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PubMed1998

[Use of an amorphous dressing in the skin care of patients after radiotherapy].

INTRODUCTION: Skin wounds caused by acute radiogen toxicity are an important side effect caused by radiotherapy treatment, therefore the prevention and immediate care is a challenge for the nursing staff. The actual traditional treatment is based on Liniment Oleocalcareo creams with Zinc Oxide as a principal agreement, but we have discovered a new alternative that at a first instance respond more effectively to the patients needs, and are classified with the terminology "amourphous dressing". MATERIAL AND METHODS: Retrospective study of the application of the amorphous dressing on 41 patients during the period between February and June 1998 in the Radiotherapy Unit of the "Hospital Universitario Sant Joan de Reus" (Tarragona). RESULTS: The application of the amorphous dressing has allowed us to evidence a slowness and decrease in the intensity of the skin damage caused by the radiation treatment. There has been a 63.86% decrease of the nursing treatment of the skin wounds as a consequence of the radiotherapy. The use of the amourphous dressing with Zinc Oxide favours the ephithelization of the moist wounds. No adverse reaction of the dressing has been observed during the time of the study, and no infections process has been detected, in none of the case was the radiotherapy treatment interrupted due to radiodermatitis, and in none of the cases an alternative dressing was needed. In some cases the amourphous dressing in combination with a tulle and a polyamide grille the healing time of the radiodermitis wound was significantly decreased. It has also been verified that the application as well as the removal of the dressing does not involve any difficulty neither for the patients nor for the nursing staff. There also has been a better level of acceptance of the new amourphous dressing as well from both patients and staff, seeing that the therapeutic results is significantly superior than that of the previously used methods. CONCLUSIONS: Having carried out the study in our Radiotherapy Unit we can assure that the new amourphous dressing, along with a strict control of the patient's evolution, increases the comfort and the quality of life of the patients. The multidisciplinary acceptance of the new treatment in a protocolized manner implies an increase in the patient quality care as well as contributing to a more efficient allocation of resources.

Adult↗

PubMed1978

[Roentgen therapy of dermatoses: indications and hazards].

Indications for radiotherapy of benign dermatoses have decreased markedly during the past decades. The remaining indications are reviewed. Side effects of ionizing radiation therapy are discussed in detail, with special emphasis on radiodermatitis and radiation cancer of the skin, mutagenic and genetic effects of x rays, and induction of carcinogenesis of interanl organs. Thyroid cancer is used as an example to discuss modern theories of radiocarcinogenesis and risk coefficients of various organ systems. Guide lines for radiotherapy of benign dermatoses are proposed.

Acne Vulgaris↗

PubMed1991

[Radiology and radiation protection in dental medicine. 1: Biological effects resulting from exposure to ionizing radiation].

The different types of biological effects produced by ionizing radiations are reviewed. Among the early effects following an acute exposure, the bone marrow syndrome and the intestinal syndrome are briefly described. They are unlikely to appear in the current conditions encountered in dental radiology. As far as skin exposure is concerned (e.g. fingers, hands), acute reactions (moist desquamation, ulceration, etc.) require high doses which are encountered only in accidental conditions. However, chronic dermatitis after repeated low dose exposure is one of the major risks in dental radiology (even without previous acute lesions), if the recommendations of radioprotection are not followed. The danger is ultimately the transformation into a radio-induced skin cancer. Among the late effects, after chronic exposure at low doses, cancer induction and the genetic effects are the most important. The risk coefficient for cancer induction is expressed by the number of lethal cancers induced per unit dose. In his last report (1988), the UNSCEAR assessed the risk coefficient between 4.5 and 7% for an absorbed dose of 1 Gy (low-LET radiation, high dose delivered at high dose rate). A low doses and low dose rates (X-and gamma rays), the UNSCEAR recommends to reduce the above risk coefficients by a factor between 2 and 10. The risk coefficient at low doses is difficult to evaluate since the rate of radio-induced cancers is small compared to the spontaneous cancer incidence. The risk of a severe genetic effect is about 1/3-1/4 of the risk of lethality from radio-induced cancer. Finally, the characteristics of the stochastic and non-stochastic effects are described. The acute effects, the late radiodermatitis and the cataract are examples of non-stochastic effects, while cancer induction and the genetic effect are stochastic effects. In the Appendix, the most important quantities and units, used in radiation protection, are presented.

