Grade Of Telangiectasia Research Articles

Long-term clinical outcomes of non-melanoma skin cancer patients treated with electronic brachytherapy.

High-dose-rate electronic brachytherapy (eBx) is a non-surgical treatment option for non-melanoma skin cancer (NMSC) patients. This study assessed long-term effectiveness and safety of eBx for the treatment of NMSC. A chart review was conducted to identify subjects who had five or more years since their last eBx treatment fraction. Subjects meeting these criteria were contacted to determine their interest in participating in a long-term follow-up study. Those who agreed, underwent a follow-up visit where consent was obtained, and their lesions were clinically assessed for recurrence and long-term skin toxicities. History and demographic data were retrospectively collected, and treatment method was verified. 183 subjects with 185 lesions were enrolled into this study at four dermatology centers in two practices in California. Three subjects in the analysis were less than 5 years from the last treatment to follow-up visit. All lesions were stage 1 basal cell carcinoma, squamous cell carcinoma, or squamous cell carcinoma in situ. Recurrence rate for the 183 subjects was 1.1%. Long-term skin toxicities were reported in 70.0% of the subjects. Hypopigmentation grade 1 was observed in 65.9% of the lesions, telangiectasia grade 1 was seen in 22.2%, scarring grade 1 in two subjects (1.1%), hyperpigmentation grade 1 in two subjects (1.1%), and induration grade 2 in one patient (0.5%). The induration grade 2 was located on the upper back and did not limit instrumental activities of daily living (ADLs). Electronic brachytherapy for the treatment of non-melanoma skin cancer is safe and effective, showing excellent long-term 98.9% local control through a median follow-up of 7.6 years (n = 183), with minimal long-term toxicities.

Bevacizumab Eye Drops Vs. Intra-meibomian Gland Injection of Bevacizumab for Meibomian Gland Dysfunction-Associated Posterior Blepharitis.

AimsThis study aimed to evaluate the efficacy and safety of bevacizumab eye drops compared with those of an intra-meibomian gland (MG) injection of bevacizumab when performed in conjunction with standard lid hygiene in patients with meibomian gland dysfunction (MGD)-associated posterior blepharitis.MethodsThis prospective, open-label, observer-blinded randomized controlled trial included 60 eyes of 30 patients with MGD-associated posterior blepharitis who exhibited lid margin telangiectasia, treated at the Chula Refractive Surgery Center of King Chulalongkorn Memorial Hospital. Patients were randomized to receive lid hygiene plus 0.05% bevacizumab eye drops or a single intra-MG injection of 2.5% bevacizumab. All patients were instructed to perform routine lid hygiene care as demonstrated in an instructional video. Primary outcomes included telangiectasia grading and the lid margin neovascularized area (LMNA). Secondary outcomes included the Ocular Surface Disease Index (OSDI) score, corneal staining, meibum quality, meiboscore, conjunctival redness, fluorescein break-up time (FBUT), lipid layer thickness, treatment compliance, and adverse events. All parameters were evaluated before and 3 months after treatment.ResultsAfter treatment, there were no significant differences in telangiectasia grade and LMNA between groups (mean difference, −0.14, 95% CI −0.42 to 0.15, p = 0.338, −0.1, 95% CI −1.1 to 0.8, p = 0.761, respectively); however, the injection group exhibited significant improvements in both telangiectasia grade and LMNA, while, in the eye drop group, only telangiectasia grade showed a significant improvement relative to baseline. The injection group also exhibited significant improvements in corneal staining (mean difference, −0.78, 95% CI −1.29 to −0.27, p = 0.003), meiboscores (mean difference, −0.37, 95% CI −0.52 to −0.21, p <0.001), and FBUT (mean difference, 1.25, 95% CI 0.21–2.29, p = 0.019) compared to the eye drop group. OSDI scores, corneal staining, meibum quality, meiboscores, and conjunctival redness significantly improved relative to baseline in both groups. No local and systemic adverse event was observed at month 3 in both groups.ConclusionWhen performed with regular lid hygiene, intra-MG injection and topical application of bevacizumab are safe and effective for improving lid margin telangiectasia and the signs and symptoms of MGD-associated posterior blepharitis. This therapy may represent an alternative or adjunctive treatment for patients with MGD-associated posterior blepharitis.

