Analysis of risk factors of radiation-induced toxicity in limited-stage small cell lung cancer treated with hypofractionated intensity-modulated radiotherapy / 中华肿瘤杂志

Objective: To compare the incidence of radiation-related toxicities between conventional and hypofractionated intensity-modulated radiation therapy (IMRT) for limited-stage small cell lung cancer (SCLC), and to explore the risk factors of hypofractionated radiotherapy-induced toxicities. Methods: Data were retrospectively collected from consecutive limited-stage SCLC patients treated with definitive concurrent chemoradiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2022. The enrolled patients were divided into two groups according to radiation fractionated regimens. Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) was used to evaluate the grade of radiation esophagus injuries and lung injuries. Logistic regression analyses were used to identify factors associated with radiation-related toxicities in the hypofractionated radiotherapy group. Results: Among 211 enrolled patients, 108 cases underwent conventional IMRT and 103 patients received hypofractionated IMRT. The cumulative incidences of acute esophagitis grade ≥2 [38.9% (42/108) vs 35.0% (36/103), P=0.895] and grade ≥ 3 [1.9% (2/108) vs 5.8% (6/103), P=0.132] were similar between conventional and hypofractionated IMRT group. Late esophagus injuries grade ≥2 occurred in one patient in either group. No differences in the cumulative incidence of acute pneumonitis grade ≥2[12.0% (13/108) vs 5.8% (6/103), P=0.172] and late lung injuries grade ≥2[5.6% (6/108) vs 10.7% (11/103), P=0.277] were observed. There was no grade ≥3 lung injuries occurred in either group. Using multiple regression analysis, mean esophageal dose ≥13 Gy (OR=3.33, 95% CI: 1.23-9.01, P=0.018) and the overlapping volume between planning target volume (PTV) and esophageal ≥8 cm(3)(OR=3.99, 95% CI: 1.24-12.79, P=0.020) were identified as the independent risk factors associated with acute esophagitis grade ≥2 in the hypofractionated radiotherapy group. Acute pneumonitis grade ≥2 was correlated with presence of chronic obstructive pulmonary disease (COPD, P=0.025). Late lung injuries grade ≥2 was correlated with tumor location(P=0.036). Conclusions: Hypofractionated IMRT are tolerated with manageable toxicities for limited-stage SCLC patients treated with IMRT. Mean esophageal dose and the overlapping volume between PTV and esophageal are independently predictive factors of acute esophagitis grade ≥2, and COPD and tumor location are valuable factors of lung injuries for limited-stage SCLC patients receiving hyofractionated radiotherapy. Prospective studies are needed to confirm these results.

Reconstructive dosimetry for cutaneous radiation syndrome

According to the International Atomic Energy Agency (IAEA), a relatively significant number of radiological accidents have occurred in recent years mainly because of the practices referred to as potentially high-risk activities, such as radiotherapy, large irradiators and industrial radiography, especially in gammagraphy assays. In some instances, severe injuries have occurred in exposed persons due to high radiation doses. In industrial radiography, 80 cases involving a total of 120 radiation workers, 110 members of the public including 12 deaths have been recorded up to 2014. Radiological accidents in industrial practices in Brazil have mainly resulted in development of cutaneous radiation syndrome (CRS) in hands and fingers. Brazilian data include 5 serious cases related to industrial gammagraphy, affecting 7 radiation workers and 19 members of the public; however, none of them were fatal. Some methods of reconstructive dosimetry have been used to estimate the radiation dose to assist in prescribing medical treatment. The type and development of cutaneous manifestations in the exposed areas of a person is the first achievable gross dose estimation. This review article presents the state-of-the-art reconstructive dosimetry methods enabling estimation of local radiation doses and provides guidelines for medical handling of the exposed individuals. The review also presents the Chilean and Brazilian radiological accident cases to highlight the importance of reconstructive dosimetry.

Prevalence of weathering nodules of the ear in patients treated at the state civil servant's hospital of São Paulo, Brazil* / Prevalência de pápulas climáticas das orelhas nos pacientes atendidos no hospital do servidor público estadual de São Paulo, Brasil

Weathering nodules of the ear are pale yellow, asymptomatic lesions which predominate on the helices of the ears. Although their pathogenesis remains unknown, there is an association with chronic exposure to ultraviolet radiation, age and thermal injuries. Few studies have been conducted to date, and these involved a very small number of patients. Study the prevalence of weathering nodules of the ear in patients treated in the Dermatology Service of the State Civil Servant's Hospital of São Paulo, and evaluate their probable relationship with sun exposure, age and phototypes I and II. Four hundred patients older than 20 years of age were examined between July 2008 and December 2008. A questionnaire evaluating age, sex, place of birth, origin, occupation and history of sun exposure was applied. All patients were examined and evaluated for the presence of lesions by only one person. The data showed that 155 (38.8%) patients had a lesion in at least one of the ears. The Chi-Square Test was used for the comparative analysis between the groups of patients with and without lesions. In the group of patients with lesions, 29% were 70 to 79 years old, 78.1% had a history of sun exposure and 45.1% belonged to FITZPATRICK skin phototypes I and II (p<0.05%). The findings suggest relevant prevalence, probable association with chronic sun exposure, advanced age and phototypes I and II. .

