 0,5) relative to the indicators of patients without LRC. It was found that baseline AsAt in patients with СС was higher in patients with LRC, respectively, by 12,2% in patients with II stage of CC (p  0,05) and 18,5% (p < 0,01) in patients with III stage of CC. Noteworthy is the statistically probable (p < 0,05) increase in urea level in patients with CC after RP: by 25,6% in patients with II stage of СС and by 24,5% in patients with III stage of CC, which differs from the dynamics to a decrease in the same indicator in patients with cervical cancer without LRC (by 22,6% and 1,9% in patients with II and III stage of CC respectively). Characterizing the level of total protein in patients with II–III stage of CC it is worth noting that in patients with LRC, the baseline values of the indicated indicator are statistically significantly (p < 0,05) higher than the similar indicators of patients without LRC by 5,5% and 6,4%, respectively, in the II stage of CC and the III stage of CC.
 Conclusions. Input indicators of hematocrit level in patients with III stage of CC with LRC statistically significant (p = 0,02) by 11,4% exceeded the corresponding figure in patients without LRC. The level of AsAt before RT in patients with III stage of CC with LRC statistically significantly (p < 0,01) exceeded by 18,5% the same indicator of patients without LRS, and after RT it tended to increase by 22,4%. It is established that patients with II and III stage of CC after RT, statistically significant (p < 0,05) increase of urea level by 25,6% and 24,5% respectively was noted.

Adaptations to Oral and Pharyngeal Swallowing Function Induced by Injury to the Mylohyoid Muscle.

Muscle injury is a frequent side effect of radiation treatment for head and neck cancer. To understand the pathophysiology of injury-related dysfunction, we investigated the effects of a single muscle injury to the mylohyoid on oropharyngeal swallowing function in the rat. The mylohyoid protects the airway from food/liquid via hyolaryngeal elevation and plays an active role during both oral and pharyngeal swallowing. We hypothesized (1) that fibrosis to the mylohyoid alters swallowing bolus flow and licking patterns and (2) that injury to the mylohyoid changes normal activity of submental, laryngeal, and pharyngeal muscles during swallowing. A chilled cryoprobe was applied to the rat mylohyoid muscle to create a localized injury. One and two weeks after injury, swallowing bolus transit was assessed via videofluoroscopy and licking behavior via an electrical lick sensor. The motor activity of five swallow-related muscles was analyzed immediately after injury using electromyography (EMG). Comparisons were made pre- and post-injury. Fibrosis was confirmed in the mylohyoid at 2 weeks after injury by measuring collagen content. One week after injury, bolus size decreased, swallowing rate reduced, and licking patterns were altered. Immediately post-injury, there was a significant depression in mylohyoid and thyropharyngeus EMG amplitudes during swallowing. Our results demonstrated that injury to the mylohyoid is sufficient to cause changes in deglutition. These disruptions in oral and pharyngeal swallowing were detected prior to long-term fibrotic changes, including delays in tongue movement, alterations in bolus flow, and changes in sensorimotor function. Therefore, injuring a single important swallowing muscle can have dramatic clinical effects.

Combined effects of gamma-irradiation, dose rate and mycobiota activity on cultural heritage – Study on model paper

