Condroradionecrose de laringe após radioterapia / Laryngeal chondroradionecrosis following radiotherapy

RESUMO Objetivo: estudar a condroradionecrose de laringe por complicação de radio-quimioterapia para tratamento do câncer de laringe e propor um fluxograma de tratamento com a utilização de câmara hiperbárica. Métodos: estudo retrospectivo de pacientes portadores de carcinoma de laringe admitidos em dois hospitais terciários num período de cinco anos. Resultados: de 131 pacientes portadores de câncer de laringe, 28 foram submetidos à radio e quimioterapia exclusiva e destes, três evoluíram com condroradionecrose. O tratamento destes pacientes foi realizado com câmara hiperbárica e com desbridamento cirúrgico, conforme proposição do fluxograma. Todos os pacientes tiveram a laringe preservada. Conclusão: a incidência de condroradionecrose de laringe por complicação de radioterapia e quimioterapia em nossa casuística foi de 10,7% e o tratamento com oxigenoterapia hiperbárica, com base no nosso fluxograma, foi efetivo no controle desta complicação.

ABSTRACT Objective: to study larynx chondroradionecrosis related to radiotherapy and chemotherapy treatment and provide a treatment flowchart. Methods: retrospective study with clinical data analysis of all larynx cancer patients admitted in a two tertiary hospital in a five years period. Results: from 131 patients treated for larynx cancer, 28 underwent chemoradiotherapy with curative intent and three of them presented chondroradionecrosis. They were treated with hiperbaric oxigen therapy and surgical debridment following our flowchart, preserving the larynx in all. Conclusions: the incidence of chondroradionecrosis as a complication of chemoradiotherapy in our series was 10,7% and the treatment with hiperbaric oxigen therapy, based in our flowchart, was effective to control this complication.

Análise videolaringoestroboscópica de pacientes submetidos à radioterapia para tratamento de câncer glótico / Videolaryngostroboscopic analysis of patients submitted to radiation therapy for the treatment of glottic cancer

Sendo a radioterapia oncologicamente adequada no tratamento do câncer precoce da laringe, é importante estudar o padrão vibratório, que é componente crítico para os resultados vocais. Objetivo: Analisar os achados videolaringoestroboscópicos em um grupo de pacientes submetidos à radioterapia para o tratamento do câncer glótico precoce. Métodos: Estudo retrospectivo realizado através da avaliação de 20 pacientes estadiados como T1a glótico de 1995 a 2005. Um protocolo videolaringoestroboscópico foi aplicado. Resultados: O fechamento glótico foi completo em 17 pacientes. A amplitude foi normal em 14 pregas vocais tratadas e em 18 pregas contralaterais. O padrão da onda vibratória mucosa foi sempre totalmente presente, normal ou discretamente diminuído em ambas as pregas vocais, com melhores resultados para a prega vocal contralateral em comparação com aqueles verificados nas pregas vocais com o tumor. A periodicidade foi sempre regular em todos os casos. A simetria e os movimentos das pregas vestibulares e das aritenoides foram normais. Houve constrição supraglótica lateral ocasional em quatro casos. O aspecto da mucosa foi edematoso em seis pacientes. Formação de bola de muco foi observada em 12 pacientes. Conclusões: O padrão vibratório foi normal ou discretamente diminuído para ambas as pregas vocais após tratamento radioterápico para câncer glótico T1a.

Radiation therapy is an adequate treatment for early laryngeal cancer, and it is important to study the vocal fold vibratory pattern, which is essential for a favorable voice outcome. AIM: To analyze laryngostroboscopic findings in a group of patients who underwent radiation therapy for the treatment of early glottic cancer. Methods: A retrospective study was conducted in order to evaluate 20 patients staged as T1a glottic tumors in the period from 1995 to 2005. A laryngostroboscopic protocol was applied. Rsualtados: Glottic closure was complete in 17 patients. The amplitude was normal in 14 treated vocal folds and in 18 contralateral vocal folds. The mucosa wave vibratory pattern was totally present in all vocal folds. The periodicity was always regular in all cases. The vestibular fold and arytenoid symmetry and movements were normal. There was occasional supraglottic lateral constriction in 4 cases. The mucosal appearance was normal in 14 and edematous in 6 patients. Mucus build up was observed in 12 patients. Conclusions: The vibratory pattern was normal or slightly diminished in both vocal folds after radiation therapy for early glottic cancer.

Colitis quística profunda posradioterapia: Caso clínico / Colitis cystica profunda: Report of one case

Colitis cystica profunda is a benign condition that can be confused with adenocarcinoma. We report a 35year-old woman that received radiotherapy for a uterine cervical carcinoma who presented intermittent hematochezia three times after ending the therapy. This episode was diagnosed and treated as a radiation colitis and the patient remained asymptomatic for six years. After this period she presented again intermittent hematochezia and a rectal mass that was surgically removed. The pathology report disclosed a colitis cystica profunda.