Efficacy of Topical Ivermectin 1% in the Treatment of Demodex Blepharitis.

Purpose:The purpose of this study was to evaluate the efficacy of topical ivermectin 1% cream application on the eyelashes in combination with eyelid hygiene in the treatment of Demodex blepharitis.Methods:One hundred two eyes of 102 patients with symptomatic Demodex blepharitis were divided into 2 groups according to the use of topical ivermectin in this retrospective case–control study. The ivermectin group (n = 51) applied topical ivermectin 1% cream on the eyelashes for 15 minutes once weekly, but the control group (n = 51) did not. In both groups, eyelid hygiene was performed once daily. The Standard Patient Evaluation of Eye Dryness (SPEED) symptom questionnaire score, Oxford staining score, eyelid debris, eyelid redness/swelling, and telangiectasia were assessed during the follow-up visits.Results:The mean follow-up periods of the ivermectin and control groups were 15.1 ± 9.7 weeks and 14.8 ± 8.6 weeks, respectively. The SPEED score and eyelid debris grade were significantly improved in both groups during the follow-up, although the SPEED score and eyelid debris grade showed greater changes in the ivermectin group than in the control group. The Oxford staining score, eyelid redness/swelling grade, and telangiectasia grade were significantly improved only in the ivermectin group but not in the control group.Conclusions:In patients with Demodex blepharitis, the use of topical ivermectin 1% cream for 15 minutes once weekly in addition to eyelid hygiene had more significantly improved symptoms, ocular surface staining, eyelid debris, redness/swelling, and telangiectasia as compared with eyelid hygiene alone. These findings support the efficacy of topical ivermectin 1% cream application in the treatment of Demodex blepharitis.

Comparison of cosmetic results after treatment in women with breast cancer who received additional radiation to the tumor bed

Objective: to compare cosmetic result of two techniques of boost delivery to the tumor bed after breast concerving treatment.Materials and methods. A retrospective analysis of the results of treatment of patients with stage IA–IIIA breast cancer from three groups was carried out: 1) 45 women received tumor bed boost with interstitial brachytherapy; 2) 48 women with electrons (energies from 6 to 18 MeV); 3) 59 women did not receive additional irradiation of the removed tumor bed. The analysis of the cosmetic results of treatment was carried out using subjective and objective methods using mammographic data, including information about the most common complications from the skin, subcutaneous fat and remaining breast tissue, such as telangiectasias, fibrosis, and fatty necrosis.Results. According to the results of self-assessment by patients and assessment by independent expert (oncologist), carried out on a 4-point Harvard scale, the cosmetic result in most cases was characterized as “excellent” or “good”. Frequency and grade of telangiectasia were used for objective evaluation of skin complications and were similar in all 3 groups. The incidence of localized fibrosis also did not differ and was most often observed as absent or moderate (grade 1–2). There were no significant differences between the severity and incidence of fatty necrosis on both physical examinations and when it was evaluated on mammography.Conclusions. additional irradiation of the tumor bed does not compromise cosmetic result of the treatment. In most cases (57–78 %) estimated as “good” and “excellent”. The cosmetic result of the treatment does not depend on the technology of boost delivery.

Phase 2 Trial of Accelerated Partial Breast Irradiation (APBI) Using Noninvasive Image Guided Breast Brachytherapy (NIBB)