Cellulose, the main constituent of paper-made objects of cultural heritage (CH), is a favorable substrate for fungal growth. Gamma irradiation is a well-established low-cost treatment convenient for decontamination of such objects. Since side-effects to paper-based CH are always a concern the aim of this work was to investigate if a synergism of microbiological contamination and gamma irradiation effects exists and if it induces changes in paper's appearance and structure. The dose rate plays an important yet generally neglected role in the efficacy of the radiation treatment so another goal was to assert its influence on decontamination efficiency and paper properties.Irradiation conditions for treating the highly resistant secondary colonizer Cladosporium sphaerospermum, as well as the naturally occurring mycobiota were evaluated. Untreated and inoculated samples of paper were irradiated with doses commonly applied to CH objects, as well as to significantly higher doses, at two dose rates that differ for two orders of magnitude. Microbiological analysis of irradiated samples was conducted. Colorimetric analysis, UV-vis and FTIR measurements were performed after short lived reaction species have decayed.The results have shown that in the case of high contaminations (104 CFU/g) the applied dose needs to be adjusted and that the corresponding dose rate needs to be high enough. While at the dose rate of 31 kGy/h the irradiation dose of 7 kGy seems to be effective to obtain proper reduction of mycobita, at the dose rate that was two orders of magnitude lower the required dose increased approximately ten times. Thus the reevaluation of the recommended dose of 8 ± 2 kGy is needed. Considering the side effects of radiation treatment the dose rate effect has also been observed. At the higher of the investigated dose rates the irradiation doses needed for decontamination did not alter the appearance of paper, while at the lower one the changes were hardly perceptible. The main species showing their contribution to color change were the carbonate anion-radicals that were formed on the CaCO3 paper filler. No oxidation or change in crystallinity of cellulose was detected. Overall changes were too insignificant to make any conclusion on the contribution of mycobiota to the irradiation side-effects on the paper under the studied conditions.

Engaging patients with radiation related skin discomfort in self-care.

Patients receiving radiation to the breast can suffer painful, moist desquamation of the axilla and inframammary fold. Intensity of skin reactions will vary with each individual and be dependent on the total dose of radiation, treatment volume, daily fraction size, energy and type of radiation, as well as other personal factors (Gosselin, 2010). Treatment-related skin reactions make it difficult for women to wear clothing and undergarments comfortably and to perform daily activities. InterDry AG is a textile dressing with an antimicrobial complex that wicks away excess moisture and reduces friction, itching, and burning. Despite showing highly beneficial properties, there is no current published evidence indicating the utility of InterDry Ag for radiation skin reactions. This project evaluated the potential utility of InterDry Ag dressing to relieve discomfort of skin reactions for breast cancer patients undergoing radiation treatment. A descriptive design was employed to better understand the effectiveness of InterDry Ag dressing in reducing side effects of radiation treatment of the breast for women. Twenty eligible participants consented to participate. A radiation oncology nurse evaluated its effect every five days, utilizing a skin assessment questionnaire developed by the nursing team from clinical observations. A personalized skin care regimen was developed with each patient's feedback. A trusting relationship was developed between the nurse and patient by building rapport that indicated nursing care support. Some women began sharing their emotional stressors with nurses, as well as the physical pain they were experiencing due to the skin reactions. This observation resulted in provision of additional resources for women and engaging them in self-care using a patient-centred approach.

Screening of Intestinal Crypt Organoids: A Simple Readout for Complex Biology

Oral and intestinal mucositis is a debilitating side effect of radiation treatment. A mouse model of radiation-induced mucositis leads to weight loss and tissue damage, reflecting the human ailment as it responds to keratinocyte growth factor (KGF), the standard-of-care treatment. Cultured intestinal crypt organoids allowed the development of an assay monitoring the effect of treatments of intestinal epithelium to radiation-induced damage. This in vitro assay resembles the mouse model as KGF and roof plate-specific spondin-1 (RSPO1) enhanced crypt organoid recovery following radiation. Screening identified compounds that increased the survival of organoids postradiation. Testing of these compounds revealed that the organoids changed their responses over time. Unbiased transcriptome analysis was performed on crypt organoid cultures at various time points in culture to investigate this adaptive behavior. A number of genes and pathways were found to be modulated over time, providing a rationale for the altered sensitivity of the organoid cultures. This report describes an in vitro assay that reflects aspects of human disease. The assay was used to identify bioactive compounds, which served as probes to interrogate the biology of crypt organoids over prolonged culture. The pathways that are changing over time may offer potential targets for treatment of mucositis.