Pápulas climáticas das orelhas são lesões assintomáticas de coloração amarelo-pálida que predominam na hélice das orelhas. Sua patogênese permanece desconhecida, no entanto é descrita a associação com exposição crônica à radiação ultravioleta, idade e injúrias térmicas. Poucos estudos foram realizados até o momento e os mesmos envolveram número muito reduzido de pacientes. Estudar a prevalência de pápulas climáticas das orelhas nos doentes atendidos no Serviço de Dermatologia no Hospital Servidor Estadual de São Paulo e avaliar a provável relação com exposição solar, idade e tipo de pele. Foram examinados 400 pacientes com idade superior a vinte anos no período compreendido entre os meses de julho de 2008 a dezembro de 2008. Foi aplicado questionário que avaliou idade, sexo, naturalidade, procedência, profissão e história de exposição solar Todos os sujeitos da pesquisa foram examinados por um único observador e avaliados quanto à presença de lesão. Os dados revelaram que 155 (38,8%) pacientes apresentavam lesão em pelo menos uma das orelhas. Foi utilizado o teste do Qui-Quadrado para análise comparativa entre o grupo de pacientes com e sem lesão. No grupo de pacientes com lesão 29% tinham idade entre 70 e 79 anos, 78,1% tinham história de exposição solar e 45,1% pertenciam ao fototipo I e II da classificação de FITZPATRICK (p<0,05%). Os achados sugerem prevalência relevante, provável associação ...

Ionizing Radiation-induced Diseases in Korea

Radiation risk has become well known through epidemiological studies of clinically or occupationally exposed populations, animal experiments, and in vitro studies; however, the study of radiation related or induced disease has been limited in Korea. This study is to find the level of occupational radiation exposure for various kinds of accidents, compensated occupational diseases, related studies, and estimations on future occupational disease risks. Research data of related institutions were additionally investigated. About 67% of 62,553 radiation workers had no exposure or less than 1.2 mSv per year. The 5 reported cases on radiation accident patients in Korea occurred during nondestructive testing. According to the recent rapid increase in the number of workers exposed to radiation, a higher social recognition of cancer, and an increasing cancer mortality rate, it is expected that occupational disease compensation will rapidly increase as well. Therefore, it is important to develop scientific and objective decision methods, such as probability of causation and screening dose in the establishment of an exposure and health surveillance system.

RTOG criteria to evaluate acute skin reaction and its risk factors in patients with breast cancer submitted to radiotherapy / Evaluación de las reacciones agudas de la piel y sus factores de riesgo en pacientes con cáncer de mama sometidos a radioterapia / Avaliação das reações agudas da pele e seus fatores de risco em pacientes com câncer de mama submetidas à radioterapia

PURPOSE: Evaluate and classify skin reactions through the Radiation Therapy Oncology Group (RTOG) criteria and characterize factors that can intervene in these reactions. METHOD: Prospective study, with 86 women submitted to adjuvant breast radiotherapy with a total dose of 5040cGy, in a 6 MeV Linear Accelerator. Personal data were collected and breast size was measured (distance between field separation and breast height). The treated skin area was evaluated weekly. RESULTS: Breast height and treatment technique were significant factors in the univariate analysis for the incidence of degree 3 skin reactions. However, only breast height was a significant factor in the multivariate analysis for the severity of skin reactions. The chances of occurring degree 3 reactions increase 2.61 times for each increase in height unit (cm). These findings allow nurses to plan more adequate and individualized procedures for each patient and contribute to the optimization of treatment.

