Estudo randomizado, aberto, utilizando protetor cutâneo em spray à base de terpolímero acrílico versus hidratante padrão na prevenção de radiodermatite aguda em pacientes com câncer de canal anal e reto / An open randomized study using a skin protector spray made of acrylic terpolymers versus and standardized moisturizer in preventing acute radiodermatitis in patients with anal and rectal cancer

Pacientes com câncer de canal anal e reto em tratamento por radioterapia apresentam alta prevalência de radiodermatite com descamação úmida, desfecho que causa impactos clínicos, econômicos e sociais. Estudos sobre a efetividade de produtos na prevenção das radiodermatites representam uma lacuna de conhecimento na área oncológica, podendo o seu desenvolvimento contribuir para a diminuição dos impactos negativos desse evento, do tempo ocioso do equipamento pela interrupção do tratamento e da possibilidade de falha local da doença. Objetivou-se analisar a efetividade do protetor cutâneo em spray à base de terpolímero acrílico na prevenção da radiodermatite com descamação úmida nos pacientes com câncer de canal anal e reto em comparação com um hidratante padronizado na instituição à base de Calendula officinalis L. e Aloe barbadensis. Ensaio clínico randomizado, aberto, em instituição única, referência nacional no tratamento de doenças oncológicas, com amostra 63 pacientes que foram randomizados nos grupos: experimental, com uso do protetor cutâneo em spray, e controle, usando o hidratante Dnativ Revita Derm. Os pacientes foram acompanhados na consulta de enfermagem, com cegamento do avaliador da pele quanto ao uso da intervenção. A escala de avaliação de pele utilizada foi a da Radiation Therapy Oncology Group. A coleta de dados ocorreu por meio dos formulários de avaliação inicial e subsequente, sendo o desfecho principal medido a ocorrência de radiodermatite com descamação úmida, e os secundários a ocorrência de interrupção temporária da radioterapia por radiodermatite, de eventos adversos aos produtos e de severidade da radiodermatite. As análises se deram por Intenção de Tratar e Protocolo, sendo utilizadas as estatísticas descritiva, analítica e inferenciais no tratamento dos dados, com nível de significância de ≤ 0,10. Pesquisa aprovada pelo Comitê de Ética sob parecer nº 5.322.985 e registrado no Clinical Trials sob número: NCT04067310T. A regressão logística binária mostrou que os participantes expostos ao protetor cutâneo em spray tiveram menor chance de apresentar a radiodermatite com descamação úmida quando comparados ao grupo controle. A redução absoluta do risco de radiodermatite foi de 18% no grupo experimental. A incidência geral de radiodermatite foi de 100%, sendo 36,5% graus mais severos. A incidência de radiodermatite Grau 1 foi maior no grupo experimental, enquanto os graus mais severos (Graus 3 e 4) tiveram maior incidência no grupo controle; 17,5% dos participantes tiveram interrupção da radioterapia por radiodermatite, variando de 3 a 15 dias, com média de seis dias interrompidos. Apesar de relevantes clinicamente, esses resultados sobre a interrupção temporária do tratamento e a severidade da radiodermatite não tiveram significância estatística. Foram considerados fatores de risco para a descamação úmida: sexo feminino, diagnóstico C.21 e C.21.8, altas doses de radioterapia (5400-6000cGy), tipo histológico carcinoma espinocelular, umidade antes e durante a radioterapia e uso de proteção íntima. Concluiu-se que o protetor cutâneo em spray é um produto efetivo na prevenção da radiodermatite com descamação úmida nos pacientes com câncer de canal anal e reto, afirmação que sustenta a tese defendida. Nesse sentido, os resultados podem orientar a revisão dos protocolos assistenciais de prevenção da radiodermatite utilizados pelo enfermeiro no âmbito da consulta de enfermagem em radioterapia, com vistas a reduzir os impactos no seguimento terapêutico e na qualidade de vida dos pacientes com câncer de canal anal e reto.

Patients' ongoing anal and rectal cancer radiotherapy exhibit a high prevalence of radiodermatitis with moist desquamation, impairing clinical, economic, and social outcomes. Clinical trials targeting product efficacy in preventing radiodermatitis are lacking in the current literature. These products could contribute to diminishing adverse effects, reducing equipment idle time by therapy interruption, and increasing the cure rate. Our goal is to evaluate the effectiveness of cutaneous spray based on acrylic terpolymers in preventing radiodermatitis with moist desquamation in patients with rectal or anal cancer. Spray effectiveness was defied against a standardized moisturizer in the institution made of Calendula officinalis L. and Aloe barbadensis extracts. An open, single-blind, randomized clinical study was conducted in a single institution, reference in national treatment in oncological diseases, with a sample size (n) of 63 patients. Patients were randomized into two groups: (i) experimental, using cutaneous protector spray; and (ii) control, using moisturizer Dnativ Revita Derm. RTOC's scale was used for evaluating skin condition. Data was collected in forms, which considered: (i) the primary outcome of radiodermatitis with moist desquamation occurrence; and (ii) the secondary outcome of radiotherapy interruption caused by radiodermatitis occurrence and severity, and product adverse effects. Analyses were performed by intention to treat and per protocol, using descriptive, analytical, and inferential statistics, with a significance level of ≤ 0.10 (α). Research was approved by the Ethics committee under approval nº 5.322.985 and registered in Clinical Trials under number NCT04067310T. Binary logistic regression demonstrated that patients exposed to cutaneous spray protector were less prone to develop radiodermatitis with moist desquamation compared to the control group. Absolute reduction in radiodermatitis risk was 18% in the experimental group. The radiodermatitis overall incidence was 100%, with 36.5% of higher severity. The incidence of grade 1 radiodermatitis was higher in the experimental group, while the more severe grades (3 and 4) had a higher incidence in the control group; 17.5% of the participants had an interruption of radiotherapy due to radiodermatitis, ranging from 3 to 15 days, with an average of six interrupted days. Despite being clinically relevant, these results regarding the temporary interruption of treatment and the severity of radiodermatitis were not statistically significant. Risk factors for moist desquamation were considered: female gender, diagnosis of C.21 and C.21.8, high radiation doses (5400 to 6000 cGy), histological type squamous cell carcinoma, humidity before and during radiotherapy, and use of intimate protection. In conclusion, the skin protector spray is an effective product in the prevention of radiodermatitis with moist desquamation in patients with anal and rectal cancer. In this sense, the results can guide the review of care protocols for the prevention of radiodermatitis used by nurses in the context of nursing consultations in radiotherapy to reduce the impacts on therapeutic follow-up and the quality of life of patients with cancer of the anal canal and straight.