Noninvasive image guided breast brachytherapy (NIBB) is a novel approach to delivery of accelerated partial breast irradiation (APBI) that may hold advantages over established techniques. NIBB is not invasive but maintains a high level of precision by using breast immobilization via breast compression and image guidance; it therefore does not require large planning tumor volume margins. We present the primary outcomes of this prospective phase 2 study (BrUOG Br-251). Eligible patients with early-stage breast cancer underwent NIBB APBI using a dose 34 Gy in 10 fractions delivered daily or twice a day. Treatment was delivered using an Ir-192 high-dose-rate source via specialized applicators. Two orthogonal treatment axes were used for each fraction. The primary endpoints were late toxicity and cosmesis assessed at 2 and 5 years. Toxicity was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. Cosmesis was assessed using the NRG/Radiation Therapy Oncology Group scale. Ipsilateral breast tumor recurrence was defined as any recurrence or new primary in the treated breast. Forty patients underwent protocol treatment. Median patient age was 68 years (50-92 years). Mean tumor size was 1.1 cm (0.3-3.0 cm). Among the cohort, 62.5% had invasive carcinoma and 37.5% had ductal carcinoma in situ. Thirty-nine percent elected to receive hormone therapy. No grade ≥3 late toxicities were observed at any time point. Grade 2 toxicity was 5% and 10% at 2 and 5 years, respectively. Telangiectasia grade 1 and 2 occurred in 27.5% and 5%, respectively. Breast separation of >7 cm was associated with telangiectasia (P < .01). The rate of good to excellent cosmetic outcome was 95% at 2 years and 100% at 5 years. With a median follow-up of 68 months, the actuarial 5-year freedom from ipsilateral breast tumor recurrence was 93.3% (±4.8%), and overall survival was 93.7% (±4.4%). NIBB to deliver APBI is well tolerated with a low incidence of significant late toxicity and has favorable cosmetic outcomes. Continued evaluation of the NIBB APBI technique in a larger cohort is warranted.

Abstract P5-21-03: Concurrent loco-regional radiotherapy and trastuzumab in early-stage breast cancer: Long term results of prospective single-institution study

Abstract Purpose: To evaluate the early and late heart and skin toxicities, as well as the efficacy of concurrent adjuvant trastuzumab-radiotherapy (RT) for breast cancer (BC), with group with internal mammary chain (IMC) RT. Material and methods: Prospective study of 308 patients (pts) treated between 2000 and 2009 by concurrent trastuzumab with normofractionated RT for non-metastatic BC. Left ventricular ejection fraction (LVEF) was assessed by echocardiography or myocardial scintigraphy at baseline, before and after RT, every three months for one year, then annually. A LVEF strictly lower than 55%, was considered as altered. Trastuzumab was delivered every three weeks (8 mg/kg in the first infusion then 6 mg/kg) during a median time of 12 months (3–62). All toxicities were evaluated using the Common Terminology Criteria for Adverse Effects version 3.0. Survival data were defined as the time from the histological diagnosis of BC until occurrence of the event. Loco-regional recurrence free- and alive pts were censored at the date of their last known contact. Survival and interval rates as well as their confidence interval (CI) were calculated using the Kaplan–Meier method. Results: Median age was 52 years (25–83). Median follow-up was 50 months (13–126). The clinical tumour staging was: T0 or T1 in 131 pts (43.4%), T2 in 122 pts (40.4%), T3 or T4 in 49 pts (16.2%). The regional lymph nodes were histologically involved in 132 pts (43.0%). The left breast was treated in 155 pts (50.3%). The IMC was irradiated in 227 pts (73.7%), among them 114 (37.0%) in the left side. Before trastuzumab, anthracycline-based regimens were administered in 280 pts (90.9%). The median dose of trastuzumab was 6145 mg (1845–29180). Acute skin toxicity was acceptable with 226 (74.1%) grade 1, 67 (22.0%) grade 2 and 12 (3.9%) grade 3 skin reactions. Esophagitis was observed in 31 pts (10.0%): 26 (8.4%) grade 1; 4 (1.3%) grade 2, and 1 (0.3%) grade 3. Out of 286 pts with assessments at the median time of 23 months, late telangiectasia grade 1 occurred in 14 pts (4.9%) and grade 2 in 10 pts (3.5%), local pain grade 1 in 39 pts (13.7%) and grade 2 in 8 pts (2.8%), fibrosis grade 1 in 53 pts (18.6%) and grade 2 in 20 pts (7.0%). At the completion of RT, 11 pts (3.6%), whose cardiologic assessment at baseline was normal, presented a clinically silent LVEF alteration. During follow-up, 44 patients experienced cardio-vascular morbidity revealed by: asymptomatic LVEF alteration (50.0%), thrombo-embolic event (18.2%), tachycardia (15.9%), ischemic cardiomyopathy (6.8%), pericarditis (4.5%), hypertrophic cardiomyopathy (2.3%) or arterial hypertension (2.3%). The cumulative incidence of these events at 48 months was 13.3% CI95% [9.4; 17.2]. A symptomatic congestive heart failure was reported for 3 pts (1.0%). No death of cardiac origin was observed. At 48 months, loco-regional control was 95% CI95% [92; 98] and overall survival was 98% CI95% [96; 100]. Conclusions: In this prospective study of BC pts treated with trastuzumab and RT, both the rates of skin and esophageal toxicities were acceptable with excellent local control. Further follow-up is warranted to assess late cardiac toxicity. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-21-03.