El objetivo fue evaluar y clasificar las reacciones de la piel según los criterios del Radiation Therapy Oncology Group (RTOG) y caracterizar factores que puedan interferir en esas reacciones. METODOLOGÍA: Estudio prospectivo, con 86 mujeres sometidas a la radioterapia en la mama, dosis total de 5040cGy, con Acelerador Lineal de 6 MeV. Fueron recolectados datos personales y medido el tamaño de la mama (distancia entre la separación de los campos y la altura de la mama). La evaluación de la piel del área de tratamiento fue realizada semanalmente. RESULTADOS: La altura de la mama y la técnica de tratamiento fueron significativos en el análisis univariado, para incidencia de reacción de piel grado 3. Sin embargo, solamente la altura de la mama fue el factor significativo en el análisis multivariado para la gravedad de la reacción de la piel. La probabilidad de ocurrir una reacción grado 3 aumenta 2,61 veces por cada aumento de 1 unidad de altura en cm. Lo encontrado le permite al enfermero planificar conductas más adecuadas e individualizadas para cada paciente y contribuir para optimizar el tratamiento.

O objetivo deste estudo foi avaliar e classificar as reações de pele, segundo os critérios do Radiation Therapy Oncology Group (RTOG) e caracterizar fatores que possam interferir nessas reações. A metodologia usada foi o estudo prospectivo, com 86 mulheres submetidas à radioterapia na mama, dose total de 5040cGy, com Acelerador Linear de 6 MeV. Coletou-se dados pessoais e foi medido o tamanho da mama (distância entre a separação dos campos e altura da mama). A avaliação da pele na área de tratamento foi realizada semanalmente. Concluiu-se que a altura da mama e a técnica de tratamento foram significantes na análise univariada, para incidência de reação de pele grau 3. Porém, apenas a altura da mama foi fator significante na análise multivariada para a gravidade da reação de pele. A chance de ocorrer reação grau 3 aumenta 2,61 vezes a cada aumento de 1 unidade de altura em cm. Esses achados permitem ao enfermeiro programar condutas mais adequadas e individualizadas a cada paciente e contribuir para a otimização do tratamento.

Prevalência de retinopatia por radiação no Instituto Ivo Corrêa-Meyer / Prevalence of radiation retinopathy in the Ivo Corrêa-Meyer Institute

Objetivo: Arregimentar os casos com diagnóstico de retinopatia por radiação atendidos nos últimos 5 anos, avaliando as manifestações mais incidentes, tempo de aparecimento, conseqüências funcionais e manejo. Material e métodos: Pacientes com retinopatia ou neuropatia associada à teleterapia, atendidos entre 2000 e 2005, com prontuários completos foram incluídos, descartando-se aqueles com diabetes melito, pós-braquiterapia, cirurgia ou fotocoagulação prévias, cirurgia orbitária, trauma craniano. Resultados: Média de idade de 48 anos, detectados num período médio de 22 meses pós-radiação. A acuidade visual final média foi de 20/60, e os sinais mais comuns foram a neovascularização iriana, papilar e retiniana, telangiectasias, exsudatos duros e algodonosos. Conclusão: Lesões secundárias à radiação apresentam-se a longo prazo, quando sintomáticas, estão associadas a perdas visuais importantes e permanentes

Purpose: Evaluated all cases of radiation ocular toxicity examined in our service inthe last 5 years, to estimate the clinical signs and functional outcome. Material and methods: Patients with ocular disease associated to the external radiation and not associated with diabetes mellitus, previous surgery or photocoagulation, orbital surgery, head trauma, or episcleral plaques were included. Results: There were 7 patients included, with average age of 48 years, and final visual acuity of 20/60. The clinical signs were recognized after a meantime of 22 months. Discussion: The retinopathy and neuropathy presents after a long time after external radiation, without rescue of visual function

Enteritis y colitis por radioterapia / Enteritis and colitis due to radiation

Desde fines del siglo XIX, con la utilización de los rayos X, aparecieron las primeras descripciones de lesiones ocasionadas por la radiación abdominal y pelviana. Luego, en la segunda mitad del siglo XX se perfeccionaron los equipos de radiación que se utilizaron en el tratamiento del cáncer. Desde esa fecha, se multiplicaron los pacientes con afección actínica de algún segmento del tubo digestivo. La radiación produce en el intestino: a) lesiones agudas en las primeras semanas, generalmente autolimitadas, que habitualmente no requieren manejo específico y b) lesiones crónicas que aparecen entre 6 meses a 2 años y se caracterizan por dolor abdominal, diarrea y sangrado digestivo, junto con las complicaciones como fístulas, estenosis y perforación, que son subsidiarias de terapias de elevada complejidad y morbimortalidad. Entre los métodos diagnósticos se incluye la colonoscopía, que muestra lesiones en la mucosa intestinal tanto en la fase aguda como en la crónica, con edema, granularidad, friabilidad, lesiones vasculares telangiectásicas y eventualmente ulceraciones o estenosis con pérdida de pliegues y haustras. La radiología contrastada con bario muestra dilatación de asas, edema de la mucosa, pérdida de haustras o pliegues, estenosis y fístula o perforación en la fase más crónica. La tomografía axial computada proporciona ayuda en la pesquisa de complicaciones como abscesos o perforación y en el diagnóstico diferencial de carcinoma versus lesión actínica. Las medidas terapéuticas incluyen apoyo nutricional y sintomático en fase aguda. En la fase crónica, a lo anterior se agregan terapias endoscópicas como aplicación de formalina tópica, coagulación con plasma argón o argón láser. Finalmente, frente a complicaciones como estenosis, fístula o perforación, se plantea el tratamiento quirúrgico