Los pacientes con cáncer de canal anal y recto en tratamiento con radioterapia tienen una alta prevalencia de radiodermatitis con descamación húmeda, desenlace que genera impactos clínicos, económicos y sociales. Los estudios sobre la efectividad de los productos en la prevención de la radiodermatitis representan un vacío de conocimiento en el área de oncología y pueden contribuir para la reducción de los impactos negativos, el tiempo de inactividad de los equipos por interrupción del tratamiento y la posibilidad de falla local de la enfermedad. El objetivo de este estudio fue analizar la eficacia de un protector cutáneo en spray a base de terpolímero acrílico en la prevención de la radiodermatitis con descamación húmeda en pacientes con cáncer anal y rectal frente a una crema hidratante estandarizada de la institución a base de Calendula officinalis L. y Aloe barbadensis. Ensayo clínico aleatorizado, abierto, en una sola institución, referente nacional en el tratamiento de enfermedades oncológicas, con una muestra de 63 pacientes que fueron aleatorizados en grupos: experimental, utilizando spray protector para la piel, y control, utilizando Dnativ Revita Derm hidratante. Los pacientes fueron seguidos en la consulta de enfermería, cegándose el evaluador de piel en cuanto al uso de la intervención. La escala de valoración de la piel utilizada fue la del RTOC. Los datos se recopilaron mediante formularios de evaluación inicial y posterior, siendo el resultado principal medido la aparición de radiodermatitis con descamación húmeda y los resultados secundarios la interrupción temporal de la radioterapia debido a la radiodermatitis, los eventos adversos de los productos y la gravedad de la radiodermatitis. Los análisis fueron realizados por Intención de Tratar y Protocolo, utilizando estadística descriptiva, analítica e inferencial en el procesamiento de datos, con nivel de significación ≤ 0,10. Investigación aprobada por el Comité de Ética con dictamen nº 5.322.985 y registrada en Ensayos Clínicos con el número: NCT04067310T. La regresión logística binaria mostró que los participantes expuestos al protector de piel en aerosol tenían menos probabilidades de tener radiodermatitis con descamación húmeda en comparación con el grupo de control. La reducción absoluta del riesgo de radiodermatitis fue del 18 % en el grupo experimental. La incidencia global de radiodermatitis fue del 100%, siendo el 36,5% grados más graves. La incidencia de radiodermatitis Grado 1 fue mayor en el grupo experimental, mientras que los grados más severos (3 y 4) tuvieron mayor incidencia en el grupo control; El 17,5% de los participantes tuvo interrupción de la radioterapia por radiodermatitis, variando de 3 a 15 días, con un promedio de seis días de interrupción. A pesar de ser clínicamente relevantes, estos resultados en cuanto a la interrupción temporal del tratamiento y la gravedad de la radiodermatitis no fueron estadísticamente significativos. Se consideraron factores de riesgo para descamación húmeda: sexo femenino, diagnóstico C.21 y C.21.8, dosis altas (5400-6000cGy), carcinoma epidermoide de tipo histológico, humedad antes y durante la radioterapia y uso de protección íntima. Se concluyó que el spray protector de piel es un producto eficaz en la prevención de la radiodermatitis con descamación húmeda en pacientes con cáncer anal y rectal, afirmación que sustenta la tesis defendida. En ese sentido, los resultados pueden orientar la revisión de los protocolos de atención para la prevención de la radiodermitis utilizados por los enfermeros en el contexto de las consultas de enfermería en radioterapia, con el objetivo de reducir los impactos en el seguimiento terapéutico y en la calidad de vida de los pacientes con cáncer del canal anal y recto.