Bone Marrow↗

PubMed1990

[Significance of radiogenic damage for lymphology].

Of the various forms of radiation injury resulting from irradiation several reactions are important in lymphology since they respond well to manual lymphatic drainage according to Vodder-Asdonk, to surgery or to fibrosis stretching. In acute and sub-acute radiation injury there is usually transient inflammatory swelling, e.g. in the extremities, and radiogenic oedema of the breast which reacts favourably to manual lymphatic drainage. Late sequelae such as ulcerating radiodermatitis and lymphatic oedema may be improved by manual lymphatic drainage or surgery as well as radiogenic fibrosis which is treated with intensive but careful stretching which may, in part, prevent further plexus injury.

Humans↗

PubMed1990

[Skin carcinoma of the face: surgery or radiotherapy?].

Surgical exeresis and radiation therapy are effective means of treatment for facial carcinomas. In some areas that are difficult to manage (nose, ears, periorbital region), the respective importance of both approaches is discussed. We report on the retrospective study of 309 patients seen after a skin carcinology consultation in which a dermatologist, a surgeon and a radiotherapist were associated. These 309 patients, with a mean age of 73 years, presented with 375 carcinomas, i.e. 246 basal-cell (BC) and 119 epidermoid (EC) carcinomas. The most frequent sites were the nose (33.8% of BC), the inner canthus (12.7% of BC), the lower lip (23.8% of EC) and the ear (15.6% of EC). Management mainly consisted of surgery (50.8%) then Curie therapy (37%). The rate of recurrence was the same (10.5%) after surgery and radiation therapy. The study of the results leads us to advocating surgery for carcinomas of the ear (due to the occurrence of radiation necrosis in every third case after radiation therapy) and Curie therapy for carcinomas of the lower lid (except the inner canthus) because of recurrence in every second case treated with surgery. We currently prefer surgery for carcinomas of the lower lip (radiodermatitis in 11.8% of cases) and Curie therapy for the nose (lower rate of recurrence than with surgery). However, in the last two cases, the proposals for treatment should be confirmed by randomized studies. Thus facial carcinomas of the skin surrounding the orifices of the face and/or those that affect patients who are difficult to treat must be seen during a skin carcinology consultation by a dermatologist, a surgeon and a radiotherapist working together.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[Plastic surgery in the aged: recent results and perspectives].

Among indications of cosmetic surgery in the aged, particularly face lifting, reductive and reconstructive mammoplasty (e.g. after mammectomy due to malignancies), and abdominoplasty were particularly mentioned. Among the operations of reconstructive surgery, above all reparation after removal of benign (e.g. rhinophyma) and malignant tumors and for pressure sores and ulcers due to burns and radiodermatitis was emphasized.

Abdominal Muscles↗

PubMed1980

[Recurrent basal cell epitheliomas and those developing on pre-existing lesions (author's transl)].

Cancerous changes occur most frequently in four types of chronic acquired lesions: rare lupus scars and those of long-standing burns, rhinophymas, and radiodermatitis. Insufficient therapy is often applied because of underestimation of potential changes, fear of hemorrhage, or lack of knowledge of the extent of the lesion. The ulcerous forms and those developing in scar tissue have the poorest prognosis, and this also applies to centrofacial basal cell epitheliomas. Recurrences after radiotherapy are of bad omen, and they must be treated by wide surgical excision.

Adult↗

PubMed1982

[Dermatologic roentgen therapy and radiocarcinogenesis].

Late somatic effects of ionizing radiation can be divided into non-stochastic effects with relatively high threshold doses (cataract, fertility problems, chronic radiodermatitis, and radiogenic skin cancer) and non-threshold stochastic effects. Theoretical and epidemiologic aspects of radiocarcinogenesis and various clinical types of radiation-induced neoplasms (leukemia, thyroid cancer, breast cancer) and genetic effects are discussed with special reference to radiation protection measures.

Breast Neoplasms↗

PubMed1982

[Retromuscular implantation of mammary prosthesis for reconstruction of the breast: report on 56 cases (author's transl)].