Implementing Evidence Based Practice in the Prevention of Radiodermatitis in an Outpatient Radiation Oncology Department

Radiation dermatitis is one of the most frequently observed acute side effects of radiation treatment. It can have a negative impact on quality of life and can cause delays in treatment. The current standard of care varies and is often based on anecdotal evidence. Most departments use a petroleum based gel. Calendula lotion is a less frequently recommended skin product. Is there recent research demonstrating significant effectiveness of calendula cream compared to petroleum based gel in decreasing radiation dermatitis to support a change in practice? A literature synthesis was completed. Picot question: among cancer patients who are undergoing radiation therapy, is treatment with a calendula lotion, as compared to treatment with a petroleum-based gel, less likely to have radiation dermatitis? There is some evidence that calendula is effective in reducing radiation dermatitis. It should be used in combination with skin cleansing, frequent assessments, and consistent education. There are many different calendula products on the market and personal preferences such as cost, availability, and ease of use should be considered with product recommendations. Patients should be informed that petroleum based gel does not cause harm, but there is no data to support any benefit. In addition, the Oncology Nursing Society lists calendula lotion as likely to be effective and petroleum based gel as effectiveness not established. Evidence pointed to a need to a change in practice. A power point presentation for nursing staff in the department of radiation oncology was completed to disseminate the findings of the literature review. Calendula lotions were recommended for use during treatment. Data was collected on patient preference of lotions used during radiation treatment including: effectiveness, ease of purchasing the product, cost, and ease of application. Twenty-one breast cancer patients undergoing daily radiation treatments were evaluated. Data was collected during weekly on treatment visit. The data collected found that all patients thought the calendula products were non-greasy and easy to apply. There was an 85% patient satisfaction with the lotion use on intact skin. A small % found the calendula products difficult to find and expensive. A new recommended skin care handout was completed, which included a list of products of various price ranges and where they could be purchased. Implications for practice: health care professionals can enhance patient care by providing education on evidenced based self-management measures. The change in practice on recommended skin care product resulted in 85% patient satisfaction and also promoted the use of evidence-based practice in radiation dermatitis.

LOW POWER BRACHYTHERAPY IN COMBINED TREATMENT IN PATIENTS WITH INTERMEDIATE RISK OF LOCALIZED PROST ATE CANCER

Objective . Estimation of the effectiveness of low power brachytherapy sources I-125 in the combined treatment in group of patients of intermediate risk of localized prostate cancer. Material and methods. The study included 126 patients with prostate cancer of intermediate risk. 104 patients (83,9%) were conducted low power brachytherapy I‑125 in combination with hormone therapy by analogues of LHWG. 22 patients (16.1%) received external beam irradiation in combination with brachytherapy I‑125 and hormonal treatment. Relapse-free survival of patients was evaluated in accordance with the criteria Phoenix (Nadir PSA + ng/ml). Evaluation of side effects of radiation treatment were carried out according to the RTOG criteria. Results. PSA relapse-free survival in the group of brachytherapy and hormone treatment at the time of observation 5 years amounted to 97.1%. In the group of combined radiation therapy with brachytherapy, and hormonal treatment PSA relapse-free survival rate was 95.5%.In both groups, relapse-free survival was noted in 96,8% of cases. Tumor-specific and overall survival in both groups was 100%. The major complications of treatment in both groups were radiation urethritis 1 to 2 degrees in 9.5% of cases (12 patients), urethral stricture in 5 patients (3.9% of cases), acute urinary retention in 1 patient (0.8% of cases) and late radiation rectitis of 2 degree in 1.58% of cases (2 patients). Conclusions. It is possible to draw tentative conclusions about the high rate of survival without progression in both treatment groups on the background of the relatively low frequency of adverse reactions. It is necessary further follow-up for patients with estimating of survival for a longer period.