Efeito de doses terapêuticas de radioterapia sobre a morfologia, composição química e microdureza do esmalte e da dentina de dentes permanentes / Effect of therapeutic doses of radiotherapy on the morphology, chemical composition, and microhardness of enamel and dentin of permanent teeth

Introdução: Padrões atípicos de cárie dentária em pacientes submetidos a radioterapia para o tratamento do câncer de cabeça e pescoço podem estar associados aos efeitos da radiação sobre as glândulas salivares e tecidos dentários duros. Somados, podem contribuir para a cárie relacionada a radiação. Embora haja evidências sobre alterações sofridas pelos tecidos dentários duros após radioterapia, não há consenso na literatura sobre a gravidade destas alterações. Objetivo: avaliar a microestrutura, composição química e microdureza do esmalte e da dentina de dentes permanentes submetidos a doses terapêuticas de radioterapia in vitro. Material e métodos: estudo experimental, qualitativo, quantitativo e semiquantitativo. Foram obtidos fragmentos coronários de 24 terceiros molares. Constituiuse 2 grupos: NIR (controle): formado por fragmentos de dentes não irradiados e IVT (irradiado): formado por fragmentos de dentes irradiados in vitro (2 Gy/dia 5 vezes por semana, totalizando 70 Gy). Os fragmentos foram submetidos a análise da microdureza (n=24), Espectroscopia de Infravermelho com Transformada de Fourier (FTIR) (n=24), análise morfológica através de Microscopia Eletrônica de Varredura (MEV) (n=19) e análise de elementos químicos por Espectroscopia de Dispersão de Energia de Raio X (EDX) (n=19). As análises foram feitas antes e após a irradiação. Os dados foram testados para distribuição normal (teste de Shapiro-Wilk, α = 0,05) e igualdade de variâncias (teste de Levene, α = 0,05), seguido de testes estatísticos paramétricos. Para a comparação das variáveis quantitativas foi aplicado o teste T de Student. Um valor de p <0,05 (5%) foi considerado estatisticamente significativo. Resultados: em relação as propriedades mecânicas observamos redução significativa da microdureza do esmalte e dentina após irradiação (p<0,001). A análise da composição química por FTIR mostrou que no esmalte não houve alteração da razão matriz/mineral (M:M) no grupo irradiado (p<0,821), mas houve redução significativa do teor relativo de carbonato (RCC) após irradiação (p<0,039). Na dentina observamos redução significativa da razão matriz/mineral (M:M) e carbonato/mineral (C:M) no grupo irradiado (p<0,001), enquanto a razão amida I/amida III, não sofreu alteração significativa após irradiação (p<0,536). Na análise de EDX realizadas no esmalte, não observamos variação no conteúdo de cálcio e fósforo após radiação, mas a razão Ca/P mostrou-se significantemente mais elevada no grupo irradiado (p<0,001). Na dentina, não houve alteração do teor de cálcio e fósforo, assim como da razão Ca/P após irradiação (p<0,267). A análise morfológica através de MEV pós irradiação, mostrou que no esmalte a maioria das amostras apresentaram uma alteração das características microestruturais com a presença de microporosidades, perda de padrões regulares das áreas prismáticas e interprismáticas e presença de áreas amorfas. Na dentina observamos manutenção do padrão de dentina peritubular e intertubular, com a presença de túbulos dentinários desobliterados e com a rede de fibras colágenas mais evidente grupo irradiado. Conclusão: as doses terapêuticas de radioterapia provocaram redução da microdureza, alterações na microestrutura e composição química do esmalte e da dentina. Assim, inferimos que doses terapêuticas de radiação exercem um impacto negativo sobre as propriedades mecânicas, químicas e micro-morfológicas dos tecidos dentários duros aumentando a vulnerabilidade destes tecidos à cárie relacionada a radiação.

INTRODUCTION: Atypical patterns of dental caries in patients undergoing radiotherapy to treat head and neck cancer may be associated with the effects of radiation on salivary glands and dental hard tissues. Together, they can contribute to radiation-related caries. Although there is evidence of changes in hard dental tissues after radiotherapy, there is no agreement in the literature on the severity of these changes. PURPOSE: This study aims to evaluate the microstructure, chemical composition, and microhardness of enamel and dentin in permanent teeth subject to therapeutic doses of in vitro radiotherapy. MATERIAL AND METHODS: This is an experimental, qualitative, quantitative, and semi-quantitative study. Coronary fragments were obtained from 24 third molars. Two groups were created: NIR (control), including fragments of non-irradiated teeth, and IVT (irradiated), including fragments of in vitro irradiated teeth (2Gy/day five times a week, totaling 70Gy). The fragments underwent microhardness analysis (n =24), Fourier-transform Infrared Spectroscopy (FTIR) (n=24), morphological analysis by Scanning Electron Microscope (SEM) (n=19), and analysis of chemical elements by Energy-dispersive X-Ray Spectroscopy (EDX) (n=19). The analyses were performed before and after irradiation. Data were tested for normal distribution (ShapiroWilk test, α = 0.05) and equality of variances (Levene test, α = 0.05), followed by parametric statistical tests. The Student's T test was applied to compare the quantitative variables. A pvalue < 0.05 (5%) was considered statistically significant. RESULTS: Concerning the mechanical properties, we observed a significant reduction in enamel and dentin microhardness after irradiation (p<0.001). The analysis of the chemical composition by FTIR showed no change in the mineral/matrix ratio (M:M) in enamel in the irradiated group (p<0.821), but there was a significant reduction in the relative carbonate content (RCC) after irradiation (p<0.039). In dentin, we observed a significant reduction in the mineral/matrix ratio (M:M) and carbonate/mineral ratio (C:M) in the irradiated group (p<0.001). In contrast, the amide I/amide III ratio showed no significant change after irradiation (p<0.536). In the EDX analysis performed on enamel, we did not observe any calcium and phosphorus content variation after radiation. However, the Ca/P ratio was significantly higher in the irradiated group (p<0.001). In dentin, there was no change either in calcium and phosphorus contents or in the Ca/P ratio after irradiation (p<0.267). The morphological analysis through SEM after irradiation showed that there is a loss in the characteristics of the enamel surface of most fragments, with the presence of microporosities, loss of regular patterns of the prismatic and interprismatic areas, and the presence of amorphous areas. In dentin, we observed maintenance of the peritubular and intertubular dentin patterns, with the presence of unobliterated dentinal tubules and with the most evident network of collagen fibers in the irradiated group. CONCLUSION: Therapeutic doses of radiotherapy caused a reduction in microhardness and changes in the microstructure and chemical composition of enamel and dentin. Thus, we conclude that therapeutic doses of radiation have a negative impact on the mechanical, chemical, and micromorphological properties of hard dental tissues, increasing the vulnerability of these tissues to radiation-related caries

