ABSTRACT
The purpose of this paper is the demonstration and analysis of the effectiveness of spinal cord stimulation in treatment of chronic drug-resistant neuropathy pain in a patient with radiation-induced plexopathy. She underwent radiation therapy for cancer of the right breast in 2000. Ten years later she complained with pain and weakness her right arm. After physical examination and investigation right-side brachial plexopathy was diagnosed. Antidepressant and anticonvulsant had positive effect during one year but then pain appeared again. That is why the patient has been implanted the system of epidural electrostimulation of thickening of the cervical spinal cord. During the post-operative period significant improvement of pain relief was noted. The doses of analgesics were decreased. Spinal cord stimulation efficacy for treatment of chronic pain was repeatedly proved in clinical investigation and meta-analyses. Nevertheless spinal cord stimulation effects on radiation-induced neurological disorders and possible pathophysiological mechanisms are not enough examined. All these facts require further investigation.
Subject(s)
Abnormalities, Radiation-Induced/therapy , Brachial Plexus Neuropathies/therapy , Breast Neoplasms/radiotherapy , Chronic Pain/therapy , Abnormalities, Radiation-Induced/diagnosis , Abnormalities, Radiation-Induced/physiopathology , Brachial Plexus Neuropathies/diagnosis , Brachial Plexus Neuropathies/physiopathology , Breast Neoplasms/complications , Breast Neoplasms/physiopathology , Chronic Pain/diagnosis , Chronic Pain/etiology , Chronic Pain/physiopathology , Female , Humans , Middle Aged , Pain Management , Radiotherapy/adverse effects , Spinal Cord StimulationABSTRACT
La radioterapia se incluye en gran parte de los regímenes terapéuticos, preventivos y de acondicionamiento, en oncología pediátrica. Numerosos efectos secundarios tardíos de la radiación craneal han sido descritos y son bien conocidos. Sin embargo, se han publicado casos esporádicos de angiomas cavernosos radio-inducidos (ACRI) y aún menos casos se han referido con presentación temprana de estas lesiones. En esta comunicación breve se muestra la aparición de un ACRI con un periodo de latencia corto entre la finalización de la radioterapia y el desarrollo del mismo, en el contexto de un paciente tratado por un tumor del SNC en edad infantil, ependimoma anaplásico infratentorial. Se comentan las diferentes variables propuestas para la formación de novo de estas lesiones y las características de imagen, el tratamiento, pronóstico y seguimiento de este tipo de cavernomas (AU)
Radiotherapy forms part of most therapeutic, preventive, and conditioning regimens in pediatric oncology. Numerous late secondary effects of cranial radiation are well known. However, radiation-induced cavernous angiomas (RICA) have been reported only sporadically and even fewer cases of earlier presentation of RICA have been reported. In this brief report, we describe a RICA that appeared in a boy treated for a CNS tumor (an infratentorial anaplastic ependymoma) after a short latency period between the end of radiotherapy and the development of the RICA (AU)
Subject(s)
Humans , Male , Child , Hemangioma, Cavernous/diagnosis , Hemangioma, Cavernous , Early Diagnosis , Magnetic Resonance Imaging/instrumentation , Magnetic Resonance Imaging/methods , Ependymoma , Vascular Malformations , Abnormalities, Radiation-Induced/epidemiology , Abnormalities, Radiation-Induced/therapy , Hemangioma, Cavernous/complications , Magnetic Resonance Imaging , Prognosis , Ependymoma/complications , Diagnosis, Differential , Radiotherapy/adverse effectsABSTRACT
AIM: Using the generalized linear-quadratic (gLQ) model, we reanalyzed published dosimetric data from patients with radiation myelopathy (RM) after reirradiation with spinal stereotactic body radiotherapy (SBRT). MATERIALS & METHODS: Based on a published study, the thecal sac dose of five RM patients and 14 no RM patients were reanalyzed using gLQ model. Maximum point doses (Pmax) in the thecal sac were obtained. The gLQ-based biological effective doses were calculated and normalized (nBEDgLQ) to a 2-Gy equivalent dose (nBEDgLQ = Gy2/2_gLQ). The initial conventional radiotherapy dose, converted to Gy2/2_gLQ, was added. RESULTS: Total (conventional radiotherapy + SBRT) mean Pmax nBEDgLQ was lower in no RM than RM patients: 59.2 Gy2/2_gLQ (range: 37.5-101.9) versus 94.8 Gy2/2_gLQ (range: 70.2-133.4) (p = 0.0016). The proportion of total Pmax nBEDgLQ accounted for by the SBRT Pmax nBEDgLQ was higher for RM patients. No RMs were seen below a total spinal cord nBEDgLQ of 70 Gy2/2_gLQ. CONCLUSION: The gLQ-derived spinal cord tolerance for total nBEDgLQ was 70 Gy2/2_gLQ.
Subject(s)
Abnormalities, Radiation-Induced/therapy , Radiosurgery , Spinal Cord Diseases/therapy , Spinal Neoplasms/radiotherapy , Abnormalities, Radiation-Induced/pathology , Adolescent , Adult , Aged , Humans , Linear Models , Middle Aged , Radiation Dosage , Radiation Tolerance , Retreatment , Spinal Cord/pathology , Spinal Cord/radiation effects , Spinal Cord Diseases/pathology , Spinal Neoplasms/pathologyABSTRACT
OBJECTIVES: This study aimed to present a clinical report of an irradiated oncologic patient who underwent hyperbaric oxygen therapy to be rehabilitated with implant-supported prosthesis. MATERIALS AND METHODS: A 67-year-old man was admitted at Oral Oncology Center (FOA-UNESP) presenting a lesion on the mouth floor. After clinical evaluation, incisional biopsy and histopathological exam, a grade II squamous cell carcinoma was diagnosed. The patient was subjected to surgery to remove the lesion and partial glossectomy. Afterwards, the radiotherapy, in the left/right cervicofacial area of the supraclavicular fossa, was conducted. After 3 years of the surgery, the patient was submitted to hyperbaric oxygen therapy. Then, four implants were installed in patient's mandible. Five months later, an upper conventional complete denture and lower full-arch implant-supported prosthesis were fabricated. CONCLUSION: The treatment resulted in several benefits such as improving his chewing efficiency, swallowing and speech, less denture trauma on the mucosa and improving his self-esteem.