Changes and predictors of radiation-induced oral mucositis in patients with oral cavity cancer during active treatment

PurposeRadiation-induced oral mucositis (OM) is the most debilitating side effect of radiation treatment in oral cavity cancer. The purpose of the study was to investigate change of prevalence of severe OM, OM-related symptoms, and predictors in oral cavity cancer patients during active treatment. Methods and sampleLongitudinal study design with repeated measures was used. Patients with oral cavity cancer were recruited from a head and neck outpatient radiation department at a major medical center in Taiwan. Patients' OM-related symptoms were measured at three time points. Patients' oral mucosa was assessed at nine time points. Generalized estimating equations (GEE) were used to analyze the predictive factors of prevalence of severe OM and OM-related symptoms. ResultsPatients reported highest prevalence of severe OM at T5 (5 weeks after beginning RT) and T6 (6 weeks after beginning radiation therapy, RT), with the combined chemotherapy and RT (CCRT) patients reporting a higher prevalence than those receiving RT alone. The peak of OM-related symptoms was at T8 (8 week after beginning RT), with primary symptoms of mouth pain, mouth dryness, eating difficulties, swallowing difficulties, and taste change. Patients with CCRT, a higher cumulative radiation dose, smoking, and lower body mass index (BMI) were at high risk to develop severe OM. OM-related symptoms were predicted by type of treatment, cumulative radiation dose, and smoking. ConclusionsPatients with oral cavity cancer suffer from OM and OM-related symptoms during aggressive RT or CCRT. Patient-specific oral care and emotional support are needed to relieve distressful OM-related symptoms during active treatment.

Assessment of radiation-induced xerostomia: validation of the Italian version of the xerostomia questionnaire in head and neck cancer patients.

Xerostomia is the most common acute and late side effect of radiation treatment for head and neck cancer. Affecting taste perception, chewing, swallowing and speech, xerostomia is also the major cause of decreased quality of life. The aims of this study were to validate the Italian translation of the self-reported eight-item xerostomia questionnaire (XQ) and determine its psychometric properties in patients treated with radiotherapy for head and neck cancer. An observational cross-sectional study was conducted in the Radiotherapy Unit of the Veneto Institute of Oncology - IOV in Padua. The XQ was translated according to international guidelines and filled out by 102 patients. Construct validity was assessed using principal component analysis, internal consistency using Cronbach's α coefficient and test-retest reliability at 1-month interval using the intraclass correlation coefficient (ICC). Criterion-related validity was evaluated to compare the Italian version of XQ with the European Organization for Research and Treatment of Cancer (EORTC) Core Quality-of-Life Questionnaire (QLQ-C30) and its Head and Neck Cancer Module (QLQ-H&N35). Cronbach's α for the Italian version of XQ was strong at α = 0.93, test-retest reliability was also strong (0.79) and factor analysis confirmed that the questionnaire was one-dimensional. Criterion-related validity was excellent with high association with the EORTC QLQ-H&N35 xerostomia and sticky saliva scales. The Italian version of XQ has excellent psychometric properties and can be used to evaluate the impact of emerging radiation delivery techniques aiming at preventing xerostomia.

Adenovirus-Mediated Bcl-Xl Gene Therapy Combined with Pronase Treatment Protects the Small Intestine from Radiation-Induced Enteritis in Mouse Model

Intestinal injury is a major side effect of radiation treatment for many malignancies. The present study investigated whether transducing Bcl-xL, a potent anti-apoptotic gene, into intestinal epithelial cells would exert protective effects against radiation-induced acute injuries. Methods: Adenoviral vectors containing the human Bcl-xL gene (AxCABclxL) or β-galactosidase gene (AxCAlacZ) driven by the CAG promoter were generated. To increase transduction efficiency into the mucosal epithelium, the intraluminal space of the small intestine of mice was washed with buffered-saline and mucus components were digested with Pronase MS®. Gene transduction was performed by injecting 2×108 pfu adenoviral vector into the pre-treated small intestine. Transduction efficiency was examined by X-gal staining 24 hours after AxCAlacZ infection. Radiation-induced acute injury of the small intestine was induced by whole body irradiation (15 Gy) performed 24 hours after adenoviral vector infection. Apoptotic epithelial cells were visualized by TUNEL assay. Morphological analysis was assessed by histological examination. Results: Successful transduction after Pronase MS® treatment was achieved in the basal crypt epithelial cells in the ileum, thought to be the location of stem cells, as determined by X-gal staining. The AxCABclxL group demonstrated significantly fewer radiation-induced apoptotic mucosal epithelial cells when compared with the other two groups at 6 hours after irradiation (p<0.05). At 72 hours after irradiation, the morphological appearance of the small intestine in the AxCABclxL group showed significantly less radiation damage in terms of mucosal thickness (p<0.001). Conclusions: The present study indicates that Bcl-xL gene expression using adenoviral vector-mediated transduction is a valuable approach to prevent intestinal injury caused by radiation exposure.