How does radiotherapy affect the adhesion of universal adhesive to enamel and dentin? A qualitative and quantitative analysis? / Efecto de la radioterapia a la adhesión del adhesivo universal al esmalte y dentina? Un análisis cualitativo y cuantitativo?

Abstract This study investigated the shear bond strength (SBS) of a universal adhesive to enamel/dentin; 1) that had undergone radiotherapy (RT) and 2) that were readily restored and had undergone RT. Enamel and dentin surfaces were obtained from 90 intact human molars. They were randomly divided into six groups according to the presence and timing of irradiation (RT0:no radiotherapy/control, RT1:RT before restoration, RT2:RT after restoration groups) and adhesive application modes (etch&rinse/ER, self-etch/SE)(n=15). A universal adhesive and resin composites were applied. The radiotherapy protocol was conducted with 60 Gy. The SBS test was subjected (1mm/min) and failure type analysis was performed. The resin-enamel/dentin interfaces were examined. Data were statistically analyzed. For enamel and dentin, the presence and timing of irradiation did not significantly influence the SBS values (p>0.05). For enamel, significantly higher SBS values were obtained using etch&rinse mode than self-etch mode (p<0.05). The predominant failure was mixed type. Loss of enamel prisms and obliterated irregular dentinal tubules were found for the radiotherapy-treated specimens. Resin tags were clearer in the irradiated enamel treated with ER than SE. Irradiation with different timings did not influence the bond strength to enamel and dentin, negatively. Irrespective of radiotherapy, the etch&rinse mode caused higher bond strength to enamel than self-etch mode.

Resumen Este estudio investigó la fuerza de unión al cizallamiento (SBS) de un adhesivo universal al esmalte/dentina en piezas que se habían sometido a radioterapia (RT). Se obtuvieron superficies de esmalte y dentina de 90 molares humanos intactos. Se dividieron aleatoriamente en seis grupos según la presencia y el momento de la irradiación (RT0: sin radioterapia/control, RT1: RT antes de la restauración, RT2: RT después de la restauración considerando los modos de aplicación del adhesivo (n=15). Se aplicó un adhesivo universal y resinas compuestas. El protocolo de radioterapia se realizó con 60 Gy. Se sometió a la prueba adhesiva (1mm/min) y se realizó análisis del tipo de falla. Se examinaron las interfases resina-esmalte/dentina. Los datos fueron analizados estadísticamente. Para el esmalte y la dentina, la presencia y el momento de la irradiación no influyeron significativamente en los valores adhesivos (p>0,05). Para el esmalte, se obtuvieron valores adhesivos significativamente más altos utilizando el modo de grabado y enjuague que el modo de autograbado (p<0,05). La falla predominante fue de tipo mixto. Se encontró pérdida de prismas de esmalte y túbulos dentinarios irregulares obliterados en las muestras tratadas con radioterapia. La irradiación con diferentes tiempos no influyó negativamente en la fuerza de unión al esmalte ni a la dentina. Independientemente de la radioterapia, el modo de grabado ácido y enjuague provocó una mayor fuerza de adhesión al esmalte que el modo de autograbado.

Corticoides sistémicos en el tratamiento de la radiodermitis grave: una serie de casos / Systemic corticoids in the treatment of severe radiodermitis: a series of cases

Introducción: la radiodermitis es uno de los efectos secundarios más frecuentes de la radioterapia y afecta aproximadamente al 95% de los pacientes que la reciben. La radiodermitis aguda se presenta dentro de los 90 días posteriores al inicio del tratamiento, tiene un profundo impacto en la calidad de vida de los pacientes y puede ser la causa de la interrupción prematura de la radioterapia. Su tratamiento es complejo y el papel de los corticoides sistémicos en él aún no ha sido evaluado. Materiales y métodos: estudio descriptivo de 6 pacientes mayores de 18 años con radiodermitis grave, tratados con corticoides sistémicos al no responder a la terapia tópica inicial. Hubo un seguimiento de 6 meses, entre el 1 de junio de 2019 y el 30 de mayo de 2020, en el Servicio de Dermatología de un hospital de alta complejidad. Resultados: se indicó tratamiento con corticoides sistémicos en dosis de meprednisona 40 mg/día o equivalentes, durante 5 días, con resolución completa del cuadro en un período máximo de 15 días. Discusión: en la bibliografía no hemos encontrado trabajos científicos que comuniquen o evalúen la utilidad de los corticoides sistémicos en la radiodermitis grave. Proponemos, entonces, demostrar su utilidad en esta patología. Conclusión: el objetivo de este trabajo es comunicar nuestra experiencia en pacientes con radiodermitis aguda grave, con gran repercusión en el estado general, que evolucionaron con una rápida resolución del cuadro y un adecuado manejo sintomático, mediante el uso de corticoides sistémicos. (AU)