Telangiectasia and venous reflux in the Edinburgh Vein Study

The purpose of this study was to correlate the clinical findings in the Edinburgh Vein Study with the results of duplex scanning of the deep and superficial venous systems. An age-stratified random sample of 1566 people (699 men and 867 women) aged 16-64 were selected from computerized age-sex registers of participating practices (twelve general practices with catchment areas geographically and socioeconomically distributed throughout Edinburgh). Screening included clinical examination, photography and duplex ultrasonography of the superficial veins and the deep veins down to popliteal level. Telangiectasia and varicose veins were graded 1-3 according to severity. Since there was good agreement between the duplex findings of the right versus left legs, the current analyses are based on 1092 subjects (486 men and 606 women) with complete duplex scan data in their left legs. There was no significant trend of increasing incompetence in either the deep veins only (P = 0.214) or in the combined deep and superficial veins (P = 0.111) with increasing severity of the telangiectasia. There was a statistically significant trend for increasing incompetence in (a) the superficial veins (P = 0.006) and (b) either the superficial or deep veins (P < 0.001) to be associated with advancing grade of telangiectasia. When stratified by gender, significant trends were maintained for male superficial vein incompetence and for either superficial or deep incompetence in both genders. Examination of incompetence in individual venous segments showed that increasing severity of telangiectasia was significantly associated with an increasing proportion of reflux in the upper and lower great saphenous and femoral vein segments. There was no significant association between small saphenous incompetence and increasing grade of telangiectasia. There is a significant, but not wholly consistent, association between grade of telangiectasia and reflux in both the deep and superficial systems. This association does not apply to the small saphenous system.

Healing of Late Endoscopic Changes in the Rectum between 12 and 65 Months after External Beam Radiotherapy

To evaluate the time course of late rectal mucosal changes after prostate cancer radiotherapy (RT). A rectosigmoidoscopy was performed at 12, 24, and 65 months after RT in 20 patients. Rectal mucosal changes (telangiectasia, congested mucosa, ulceration, stricture, and necrosis) were scored and documented according to the Vienna Rectoscopy Score (VRS, score 0-3). VRS of 0 and 3, were found in 20% of patients (n = 4) and 5% of patients (n = 1), respectively at all time points. A shift of the VRS from 2 to 1 was found with incidence rates of 60% at 12 months and 20% at 65 months, which is equivalent to an improvement rate of 67%. Laser coagulation was required in 3 patients (15%) with rectal bleeding due to telangiectasia grade ≥2. Late rectal mucosal changes are frequent after pelvic RT. Generally only the incidence rates corresponding to the initial diagnosis of the complications, independent of subsequent recovery, are reported. The results reported in the present study show that complications often improve over time. Hence, the usual reports of complication rates overestimate the proportion of patients presenting with side effects of certain grades.

The acute skin and heart toxicity of a concurrent association of trastuzumab and locoregional breast radiotherapy including internal mammary chain: A single-institution study

Background To evaluate the skin and heart toxicity of a concurrent adjuvant trastuzumab-radiotherapy for breast cancer (BC), especially in the case of internal mammary chain (IMC) irradiation. Material and methods Prospective study of 106 patients treated between 06/2003 and 03/2007 by concurrent trastuzumab-radiotherapy for non-metastatic BC. Left ventricular ejection fractions (LVEF) was assessed at baseline, before and after radiotherapy and then every 4–6 months. All toxicities were evaluated using CTCAEV3. Results Median age was 52 years (25–76). Chemotherapy with anthracycline was administered in 92% of patients. All patients received trastuzumab every three weeks (8 mg/kg followed by 6 mg/kg) for a median duration of 12 months (3-40). The IMC was irradiated in 83% of patients. There were: 87 grade 1, 14 grade 2 and 2 grade 3 skin reactions. There were 13 oesophagitis: 9 grade 1; 3 grade 2, and 1 grade 3. Out of 101 patients with assessments after 6 months, late telangiectasia grade 1 occurred in 5 patients, local pain grade 1 in 19 patients and grade 2 in 3 patients, fibrosis grade 1 in 16 patients. A reversible grade ⩾2 left ventricular systolic dysfunction occurred in 6 patients. Conclusion In this prospective study of breast cancer patients treated with trastuzumab-radiotherapy with, in most cases, anthracycline-based chemotherapy and IMC irradiation, both the rate of abnormal LVEF after concurrent trastuzumab-radiotherapy and the skin toxicity were deemed acceptable. Further follow-up is needed.