¿Es curable el cáncer de mama en etapa precoz?: Resultados del tratamiento combinado con cirugía, radioterapia y quimioterapia / Treatment results of early breast cancer: A retrospective review

Background: Breast cancer will develop in one out of ten women during their lifetime. Early diagnosis has increased in recent years. Aim: To describe a population of women with breast cancer stage T1N0M0. To analyze radiation therapy toxicity and to evaluate treatment results. Material and methods: Retrospective review of the medical records of 125 women (aged 35 to 80 years) with breast cancer T1N0M0, that were treated between January 1997 and May 2004, with breast conserving surgery and postoperative radiation therapy at an oncology center. Patients lost from follow up were contacted by telephone. Results: An abnormal screening mammography was the reason for consult in 62 percent of cases. The average tumor size was 11.6 mm. Tumors detected with screening mammogram were smaller than those detected on physical exam. The most common radiotherapy toxicity was erithema, which was severe in 2.5 percent of cases. No patient had to stop the radiation treatment due to toxicity. One patient developed arm edema. Tamoxifen was prescribed for 5 years to 80 percent of patients and 17 patients received chemotherapy. After an average follow up of 40 months, no patient has developed local breast relapse, three patients developed contralateral breast cancer and three developed distant metastasis. Two patients died from breast cancer. Disease free survival was 95 percent. Conclusions: Radiotherapy was well tolerated and had excellent local control. Screening mammography detects small tumors. Survival is excellent for early stage breast cancer.

Protective Effects of Epigallocatechin Gallate after UV Irradiation in Cultured Human Retinal Pigment Epithelial Cells

PURPOSE: To evaluate the protective effects of Epigallocatechin gallate (EGCG) against UV irradiation in cultured human retinal pigment epithelial (RPE) cells. METHODS: UV irradiation was produced by a UV lamp for 30 seconds with an irradiance of 3.3 mW/cm2. After 5 minutes and 1 hour, we administered different concentrations of EGCG (0, 5, 10, 15, 25, 50, 100 uM). The cell count was determined under a microscope using a counting chamber and the cell activity was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. RESULTS: The cell count of cultured human RPE cells after UV irradiation was markedly increased in the EGCG administration group, compared with the non-administrated group. The cell activity of the cultured human RPE cells after UV irradiation was markedly increased in the EGCG administration group and was increased in a dose-dependent way as determined by the MTT assay. CONCLUSIONS: The administration of EGCG increased the cell count and the cell activity after UV irradiation in cultured human retinal pigment epithelial cells; this suggests that EGCG provided protection against UV damage in cultured human retinal pigmented epithelial cells.

Upregulation of VEGF and FGF2 in Normal Rat Brain after Experimental Intraoperative Radiation Therapy

The expression of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF)2 in the irradiated brain was examined to test how a single high dose radiation, similar to that used for intraoperative radiation therapy given to the normal cerebrum, can affect the vascular endothelium. After a burr hole trephination in the rat skull, the cerebral hemisphere was exposed to a single 10 Gy dose of gamma rays, and the radiation effect was assessed at 1, 2, 4, 6, and 8 weeks after irradiation. His-tological changes, such as reactive gliosis, inflammation, vascular proliferation and necrosis, were correlated with the duration after irradiation. Significant VEGF and FGF2 expression in the 2- and 8-week were detected by enzyme-linked immunosorbent assay quantification in the radiation group. Immunohistochemical study for VEGF was done and the number of positive cells gradually increased over time, compared with the sham operation group. In conclusion, the radiation injuries consisted of radiation necrosis associated with the expression of VEGF and FGF2. These findings indicate that VEGF and FGF2 may play a role in the radiation injuries after intraoperative single high-dose irradiation.

Extensive acute lung injury following limited thoracic irradiation: radiologic findings in three patients

The aim of our study was to describe the radiologic findings of extensive acute lung injury associated with limited thoracic irradiation. Limited thoracic irradiation occasionally results in acute lung injury. In this condition, chest radiograph shows diffuse ground-glass appearance in both lungs and thin-section CT scans show diffuse bilateral ground-glass attenuation with traction bronchiectasis, interlobular septal thickening and intralobular smooth linear opacities.

Colorectal adenocarcinoma as a second malignant neoplasm following rhabdomyosarcoma of the urinary bladder: a case report

Following improvements in therapy for childhood malignancies, the striking increase in survival rate over the past 30 years has led to the increase risk of developing second malignant neoplasms (SMNs). We report a case of colorectal carcinoma as a SMN, following treatment for rhabdomyosarcoma. The patient was diagnosed with rhabdomyosarcoma of the urinary bladder at his age of three years, and developed adenocarcinoma in the colon 13 years later. Histologic examination of the surgical specimen revealed adenocarcinoma involving the rectosigmoid area with radiation colitis in its background. The tumor cells showed strong immunoreactivity for p53 protein, suggesting the role of irradiation and p53 mutation in carcinogenesis. This case emphasizes the need for dose observation in survivors of early childhood malignancies treated with radiation and multiagent chemotherapy.

Colorectal adenocarcinoma as a second malignant neoplasm following rhabdomyosarcoma of the urinary bladder: a case report

Following improvements in therapy for childhood malignancies, the striking increase in survival rate over the past 30 years has led to the increase risk of developing second malignant neoplasms (SMNs). We report a case of colorectal carcinoma as a SMN, following treatment for rhabdomyosarcoma. The patient was diagnosed with rhabdomyosarcoma of the urinary bladder at his age of three years, and developed adenocarcinoma in the colon 13 years later. Histologic examination of the surgical specimen revealed adenocarcinoma involving the rectosigmoid area with radiation colitis in its background. The tumor cells showed strong immunoreactivity for p53 protein, suggesting the role of irradiation and p53 mutation in carcinogenesis. This case emphasizes the need for dose observation in survivors of early childhood malignancies treated with radiation and multiagent chemotherapy.