Introduction: radiodermitis is one of the most frequent side effects of radiotherapy and affects approximately 95% of the patients who receive it. Acute radiodermitis occurs within 90 days after the start of treatment, has a profound impact on the quality of life of patients and may be the cause of premature discontinuation of radiotherapy. Its treatment is complex and the role of systemic corticosteroids in it has not yet been evaluated. Materials and methods: descriptive study of 6 patients older than 18 years with severe radiodermatitis, treated with systemic corticosteroids when they did not respond to initial topical therapy. With a 6-month follow-up, between June 1, 2019 and May 30, 2020 at the Dermatology Service of a high complexity hospital. Results: treatment with systemic corticosteroids was indicated at a dose of meprednisone 40 mg/day or equivalent, for 5 days, with complete resolution of the symptoms in a maximum period of 15 days. Discussion: in the literature, we have not found scientific papers that report or evaluate the usefulness of systemic corticosteroids in severe radiodermatitis. We propose to demonstrate their usefulness in this pathology. Conclusion: the objective of this work is to communicate our experience in patients with severe acute radiodermatitis, with great repercussions on the general state, who evolved with rapid resolution of the symptoms and adequate symptomatic management, with the use of systemic corticosteroids. (AU)

Evaluación del estatus del tejido pulpar postratamiento oncológico / Assessment of the status of the pulp tissue post oncological treatment

La OMS cataloga al cáncer como uno de los principales problemas en el ámbito mundial, los pacientes sometidos a terapia oncológica son más vulnerables a desarrollar complicaciones en los tejidos de la cavidad bucal entre las que tenemos: mucositis, infecciones, osteorradionecrosis. En el manejo endodóntico hay que tomar en consideración que los trata- mientos como yodoterapia, radioterapia y quimioterapia pueden generar efectos sobre el complejo dentinopulpar. El objetivo de este artículo es determinar el estatus del tejido pulpar postratamiento oncológico mediante la revisión sistemática en bases de datos de gran relevancia científica, como PubMed, Scielo, Medigraphic, Science direct. Se concluye que el sistema estomatognático es un receptor importante de estos efectos y secuelas en pacientes con terapia oncológica, el tejido pulpar no está libre de estas secuelas ya que genera daño celular, como la hipovascularidad, hipocelularidad e hipoxia la cual incrementa el riesgo de necrosis de la región (AU)

The WHO lists cancer as one of the main problems worldwide, patients undergoing oncological therapy are more vulnerable to developing complications in the tissues of the oral cavity among which we have: mucositis, infections, osteoradionecrosis. In endodontic management, it should be taken into consideration that treatments such as iodine therapy, radiotherapy, and chemotherapy can generate effects on the dentin-pulp complex. This article aims to determine the status of the pulp tissue after oncologic treatment. Through a systematic review in databases of great scientific relevance, such as PubMed, Scielo, Medigrafhic, Science direct. It is concluded that the stomatognathic system is an important receptor of these effects and sequelae in patients with oncological therapy, the pulp tissue is not free of these sequelae as it generates cellular damage because of the hypo vascularity, hypocellularity, and hypoxia which increases the risk of necrosis of the region (AU)

Argon plasma coagulation in radiation-induced proctitis

Abstract Background Argon plasma coagulation (APC) is a non-tactile ablative therapy that helps to stop rectal bleeding in patients who have developed actinic proctitis after exposure to radiotherapy. This approach seems to be more effective than medications or surgical procedures. Objective To review the literature to verify the effectiveness of APC in the treatment of patients with actinic proctitis induced by radiation therapies. Methods A systematic search was conducted on the following databases: MEDLINE/PubMed, LILACS, SCIELO, and the Cochrane Central Register of Controlled Trials. We identified 81 studies, and 5 of them fulfilled the inclusion criteria. Results In the articles included, a total of 236 patients were evaluated. Most of them were men (67.7%) with a mean age of 66.6 years. Prostate cancer was the main cause of actinic proctitis (67.3%), and control of the bleeding was achieved in 83.3% of the cases, after a mean of 1.67 session of APC. Moreover, 66 patients had complications with the treatment, and rectal pain was the most referred. Conclusions Argon plasma coagulation is a well-tolerated and effective treatment to control rectal bleeding in patients who underwent radiotherapy, and the number of sessions varies from 1 to 2, according to the case. (AU)

Uso de antitranspirante en pacientes en tratamiento de radioterapia por cáncer de mama / Use of antiperspirant in patients undergoing radiotherapy treatment for breast cancer / Uso de antitranspirante em pacientes submetidos a tratamento radioterápico para câncer de mama

Patients who are diagnosed with breast cancer face multiple challenges and fears: from the diagnosis, the acceptance of the diagnosis and the beginning of the treatments, as well as the side effects that they entail, the most worrying for the patients being the possible anatomical alterations due to surgery, alopecia due to chemotherapy treatment, and radiodermatitis due to radiant treatment. A systematic review was carried out in MedLine/Pubmed following the PRISMA 2020 criteria on the use of antiperspirant during radiant treatment in the axilla and its relationship or not with the increase in acute adverse effects. Based on the analysis of the results of this search and with emphasis on: dosimetric aspects, psychological impact, treatment acceptance, feeling of well-being and adherence. We justify its use.