Telangiectasia in the Edinburgh Vein Study: Epidemiology and Association with Trunk Varices and Symptoms

ObjectiveLittle research has been devoted to telangiectasia. The purpose of this study was to analyse the data in the Edinburgh Vein Study to determine the prevalence of telangiectasia in the general population, to analyse the demographic characteristics and association with symptoms and to compare the findings to those relating to varices of the saphenous systems. DesignCross-sectional population study. SettingTwelve general practices with catchment areas geographically and socioeconomically distributed throughout Edinburgh. ParticipantsAn age stratified random sample of 1566 people (699 men and 867 women) aged 16–64 selected from computerised age-sex registers of participating practices. MethodsIncluded in the population screening was a clinical examination, photography and duplex ultrasonography of the superficial veins and the deep veins down to popliteal level. Telangiectases and varicose veins were graded 1–3 according to severity. ResultsA total of 1322 (84%) of the population were classified as having telangiectasias in their right legs; 555 (79%) of men and 767 (88%) of women; 1226 (92%) as grade 1 and 96 (8%) as grades 2 and 3. There were no significant differences between left and right legs (p=0.144). The commonest locations for telangiectases were the postero-medial aspects of the thigh, popliteal fossa and upper one third of calf. There was a highly significant association between the degree of severity of varicose veins and the grade of telangiectasia (p<0.001). Less than 1% of subjects with grades 2–3 trunk varices were free of telangiectasia, but 51% of subjects with grades 2–3 telangiectasia had no clinical evidence of varicose veins. There was a significant linear trend in the proportion of subjects reporting heaviness, swelling, aching and cramps being highest among those with neither telangiectasia nor varicose veins, lower in those with telangiectasia or varicose veins only and lowest in subjects having both. The highest frequency of most symptoms was found in subjects with both telangiectasia and varicose veins. ConclusionsTelangiectasia is so common in the general population, especially in women, as to represent the norm. The anatomical distribution is entirely different from the distribution of the skin and subcutaneous manifestations of chronic venous insufficiency. Our confirmation of a strong association between trunk varices and grades 2–3 telangiectasia suggests the need for controlled studies into which condition should be treated. We found no evidence that telangiectasia per se was entirely responsible for leg symptoms.

Long term results of pulse dose rate brachytherapy for repeat irradiation in locally recurrent breast cancer

Purpose: To assess the effectiveness and tolerability of PDR-brachytherapy as a second radiotherapy treatment regime for locally recurrent breast tumours. To evaluate the feasibility of interstitial partial breast irradiation after local excision as an alternative to mastectomy in patient with recurrent breast cancer. Material and methods: 32 patients with small local recurrent breast cancer initially undergoing breast conserving therapy, which included postoperative radiotherapy, were prospectively treated with local tumour excision and PDR-brachytherapy from 11/1996 to 09/2005. Recurrences occurred after a median interval of 119 months (range, 13–310 months) after primary treatment. All patients received local excision for their recurrence followed by radiation therapy with median 50.4Gy (range, 48–60.2Gy) PDR-brachytherapy. The prescribed dose was 0.6–1Gy per pulse. 32 patients were examined for local tumour control, in 18 patients late side effects and global cosmetic outcome have been evaluated. Results: Thirty (93.8%) of 32 patients are still alive after a median follow up of 41 months (range 6–117) after recurrent breast cancer. Four of these patients showed signs of having distance disease (2) or axillar lymph node metastasis (2). Two different women had secondary local tumour recurrence 12 months after PDR-brachytherapy and had to undergo mastectomy. Three women had contralateral breast cancer (before the appearance of ipsilateral recurrent breast cancer) and one patient had an ipsilateral tumour with a different histology to the primary tumour. One women died due to distance metastasis (156 months after primary tumour), the other due to cardiac problems. Global cosmetic result, classified by radiooncologists, was excellent to fair in 64.7% of patients. From the patients view, results were even better, with 88.2% excellent to fair cosmetic outcome. Concerning late side effects, scored using LENT-soma, no telangiectasis was found in 66.7% of patients. Each time 16.7% of women developed telangiectasia grade 1 and grade 2. Fibrosis grade 1 was found in 16.7%, grade 2 in 61.1% and grade 3 in only one patient (5.6%). Atrophy was found in 55.6% of women, mostly grade 1. Conclusion: PDR-brachytherapy following surgical intervention for locally recurrent breast cancer after primary BCT gives encouraging results in patient's local tumour control and recurrent free survival. Furthermore it is a well tolerated therapy with moderate late side effects and good cosmetic outcome and gives an attractive opportunity to mastectomy.