Radiation oncologists work to protect patients' oral health

Radiation oncologists work to protect patients' oral health

19 Identification of gene variants and gene expression profiles predicting long term adverse side effects of radiation treatment in breast cancer patients

The aim of the present study was to analyze the long-term incidence of hip complications after external beam radiation therapy compared with age-matched controls from the general population. We also investigated whether there were any dose−response associations.A total of 349 patients with prostate cancer treated to curative dose with external beam radiation therapy between 1997 and 2002 were included in the study. Physical and fractionation-corrected dose-volume descriptors were derived for the femoral heads, pubic bone, and sacrum. Information on skeletal events was collected for the patients and 1661 matched controls through the Prostate Cancer database Sweden. Uni- and multivariable Cox proportional hazard regressions were used to analyze the time to event.Data from 346 patients were available for analysis. The median mean physical dose and corresponding equivalent 2-Gy/fraction dose (EQD2) to the femoral heads were 35.5 Gy and 28.7 Gy, respectively. The median follow-up time was 16.0 years. During the follow up, 12 hip fractures occurred. Hip osteoarthritis was diagnosed in 36 cases, with 29 cases leading to replacement surgery. No increased risk of hip fractures was found. Hip osteoarthritis was the only event for which a statistically significant difference was found between the irradiated cohort and the controls (cause-specific hazard ratio: 1.56; 95% confidence interval, 1.07-2.26; P = .02). The cumulative incidence of osteoarthritis at 10 years was 8.1% and 4.9% in the irradiated cohort and the controls, respectively. A significant relationship between osteoarthritis and the volume of the femoral head receiving ≥40 Gy (ie, EQD2) was found.In this study of 346 patients treated with conventional radiation therapy, we found no increased risk of hip fracture but an increased risk of clinically relevant osteoarthritis at long-term follow up. Our results indicate a dose–response relationship between osteoarthritis and the volume of the femoral head receiving an EQD2 dose of ≥40 Gy.

Somnolence syndrome after cranial irradiation: a literature review

AbstractSomnolence syndrome is a commonly seen, early‐delayed side effect of radiation treatment to the brain. Despite being a recognised side effect for over 30 years, many associated aspects of the syndrome are still unclear, such as which patients are most prone to the condition, what are its associated symptoms, what is its aetiology, what treatment factors affect it and how can it be managed? Literature has shown that somnolence syndrome can occur in children and adults after receiving cranial irradiation. The syndrome is characterised by a variety of symptoms, including mild drowsiness to extreme exhaustion, low‐grade fever, nausea, anorexia and headache. Symptoms generally appear between five to six weeks after the completion of treatment. Why and how the syndrome comes about is still uncertain. Popular theory suggests that it is due to transient demyelination of the nerve fibre. The condition has been shown to appear at doses as low as 12 Gy and up to 54 Gy with a fraction size dependence not yet established. The use of steroid therapy has proven to be an effective method to reduce the occurrence of somnolence syndrome in patients receiving cranial irradiation, with the optimal regime still to be determined. Health care professionals should acknowledge and warn their patients of the syndrome, ensuring proper care is available if it develops. Further study is required on the aetiology of the syndrome, the late neurological outcomes of the syndrome and the optimal steroid schedule for its management.