Cáncer radioinducido / Radioinduced cancer

Publications about approximately 2 million irradiated people and their death after irradiation, were reviewed. This review considers only statistically important publications. In 140.000 people exposed to environmental radiation in zones of high background and in 350.000 occupationally exposed within recommended annual doses, no excess cancer was detected. In 1,504,000 people prenatally exposed to low doses (about 1cGY) due to diagnostic radiological examinations, the rate of cancer death before 15 years of age, was similar to unexposed populations. In 195,000 exposed to high radiotherapeutic doses, a variable increase in the incidence of cancer was detected. In 825,000 people that received internal and external irradiation in Chernobyl, no increase in cancer deaths was detected until 1991. In 1993, an increased incidence of thyroid gland carcinoma was preliminarily reported. Finally, in 100,000 people irradiated at Hiroshima and Nagasaki ab excess leukemia rate was found in the group that received doses over 200 cGY

Repercussöes dermatológicas no acidente radioativo com o Césio 137 em Goiânia / Dermatological repercussions in the radioactive accident with Cesio 137 in Goiânia

O objetivo deste estudo foi analisar a ocorrência de dermatoses nos indivíduos expostos ao césio-137 no acidente radioativo ocorrido na cidade de Goiânia, em setembro de 1987, e evidenciar dermatoses precancerosas ou preditoras de baixa imunidade. Avaliaram-se grupos, conforme a intensidade de radiação, e um grupo-controle, composto por pessoas não expostas a radiação. Neste estudo a população exposta ao césio-137 corresponde a 109 pessoas, divididas em Grupos I e II, conforme normas da CNEN. No Grupo I incluiram-se 54 pessoas com exposição maior que ou igual 20 rads e/ou radiolesão, no Grupo II, 55 pessoas, sendo 42 pessoas com exposição menor que 20 rads e 13 filhos de pacientes do Grupo I. O estudo foi de coorte histórica, ou seja, retropectiva, por 9 anos, de setembro de 1987 a agosto de 1996. Pesquisou-se a presença da oncoproteina p-53 nas radiolesöes de 10 pacientes. Não se evidencia aumento na incidência das dermatoses nos grupos expostos, exceto as piodermites nos pacientes com radiolesão. As dermatoses mais frequentes foram as piodermites, a pitiriase vesicolor, a escabiose, as dermatofitoses e as dermatites seborreicas. Os resultados obtidos não apresentam significância estatística na avaliação das dermatoses precancerosas. A oncoproteína p-53, nos indivíduos com radiolesão, revela 80 (por cento) de positividade e um fator de risco estimado em oito vezes para o teste. Este teste mostra-se útil no sentido de acrescentar opçöes na avaliaço propedêutica e sugere uma atenção contínua para melhor controle evolutivo destes indivíduos

Actinic rectitis--the role of colostomy

From 4132 patients treated with radiation therapy due to gynecological malignancy from 1974 to 1988, 527 (12.75%) developed some grade of actinic rectitis with clinical manifestation. The authors analyzed the efficacy of colostomy in the management of 10 women with actinic rectitis grades I and II (Sherman classification) submitted to clinical treatment without response. Pelvic radiation therapy, clinical findings, proctoscopy and rectal biopsy were the basis for the diagnosis and staging of the actinic rectitis. All colostomies were made in the transverse colon and the median follow up from colostomy to last review was 53 months. Eight patients had complete remission of clinical findings after colostomy, but one had recurrence of symptoms 2 years later. One patient had incomplete remission but with clinical improvement and one patient had tumor recurrence. From 8 patients with complete clinical remission, 2 had the colostomies closed, but in 1 was restored 3 months later due to rectum-vaginal fistula

Effect of radiation on pulmonary functions in patients with breast cancer.

There is no systematic study available from our country regarding pulmonary function tests in patients of breast cancer who receive postoperative radiotherapy. Therefore, we planned a prospective study to find out the effect of radiation on pulmonary functions in patients with breast cancer; who had undergone surgery in the form of simple mastectomy and axillary clearance. Transient radiological changes were seen in two cases and one patient had fibrosis at 9 months.