Teilbrustbestrahlung beim Mammakarzinom mit günstigen prognostischen Faktoren: 3-Jahres-Ergebnisse der deutsch-österreichischen Phase II-Studie

To evaluate perioperative morbidity, toxicity and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole radiation modality after breast conserving surgery. From 11/2000 to 11/2004, 240 women with early stage breast cancer participated in a protocol of tumor bed irradiation alone using pulsed dose rate (PDR) or high dose rate (HDR) interstitial multi-catheter implants (partial breast irradiation). Perioperative morbidity, acute and late toxicity as well as cosmetic outcome were assessed. Of the first 51 patients treated in this multicenter trial, we present interim findings after a median follow-up of 36 months. Perioperative Morbidity: Bacterial infection of the implant: 2 % (1/51). Acute toxicity: radiodermatitis Grade 1: 4 % (2/51). Late toxicity: breast pain Grade 1: 8 % (4/51), Grade 2: 2 % (1/51); dyspigmentation Grade 1: 8 % (4/51); fibrosis Grade 1: 4 % (2/51), Grade 2: 8 % (4/51); telangiectasia Grade 1: 10 % (5/51), Grade 2: 4 % (2/51). Cosmetic results: Excellent and good in 94 % (48/51) of the patients. This analysis indicates that accelerated partial breast irradiation with 192-iridium interstitial multicatheter PDR-/HDR-implants (partial breast irradiation) is feasible with low perioperative morbidity, low acute and mild late toxicity at a median follow-up of 36 months. The cosmetic result is not significantly affected.

Deterministic rather than stochastic factors explain most of the variation in the expression of skin telangiectasia after radiotherapy

Background: The large patient-to-patient variability in the grade of normal tissue injury after a standard course of radiotherapy is well established clinically. A better understanding of this individual variation may provide valuable insights into the pathogenesis of radiation damage and the prospects of predicting the outcome. Purpose: To estimate the relative importance of the stochastic vs. patient-related components of variability in the expression of radiation-induced normal tissue damage. Methods and Materials: The study data were selected from the dose fractionation studies of Turesson in Gothenburg. Patients treated with bilateral internal mammary fields, who completed at least 10 years of follow-up, were included. The material included 22 different fractionation schedules (11 on each side). Telangiectasia was graded on an arbitrary 6-point scale using clinical photographs of the irradiated fields. For each field, in each patient, a curve showing the grade of telangiectasia as a function of time was constructed. A measure of radioresponsiveness was obtained from the difference between the area under the curve (AUC) for a specific field in an individual patient minus the mean AUC of fields receiving the same dose fractionation schedule. As a confirmatory procedure, the same analysis was repeated with a weighted area under the curve (WAUC) approach, in which the time spent at or above each of the 5 nonzero grades was calculated for each field in each patient. These times were used as explanatory variables in a linear regression analysis of biological equivalent dose to establish statistically the weight of each grade providing the optimal relationship between dose and effect. Using these regression coefficients, the weighted area under the grade-time curve (WAUC) was estimated. Results: The AUC was significantly correlated with the isoeffective dose in 2-Gy fractions (ID2). An analysis of variance components, using the maximum likelihood method, showed that 90% (with 95% confidence limits 65% and 100%) of the variance in radioresponsiveness in the right-sided field was explained by the radioresponsiveness on the left-sided field. Through the linear regression analysis between the AUC and the ID2, it was estimated that patients with a reaction that is 1 SD from the population mean would require a dose modification of approximately 23 Gy (from the group mean of 56 Gy) to give them a level of reaction similar to the group average. Similarly, the WAUC was significantly correlated with the ID2, and 81% (with 95% confidence limits 49% and 100%) of the variance in radioresponsiveness in the right-sided field was explained by the radioresponsiveness on the left-sided field. Patients with a reaction that is 1 SD from the population mean would require a dose modification of approximately 21 Gy (from the group mean of 56 Gy) to give them a level of reaction similar to the group average. Conclusion: For a given fractionation schedule, patient-related factors explain 81–90% of the patient-to-patient variation in telangiectasia level seen after radiotherapy. The remaining 10–19% are explained by stochastic effects. This observation encourages further research into genetic or phenotypic assays of normal tissue radioresponsiveness.

