RESUMO
INTRODUCTION: Radiation recall dermatitis is an uncommon inflammatory reaction of the skin appearing after several days to several years at the site of previous irradiation; it is precipitated by the use of triggering drugs, although rarely by BRAF or MEK inhibitors. PATIENTS AND METHODS: We report an unusual case of recall dermatitis induced 3 months after initiation of vemurafenib and cobimetinib therapy. DISCUSSION: Radiation recall dermatitis is a cutaneous reaction that must be known and which in rare cases such as ours may occur a long time after the end of radiotherapy.
Assuntos
Antineoplásicos/efeitos adversos , Azetidinas/efeitos adversos , Dermatoses Faciais/induzido quimicamente , Piperidinas/efeitos adversos , Radiodermite/induzido quimicamente , Vemurafenib/efeitos adversos , Neoplasias das Glândulas Suprarrenais/tratamento farmacológico , Neoplasias das Glândulas Suprarrenais/secundário , Pavilhão Auricular/efeitos da radiação , Neoplasias da Orelha/radioterapia , Humanos , MAP Quinase Quinase 1 , Masculino , Melanoma/radioterapia , Melanoma/secundário , Pessoa de Meia-Idade , Neoplasias Cutâneas/radioterapiaAssuntos
Pavilhão Auricular/patologia , Leucemia Linfocítica Crônica de Células B/patologia , Leucemia Linfocítica Crônica de Células B/radioterapia , Infiltração Leucêmica/patologia , Pele/patologia , Adulto , Biópsia por Agulha , Pavilhão Auricular/efeitos da radiação , Seguimentos , Humanos , Imuno-Histoquímica , Leucemia Linfocítica Crônica de Células B/diagnóstico , Infiltração Leucêmica/radioterapia , Masculino , Terapia com Prótons/métodos , Doenças Raras , Medição de Risco , Resultado do TratamentoRESUMO
PURPOSE: This paper describes an uncommon radiation treatment of the external ear, with ultrasound (US) transmission gel used as bolus device to compensate for the irregularity of the target surface. MATERIALS AND METHODS: Postoperative radiotherapy for cutaneous carcinoma was performed with a single high-energy electron beam directed over the ear auricle. Due to the irregular surface of the target, a "missing tissue" compensator was employed. Daily, after patient positioning, the concha was filled and flattened with US gel, and a dose of 54 Gy in 27 fractions was delivered. RESULTS: Water equivalence of the gel was verified by comparing the gel's computed tomography (CT) number [Hounsfield units (HU)] and density with the corresponding values for water and another commercial bolus device. Whereas ultrasound gel and water had comparable values (HU: 0; density 1 g/cm(3) for both), the corresponding values for the commercial device were slightly higher (HU: 80; density 1.02 g/cm(3)). CONCLUSIONS: Ultrasound gel proved to be an easy, fast and cheap compensating tool. Its water equivalence allows it to be used as an alternative to water, though easier to position and with lower risk of displacement. Thus, it is recommendable as a practical tool for most irregular sites. Further investigations are warranted to validate this solution in more complex irradiation techniques.
Assuntos
Carcinoma/radioterapia , Pavilhão Auricular/efeitos da radiação , Géis , Neoplasias Cutâneas/radioterapia , Humanos , Posicionamento do Paciente , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Resultado do Tratamento , UltrassomRESUMO
PURPOSE: Proton minibeam radiation therapy is a novel approach to minimize normal tissue damage in the entrance channel by spatial fractionation while keeping tumor control through a homogeneous tumor dose using beam widening with an increasing track length. In the present study, the dose distributions for homogeneous broad beam and minibeam irradiation sessions were simulated. Also, in an animal study, acute normal tissue side effects of proton minibeam irradiation were compared with homogeneous irradiation in a tumor-free mouse ear model to account for the complex effects on the immune system and vasculature in an in vivo normal tissue model. METHODS AND MATERIALS: At the ion microprobe SNAKE, 20-MeV protons were administered to the central part (7.2 × 7.2 mm(2)) of the ear of BALB/c mice, using either a homogeneous field with a dose of 60 Gy or 16 minibeams with a nominal 6000 Gy (4 × 4 minibeams, size 0.18 × 0.18 mm(2), with a distance of 1.8 mm). The same average dose was used over the irradiated area. RESULTS: No ear swelling or other skin reactions were observed at any point after minibeam irradiation. In contrast, significant ear swelling (up to fourfold), erythema, and desquamation developed in homogeneously irradiated ears 3 to 4 weeks after irradiation. Hair loss and the disappearance of sebaceous glands were only detected in the homogeneously irradiated fields. CONCLUSIONS: These results show that proton minibeam radiation therapy results in reduced adverse effects compared with conventional homogeneous broad-beam irradiation and, therefore, might have the potential to decrease the incidence of side effects resulting from clinical proton and/or heavy ion therapy.
Assuntos
Pavilhão Auricular/efeitos da radiação , Terapia com Prótons/efeitos adversos , Terapia com Prótons/métodos , Lesões Experimentais por Radiação/prevenção & controle , Animais , Otopatias/etiologia , Otopatias/patologia , Eritema/etiologia , Eritema/patologia , Feminino , Camundongos , Camundongos Endogâmicos BALB C , Modelos Animais , Otite Externa/etiologia , Otite Externa/patologia , Doses de Radiação , Lesões Experimentais por Radiação/patologiaRESUMO
BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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%). CONCLUSION: The findings suggest relevant prevalence, probable association with chronic sun exposure, advanced age and phototypes I and II.