Though retromuscular implantation of mammary prosthesis for breast reconstruction presents certain advantages, a retrospective study of the results of 56 such prostheses implanted in 38 patients demonstrated certain complications related to this procedure. These included: ectopy, secondary migration, poor aesthetic appearance during muscle contractions, formation of a hard shell (33 p. cent of cases), and residual mammary asymmetry. However, the advantages related to the retromuscular site of implantation are sufficiently marked for this technique, described in detail, to be employed in certain chosen indications: sequelae to subcutaneous fatty mammectomies ("benign" breast), mammary reconstruction after resection for cancer or radiodermatitis, and perhaps after the use of musculocutaneous flap from the large dorsal muscles ("malignant" breast), and to increase mammary size in cases of agenesis or total aplasia (Poland's syndrome, "unesthetic"" breast).

Breast↗

PubMedDate not supplied

Combined modality therapy of resectable high risk rectal cancer.

Aim of this phase I-II study was to evaluate the efficacy of preoperative concomitant radiochemotherapy in resectable high risk (TNM stage: II and III) rectal tumors, 64 patients entered the study: 37 had low rectal cancer, 27 mid-rectal cancer. 50 patients were clinically staged as stage III (Dukes C) and 14 as stage II (Dukes B). Treatment protocol included bolus mitomycin C at the dose of 10 mg/m2 on day 1 and 5FU continuous infusion at the daily dose of 1000 mg/m2 on day 1, 2, 3, 4. Concomitant external radiotherapy up to a dose of 3780 cGy was delivered at the daily dose of 180 cGy. Surgery was performed 4 to 5 weeks after radiation therapy (RT). Before surgery all patients were clinically restaged to evaluate the response to concomitant radiochemotherapy. Treatment compliance was 97%. Toxicity was 27% prevalently shown as bone marrow depletion and radiodermatitis. In 37 patients (61%) there was 50% reduction (partial response) of neoplastic volume. In 5 patients (8%) no neoplastic cells were evidenced in the surgical specimen on histology (complete response). The distance between the lower margin of the tumor and the internal anal orifice increased in 72% of cases. Postoperative morbidity was 28%. The incidence of anastomotic dehiscences was 8.7% over 46 anterior resections. Postoperative mortality was nil. Definitive staging evidenced 24 patients (39%) stage I or with no evidence of tumor. The incidence of local recurrence was 5% and that of distant metastasis 8%.

Antibiotics, Antineoplastic↗

PubMed1996

Flow cytometric DNA content analysis on squamous cell carcinomas according to the preceding lesions.

DNA-ploidy in primary cutaneous squamous cell carcinomas which had developed from different preceding clinical lesions was examined by flow cytometry using paraffin-embedded blocks. DNA-aneuploidy was detected in none of 15 squamous cell carcinomas arising from a burn scar. On the other hand, 12 of 26 squamous cell carcinomas arising from sun-damaged skin in the elderly, and two of four arising from chronic radiodermatitis, showed aneuploid patterns. A significantly higher incidence of DNA-aneuploidy was observed in squamous cell carcinomas arising from sun-damaged skin than those from a burn scar (P < 0.01); the mean diameter size of the former was significantly smaller than that of the latter (P < 0.0001). The mean age of patients with aneuploid tumours (74.2 +/- 9.2: years +/- standard deviation (SD)) was significantly higher than that with diploid tumours (64.1 +/- 13.8) (P < 0.01).

Aged↗

PubMed1977

Topical mechlorethamine. Cutaneous changes in patients with mycosis fungoides after its administration.

Six patients with mycosis fungoides were treated with topical mechlorethamine hydrochloride for periods of two to four years. Clinical and histological studies for radiomimetic and radiodermatitis-like effects failed to demonstrate any abnormalities. The only observed changes were generalized hyperpigmentation of the skin and melanin-containing melanophages in the papillary dermis. We consider that the long-term use of topical mechlorethamine may be a safe form of therapy, but that a continuous indefinite follow-up of patients on this medication should be mandatory.

Administration, Topical↗

PubMed1990

Facial reconstruction for radiation-induced skin cancer.