As pacientes diagnosticadas com câncer de mama enfrentam múltiplos desafios e medos: desde o diagnóstico, a aceitação do diagnóstico e o início do tratamento, bem como os efeitos colaterais que estes acarretam, o mais preocupante para as pacientes são as possíveis alterações anatômicas devidas à cirurgia, alopecia devido ao tratamento quimioterápico e a radiodermatite devido ao tratamento radiante. Foi realizada uma revisão sistemática no MedLine/Pubmed seguindo os critérios do PRISMA 2020 sobre o uso de antitranspirante durante o tratamento radiante na axila e sua relação ou não com o aumento dos efeitos adversos agudos. Com base na análise dos resultados desta busca e com ênfase em: aspectos dosimétricos, impacto psicológico, aceitação do tratamento, sensação de bem-estar e aderência. Justificamos seu uso.

Las pacientes que son diagnosticadas con cáncer de mama se enfrentan a múltiples desafíos y temores: desde el diagnóstico, la aceptación del mismo y el inicio de los tratamientos, así como los efectos secundarios que ellos conllevan, siendo los más preocupantes para las pacientes las posibles alteraciones anatómicas por cirugía, la alopecia por el tratamiento quimioterápico, y la radiodermitis por el tratamiento radiante. Se realizó una revisión sistematizada en MedLine/Pubmed, Google Académico, EMBASE, SciELO y Epistemonikos, siguiendo los criterios PRISMA 2020 del uso de antitranspirante durante el tratamiento radiante en axila y su relación o no con el aumento de efectos adversos agudos. En función del análisis de los resultados de dicha búsqueda y con énfasis en: aspectos dosimétricos, impacto psicológico, la aceptación al tratamiento, el sentimiento de bienestar y la adherencia. Justificamos su uso.

Therapeutics in radiation-induced proctopathy: a systematic review

Malignant neoplasms are increasingly prevalent in the daily clinical practice. Up to 61% of patients with pelvic malignancies undergo pelvic radiotherapy in different doses, which may cause intestinal damage, and the rectum is the segment most frequently affected due to its fixed position in the pelvis. Currently, there are several strategies to minimize the effects of radiation on the tissues surrounding the neoplastic site; despite those strategies, radiotherapy can still result in serious damage to organs and structures, and these injuries accompany patients throughout their lives. One of the most common damages resulting from pelvic radiotherapy is acute proctitis.The diagnosis is confirmed by visualizing the rectal mucosa through rigid or flexible rectosigmoidoscopy and colonoscopy. The objective of the present study was to review the forms of radiation-induced proctopathytherapy, and to evaluate the results of each method to propose a standardization for the treatment of this pathology. Despite the prevalence of radiation-induced proctopathy, there is no definitive standardized treatment strategy so far. The first approach can be tried with local agents, such as mesalazine and formalin. For refractory cases, control can usually be achieved with argon plasma coagulation, hyperbaric oxygen, and radiofrequency ablation therapies. Regarding the study of radiation-induced proctopathy, there is a lack of robust studies with large samples and standardized therapies to be compared. There is a lack of double-blinded, randomized controlled studies to determine a definitive standard treatment algorithm. (AU)

Association between fecal incontinence and lower urinary tract symptoms and their impact on the quality of life of patients with prostate cancer

Objective: To evaluate the association of fecal incontinence (FI) and lower urinary tract symptoms (LUTS) in patients diagnosed with initial prostate cancer (PC) and after any therapeutic approach (surgery and radiotherapy). Methods: Cross-sectional study using the Cleveland Clinic Incontinence Score (CCIS), the Fecal Incontinence Quality of Life (FIQL) questionnaire, and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB). Results: A total of 84 patients with PC were included: 40 of them had not started treatment, 31 were submitted to radical prostatectomy (RP), and 13 were submitted to radiotherapy (RT). Those submitted to RT presented higher scores on the ICIQ-OAB (p=0.01). When comparing the whole sample reagarding the patients with and without FI, we observed that the incontinents presented a higher frequency of urinary incontinence (UI) (p<0.001). Moreover, when comparing patients with/without FI within their treatment groups regarding the presence of UI and FIQL scores, we identified that patients undergoing RP presented an association between UI and FI (p<0.001) and a greater impact of FI on the FIQL (p<0.001). Conclusion: Patients submitted to RT present more intense LUTS. Moreover, patients with FI present a higher association with UI, and this association is more marked in those with FI submitted to RP. (AU)

Tratamiento quirúrgico de las úlceras por radionecrosis con colgajos músculo y fasciocutáneos / Surgical treatment of radionecrosis ulcers with myocutaneous and fasciocutaneous flaps

Resumen Introducción: La Ulcera con radionecrosis debe ser resecada ampliamente y reparada con colgajos miocutáneos y fasciocutáneos. Objetivo: Presentar el tratamiento quirúrgico de las úlceras por radionecrosis mediante colgajos Miocutáneos y Fasciocutáneos pediculados y microquirúrgicos. Materiales y Método: La casuística es de 31 pacientes portadores de úlceras por radionecrosis resueltas con colgajos miocutáneos y fasciocutáneos. Ellos han sido pediculados y microquirúrgicos. Las edades fluctuaron entre 30 y 75 años operados entre el 2000 y el 2019. Resultados: Se realizaron 19 colgajos musculares o miocutáneos y 12 fasciocutáneos en diferentes zonas del organismo. Los colgajos correspondieron a: temporal, latissimus dorsi de pedículo central y en reversa, latissimus dorsi microquirúrgicos, recto abdominal, escapular microquirúrgico, para escapular, gracilis, gastrocnemius, rectus femoris, cubital microquirúrgico, fasciocutaneos: cone flap y de rotación local. Las complicaciones fueron dehiscencia de herida operatoria suturada y celulitis tratada con antibióticos. No hubo necrosis completa de los colgajos. El seguimiento fue de 3 a 6 meses. Discusión: En esta serie hemos utilizados los colgajos músculo cutáneos de preferencia, los fasciocutáneos los hemos reservados para aquellos casos en los que por razones anatómicas, de localización de las úlceras, era más adecuado usar estos últimos, como en las lesiones planas o poco profundas. Generalmente los colgajos fueron pediculados y en determinados casos, cuando el tejido vecino de reparación no estaba disponible, realizamos colgajos con microcirugía. Conclusión: El tratamiento de las úlceras por radionecrosis es efectivo cuando se realiza desbridamiento exhaustivo con cobertura inmediata con colgajos musculares o músculocutáneos y fasciocutáneos. Fueron colgajos pediculados y microquirúrgicos.