Endoscopic scoring of late rectal mucosal damage after conformal radiotherapy for prostatic carcinoma

Purpose: To describe rectal mucosal damage in an endoscopic study after conformal radiotherapy of prostate cancer and to correlate this with clinical outcome. Materials and methods: Flexible rectosigmoidoscopy was performed on 44 patients who voluntarily accepted the examination. The median follow-up was 29 months (20–41 months) after 3-D-planned conformal radiotherapy of prostate cancer (66 Gy at the ICRU Reference point, 2 Gy per fraction). To enable a systematic topographic description of endoscopic findings the rectum was divided into four sections. Additionally we differentiated between anterior, posterior, right and left lateral rectal wall. Due to the lack of an existing valid graduation system for radiation induced proctitis, we introduced a six-scaled rectoscopy score for describing and reporting endoscopic findings based on the standardization of the endoscopic terminology published by the ESGE (European Society for Gastrointestinal Endoscopy). Endoscopic findings were compared to the EORTC/RTOG morbidity score. In addition, since 3-D dose distribution of organs at risks was available, a correlation could be made between the location of the rectal lesions and the absorbed dose at that level. Results: In general, endoscopic findings increased from the proximal rectum to the anorectal transition, as well as from the posterior to the anterior rectum wall. Telangiectasia grade 1 and 2 were observed at the whole circumference, only telangiectasia grade 3 were limited to the high dose region at the anterior rectum wall. Similar results were found for congested mucosa (reddening and edematous mucosa). Correlation with symptoms, 7/9 patients who suffered from intermittent rectal bleeding (EORTC/RTOG grade 2) had multiple telangiectasia grade 2–3 and/or congested mucosa grade 3 and microulcerations. However, the same extent of mucosal damage (rectoscopy score 2–3) was found in seven out of 35 patients who have never developed a period of macroscopic rectal bleeding. Conclusion: Rectoscopy offers the possibility of detecting signs of tissue dysfunction below the level of subjective symptoms. Systematic analytic examinations such as rectoscopy, in addition to clinical examinations, as already foreseen in the LENT-SOMA-score, will be necessary due to the fact that even telangiectatic lesions have been observed for asymptomatic patients. For the opportunity of sharing and comparing data collected from endoscopy after radiotherapy a graduation system as proposed based on a standardisation of the endoscopic terminology will be necessary.

Fractionation sensitivity and latency of telangiectasia after postmastectomy radiotherapy: a graded-response analysis

Latent time and dose-fractionation characteristics for telangiectasia are estimated in a series of 401 treatment fields in 335 patients treated with postoperative radiotherapy at the Department of Oncology in Gothenburg. To this end an extension of the mixture model to include graded-response data is proposed. In addition, a method for non-parametric estimation of median latent time is presented. Severity of telangiectasia was scored on an arbitrary 4-point scale ranging from no reaction to severe telangiectasia. The estimated number of tissue-rescuing units for the three grades of telangiectasia increased with increasing grade of reaction. The average length of time to expression of 90% of the ultimately expected damage was estimated at 6.6 years, 9.1 years and 14.8 years for grades ⪖ 1, ⪖ 2 and equal to 3, respectively. Thus increasing grades of telangiectasia occurred at progressively longer follow-up times. A statistically significant correlation was found between the level of tissue injury and the latent period. Patients with a high probability of ultimately expressing a specific grade of telangiectasia had a shorter latent period the higher the level of injury.