Radiation-induced skin cancers can be difficult to diagnose and treat. Typically, a patient who has received orthovoltage radiotherapy for disorders such as acne, eczema, tinea capitis, skin tuberculosis, and skin cancer can expect that aggressive skin cancers and chronic radiodermatitis may develop subsequently. Cryptic facial cancers can lead to metastases and death. Prophylactic widefield excision of previously irradiated facial skin that has been subject to multiple recurrent skin cancers is suggested as a method of deterring future cutaneous malignancy and metastases. The use of tissue expanders and full-thickness skin grafts offers an expedient and successful method of subsequent reconstruction.

Acne Vulgaris↗

PubMed1986

Skin cancer caused by grenz rays.

A 30-year-old woman developed chronic radiodermatitis and five squamous cell carcinomas within 7 years following a 16-year period of repeated grenz irradiations given to her psoriasis. The estimated cumulative dose of grenz radiation was approximately 3,000 rads (r) to each treated area. This case, illustrating a rather underestimated carcinogenic potential of grenz rays, is interpreted in light of the available literature on the subject. The technical bases of grenz ray therapy are also briefly reviewed.

Adult↗

PubMed2002

Perioperative brachytherapy for pretreated chest wall recurrence of breast cancer.

PURPOSE: To demonstrate the technical aspects of high-dose-rate afterloading (HDR-AL) brachytherapy for isolated local chest wall recurrence of breast cancer pretreated with mastectomy and axillary node dissection plus postoperative radiotherapy. CASE REPORT: A 63-year-old female patient with left ductal breast cancer, pT2pN1biM0, was reoperated for an isolated local chest wall recurrence 13 years after primary treatment (mastectomy, axillary dissection, and 50 Gy postoperative irradiation). Radical surgery would have involved extreme mutilation. Reoperative surgical margins of 3 mm width were involved, and four parallel afterloading catheters were placed intraoperatively in this histologically positive margin site. Perioperative HDR-AL (Ir-192 stepping source, 370 GBq activity, dose rate: reference air kerma rate at 1 m 40.84 mGy/h kg) was performed. Dose per fraction: 6 Gy to the reference line, two fractions per week, total dose 30 Gy. Follow-up after secondary treatment: 5 years. RESULTS: Firm local control and 5-year disease-free survival were obtained with perioperative HDR-AL therapy; staging procedures (clinical exam, MRI, abdominal ultrasound, and bone scan) showed no evidence of disease. The development of radiodermatitis did not exceed grade 2 level and healed spontaneously within 6 weeks. CONCLUSIONS: Isolated local chest wall relapse can be effectively controlled by wide surgical excision and perioperative reirradiation with HDR-AL. This technique may represent a treatment alternative to ultraradical surgery, with equal healing probability and a better quality of life. Small-volume irradiation of the postoperative scar can be performed with HDR-AL brachytherapy, and long-term local control can be achieved with a total dose of 30 Gy.

Brachytherapy↗

PubMed2004

Accelerated partial breast irradiation with iridium-192 multicatheter PDR/HDR brachytherapy. Preliminary results of the German-Austrian multicenter trial.

PURPOSE: To evaluate perioperative morbidity, toxicity, and cosmetic outcome in patients treated with interstitial brachytherapy to the tumor bed as the sole irradiation modality after breast-conserving surgery. PATIENTS AND METHODS: From November 1, 2000 to January 31, 2004, 176 women with early-stage breast cancer became partakers in a protocol of tumor bed irradiation alone using pulsed-dose-rate (PDR) or high-dose-rate (HDR) interstitial multicatheter implants. Patients became eligible, if their tumor was an infiltrating carcinoma < or = 3 cm in diameter, the surgical margins were clear by at least 2 mm, the axilla was surgically staged node-negative, the tumor was estrogen and/or progesterone receptor-positive, well or moderately differentiated (G1/2), the tumor did not contain an extensive intraductal component (EIC) and the patient's age was > 35 years. Implants were positioned using a template guide, delivering either 49.8 Gy in 83 consecutive hours (PDR) or 32.0 Gy in two daily fractions over 4 days (HDR). Perioperative morbidity, toxicity, and cosmetic outcome were assessed. Interim findings of the first 69 patients, who were treated in this multicenter trial, after a median follow-up of 24 months (range, 15-39 months) are presented. RESULTS: One of the 69 patients (1.4%) developed a bacterial infection of the implant. No other perioperative complications, for example bleeding or hematoma, were observed. Acute toxicity was low: 2.9% of the patients (2/69) experienced mild radiodermatitis. Late toxicity: hypersensation/mild pain 7.2% (5/69), intermittent but tolerable pain 1.4% (1/69), mild dyspigmentation 10.1% (7/69), mild fibrosis 11.6% (8/69), moderate fibrosis 1.4% (1/69), mild telangiectasia (< 1 cm(2)) 11.6% (8/69), and moderate teleangiectasia (1-4 cm(2)) 1.4% (1/69). Good to excellent cosmetic results were observed in 92.4% of the patients evaluated. All patients (n = 176) remained disease-free to the date of evaluation. CONCLUSION: This analysis indicates that accelerated partial breast irradiation with iridium-192 interstitial multicatheter PDR/HDR implants is feasible with low perioperative morbidity, low acute and mild late toxicity, and does not significantly affect cosmetic results at a median follow-up of 24 months.