Introduction: The radionecrosis ulcer have to be widely resected and repaired trough flaps with good blood supply who contibute with oxigen, nutrients and antibiotics. Thinking on this the more suitable flaps are the myocutaneous ones and in special conditions the fasciocutaneous. Aim: The objetive of this paper is to show the surgical treatment of radionecrosis ulcers with myocutaneous and fasciocutaneous flaps. Materials and Method: Casuistic is 31 patients with radionecrosis ulcers treated with, mainly, myocutaneous flaps and in special areas with fasciocutaneous ones. The majority were pedicle flaps and in less number microsurgical flaps. The age of patients were betwee30 and 75 years old. Results: 19 muscle or myocutaneous flaps and 12 fasciocutaneous flaps were made. Flaps were latissimus dorsi, temporal, escapular, para escapular, rectus abdominis, rectus femoris, gracilis, gatrocnemius, cone flap and local fasciocutaneous flaps. Complications were sutured operative wound dehiscence and cellulitis treated with antibiotics. There were no complete necrosis of any flap. Discusion: In this serie we used muscle or myocutaneous flaps because they give good blood supply, oxigen, nutrients and arrival of antibiotic with filling of the deep ulcers. When the ulcers were shallow we use fasciocutaneous flaps. The majority of our flaps were pedicles and microsurgical flaps were used when there was no near avialable tissue. Conclusion: The treatment have to be wide debridement of the ulcer. The surgical treatment is with myocutaneous and fasciocutaneous flaps sometimes pediculates and in others conditions microsurgicals.

Obstrução lacrimal pós-tratamento oncológico: revisão de literatura / Lacrimal drainage system obstruction after cancer treatment: a literature review

RESUMO A obstrução de via lacrimal é uma possível complicação decorrente de tratamentos oncológicos sistêmicos e locais. A epífora crônica gera grande impacto na qualidade de vida desses pacientes, e, como a fibrose terminal da via lacrimal pode necessitar de procedimentos complexos para sua resolução, é importante estarmos atentos a esse efeito adverso, com o objetivo de reconhecê-lo e tratá-lo precocemente, ou mesmo preveni-lo. Nesta revisão da literatura, os autores analisam todos os agentes quimioterápicos e radioterápicos associados à obstrução lacrimal e descrevem os mecanismos, a frequência, os tratamentos e a profilaxia. Os tratamentos oncológicos associados à obstrução lacrimal foram: radioterapia em cabeça e pescoço (dosagem acima de 45 a 75Gy), radioiodoterapia (dosagem acima de 150mCi) e quimioterapia com 5-FU, S-1, capecitabine e docetaxel. A obstrução lacrimal pode ser irreversível, e a intubação profilática das vias lacrimais é uma possibilidade descrita de tratamento profilático em casos de radioterapia e uso do 5-FU, S-1 e docetaxel. O tratamento cirúrgico de todos os casos é a dacriocistorrinostomia.

ABSTRACT Lacrimal duct obstruction can be a side effect of systemic and/or local cancer treatments. Chronic epiphora has a great impact on the quality of life of oncological patients. Since terminal fibrosis of the lacrimal system may require complex procedures, it is important to be aware of this adverse effect in order to recognize and treat it, or even prevent it. A literature review was performed to identify all types of systemic cancer treatment associated with lacrimal obstruction and to describe the mechanisms, frequency, treatment, and prophylaxis. The oncological treatments associated with lacrimal obstruction were head and neck radiotherapy (dosage above 45-75 Gy), radioiodine therapy (dosage above 150 mCi), and chemotherapy with 5-FU, S-1, Capecitabine and Docetaxel. Depending on the dose, this complication may be irreversible. Prophylactic intubation of the lacrimal system is an option for prophylaxis in cases of radiotherapy, use of 5-FU, S-1, and Docetaxel. Final surgical treatment is dacryocystorhinostomy.