Adult↗

PubMed2004

Target cells in radiation pneumopathy.

Radiation pneumopathy is the reaction of the organ lung to radiation effects in various target cells. It starts as an exudative inflammation, with the clinical picture of interstitial pneumonia 6-12 weeks after irradiation, and proceeds to a productive chronic inflammation lasting several months and terminating, as other chronic inflammations do, in scar formation, called lung fibrosis. Lung fibrosis is the common end point after lung damage from a wide range of damaging agents. The pathogenetic process leading to the signs and symptoms of radiation pneumopathy is an integrated response of the complex organization of lung tissue. Clinical and pathologic data in patients do not support the hypothesis that the early inflammatory phase of radiation "pneumonitis" and late "radiation fibrosis" are independent pathogenetic processes in the same way as acute radiodermatitis and subcutaneous fibrosis are separate pathologic entities. The target cell population that initiates the pathogenetic process in the lung is not known, and it has been suggested that no single identifiable target exists. The entire process is the result of complex functional alterations in endothelial cells, pneumocytes, macrophages, and other resident and transient cells. No evidence has been found for a role of stem cell sterilization, for impaired transit cell proliferation, or for hypoplasia, which is the hallmark of other acute inflammatory normal tissue damage (i.e., in the mucosa). The radiobiologic concepts developed in cellular radiobiology are not adequate for the quantitative analysis of radiation pneumopathy. A new analytical framework based on structurally defined intercellular interaction by signaling molecules and their activation needs to be developed. This would not be only an abstract radiobiologic paradigm but would be the key to the development of potential therapeutic interventions in irradiated patients.

Animals↗

PubMed1998

Reduction of radiation exposure time during catheter ablation with the use of pulsed fluoroscopy.

UNLABELLED: Prolonged exposure to radiation during radiofrequency catheter ablation implies a potential risk of radiodermatitis, neoplasm and genetic defects to the patient and to the operator-physician. The use of pulsed fluoroscopy is thought to reduce such a risk because the radiation dose decreases for the same period of time. The aim of the present study was to compare the radiation exposure time during pulse and continuous radiofrequency catheter ablation. METHODS: Procedures were divided according to the sort of fluoroscopy utilized and the last four cases of atrioventricular (AV) junction ablation, four of atrial flutter, five of atrial tachycardia, 16 of AV node reentrant tachycardia, 16 of AV tachycardia and 10 of ventricular tachycardia in which pulsed and continuous fluoroscopy were utilized were respectively separated into Group I (pulse fluoroscopy) and Group II (continuous fluoroscopy) with 55 patients in each group. Fluoroscopy was generated by the same device in the two groups. Continuous fluoroscopy used 2 mA and automatic kV adjustment (automatic brightness stabilizer) ranging from 70 to 110 kV. Pulsed fluoroscopy was set at 7 squares/s with 25 mA and automatic kV adjustment. Fluoroscopy time was registered by the fluoroscopy device counter. RESULTS: Procedure duration, success rate and complications did not differ between Groups I and II. Fluoroscopy time, however, was 4.4+/-4 min during pulsed fluoroscopy and 27+/-23 min during continuous fluoroscopy (p=0.001). CONCLUSION: During radiofrequency catheter ablation procedures, the use of pulsed fluoroscopy set at 7 squares/s, decreases the radiation exposure time by 80% as compared to continuous fluoroscopy without changing procedure duration and success rate.

Cardiac Catheterization↗