Enfermedad cardíaca inducida por radiación: Implicaciones prácticas en su prevención, diagnóstico y tratamiento / Radiation-Induced Heart Disease: Practical Implications for Its Prevention, Diagnosis, and Treatment

Resumen La radioterapia representa una herramienta terapéutica de gran utilidad en el tratamiento de varios tipos de cáncer. Cuando se emplea a lesiones en tórax existe el riesgo de aplicar determinada radiación en el corazón y consecuentemente presentar complicaciones cardíacas. Los efectos adversos se pueden observar en los distintos componentes del corazón y las manifestaciones pueden apreciarse principalmente a largo plazo. Mediante una evaluación integral del riesgo cardiovascular, la identificación de las terapias concomitantes con potencial cardiotóxico, la aplicación de técnicas de radioterapia con función protectora del corazón y el control con estudios cardiológicos se intenta optimizar el desenlace oncológico y cardiovascular de los pacientes. En aquellos pacientes que se presenten con complicaciones cardíacas, existen varias opciones terapéuticas tanto quirúrgicas como percutáneas, que implican un desafío dado la complejidad de los casos. Finalmente, existen distintas consideraciones de manejo para los pacientes con dispositivos electrónicos cardíacos implantables. Estrategia de búsqueda: Se realizó una búsqueda en Pubmed de artículos bajo el criterio de radioterapia y corazón, con un intervalo de tiempo de los últimos 5 años hasta agosto 2020, escritos en inglés. Además, se buscaron referencias cruzadas y se incluyeron documentos de consenso de parte de sociedades de cardiología internacionales.

Abstract Radiation-Induced Heart Disease: Practical Implications for Its Prevention, Diagnosis, and Treatment The radiotherapy represents a very useful therapeutic tool for the treatment of different types of cancer. When it is used to treat thoracic lesions there is a risk of appliying a determined radiation dose to the heart and consequently develop cardiac complications. The adverse effects can be seen in distinct heart components and the manifestations can be appreciated mainly in the long term. Through an integral evaluation of the cardiovascular risk, the identification of concomitant therapies with cardiotoxic potential, the application of heart sparing radiotherapy techniques and the control with cardiac tests, it is intended to optimize the oncologic and cardiovascular outcomes of the patients. In those patients who present with cardiac complications, there are several therapeutic options ranging from chirurgic to percutaneous, which are challenging given the complexity of the cases. Finally, there are different considerations in regard to the management of patients with electronically implantable cardiaca devices. Search strategy: A search was carried out in Pubmed for articles under the criteria of radiotherapy and heart, with a time interval of the last 5 years until August 2020, written in English. In addition, cross-references were searched and consensus documents from international cardiology societies were included.

Photobiomodulation therapy for oral mucositis management in head and neck cancer patients undergoing radiotherapy: case reports

Introduction: Photobiomodulation therapy (PBM) has been recommended for the prevention of oral mucositis (OM). Objective: to evaluate the use of PBM to prevent and control the severity of oral mucositis lesions and painful sensitivity in patients undergoing radiotherapy for head and neck cancer (HNC) treatment. Case reports: Eight patients with HNC attended for radiotherapy treatment, either associated with chemotherapy, or not were followed up. Clinical evaluation was performed, including meticulous anamnesis. The patients were followed up throughout the entire period of radiotherapy treatment. For the protocol of prophylaxis of OM, low level laser equipment was used, with a wavelength in the range of 660nm, in a contact mode, 30 mW of continuous emission 4J/cm² three times per week and for the therapeutic protocol wavelength in the range of 660nm, in a contact mode, 30 mW of continuous emission 8 J/cm², in the respective areas compromised by oral mucositis, 3 times per week till the complete remission of the lesions. All the patients were clinically followed up from the beginning of the antineoplastic therapy up to the conclusion of the medical treatment or total remission of the oral lesion, involving post radiotherapy control. A visual analog scale (VAS) was used to measure pain every week. Results: A progressive development of the lesions was observed from the 1st to the 5th week. Remission of OM was observed from the 7th week up to the conclusion of treatment. There is a continuous increase in the pain process, attaining the maximum level in the 6th week, with decline occurring up to the 7th week. Conclusion: Photobiomodulation therapy was able to control the severity of OM lesions and painful sensitivity in patients undergoing radiotherapy for head and neck cancer treatment, avoiding the interruption of the cancer therapy.

Introdução: A terapia com fotobiomodulação (FBM) tem sido recomendada para a prevenção da mucosite oral (MO). Objetivo: avaliar o uso de FBM para prevenir e controlar a gravidade das lesões da mucosite oral e a sensibilidade dolorosa em pacientes submetidos à radioterapia para tratamento de câncer de cabeça e pescoço (CCP). Relato dos casos: Oito pacientes com CCP atendidos para tratamento radioterápico, associado ou não à quimioterapia, foram acompanhados. Foi realizada avaliação clínica, incluindo anamnese meticulosa. Os pacientes foram acompanhados durante todo o período de tratamento radioterápico. Para o protocolo de profilaxia de MO, foi utilizado um equipamento laser de baixa potência, com comprimento de onda na faixa de 660nm, em modo de contato e 30 mW de emissão contínua com 4J/cm2. Para o protocolo terapêutico, e para comprimento de onda na faixa de 660nm, em modo de contato e 30 mW de emissão contínua com 8J/cm2 na área da lesão, até sua completa remissão. Todos os pacientes foram acompanhados clinicamente desde o início da terapia antineoplásica até a conclusão do tratamento médico ou remissão total da lesão oral, envolvendo o controle pós-radioterapia. Uma escala visual analógica (EVA) foi usada para medir a dor semanalmente. Resultados: Observou-se um desenvolvimento progressivo das lesões da 1ª à 5ª semana. A remissão da mucosite oral foi observada a partir da 7ª semana até o final do tratamento. Houve um aumento contínuo do processo doloroso, atingindo o nível máximo na 6ª semana, com declínio ocorrendo até a 7ª semana. Conclusão: A terapia de fotobiomodulação foi capaz de controlar a gravidade das lesões de MO e a sensibilidade dolorosa em pacientes submetidos à radioterapia para tratamento do câncer de cabeça e pescoço, evitando a interrupção da terapia oncológica.