Chinese expert consensus on multidisciplinary diagnosis and treatment of radiation rectal injury (2021 edition) / 中华胃肠外科杂志

Radiation therapy plays a significant role in the integrated treatment for patients with pelvic malignancies, but may lead to radiation-induced rectal injury in some patients, which may affect their physical health and quality of life negatively. Patients with radiation-induced rectal injury are often complicated with pelvic multi-organ injury. Collaborative, multidisciplinary evaluation of pelvic injuries should be highlighted in clinical practices, including clinical, endoscopic, radiological and histopathologic evaluation. To determine the overall treatment strategy and develop individualized treatment strategy, it is necessary to assess the oncologic prognosis, severity and stage of radiation-induced rectal injury and clinical classification using different rating scales. Considering that the disease is self-limiting, non-surgical treatment should be performed for patients with early lesions, while surgical interventions should be performed as soon as possible for patients with severe complications. In terms of prevention of radiation-induced rectal injury, prevention should be targeted for patients at high risk of radiation-induced rectal injury through technique improvement, physical protection and drug prevention. This consensus aims to provide guidance for the clinical practice of radiation-induced rectal injury in China.

Interpretation of Chinese expert consensus on multidisciplinary diagnosis and treatment of radiation rectal injury (2021 edition) / 中华胃肠外科杂志

Although pelvic radiotherapy has played an important role in the treatment of malignant tumors, it is still difficult to avoid radiation damage within a certain period of time. In 2021, under the joint promotion of Colorectal Surgery Group of Chinese Medical Association Surgery Branch, Colorectal Surgeons Committee of Chinese Medical Doctor Association Surgeons Branch, Colorectal Surgeons Committee of Chinese Medical Doctor Association, and Colorectal Cancer Professional Committee of Chinese Anti-Cancer Association, Expert Group on Diagnosis and Treatment of Radiation Intestinal Injury has updated and formulated the 2021 edition of the "Chinese expert consensus on the multidisciplinary diagnosis and treatment of radiation rectal injury" (hereinafter referred to as "Consensus"). This Consensus edition has major changes compared with the "Chinese consensus on the diagnosis and treatment of radiation proctitis (2018)", which mainly updates in the following aspects: (1) adjusting the name of radiation rectal injury: the term "radiation proctitis" was adjusted to "radiation rectal injury"; (2) advocating the concept of pelvic integral injury and the multidisciplinary diagnosis and treatment model; (3) putting forward the clinical classification of diseases: the classification of the chronic rectal injury includes telangiectasia, ulcer, stenosis and mixed type; (4) carrying out individualized treatment based on the characteristics of the above-mentioned disease classification, and adjusting the recommended level of non-surgical treatment; (5) proposing specific guiding principles and details of surgical treatment: "damage control" and "expanded resection" principles, etc. This new edition (2021) of Consensus further refines the disease analysis and treatment strategies, which not only improves the guiding value of clinical practice, but also provides an important reference for the standardized diagnosis and treatment of radiation rectal injury in China.

Treatment of radiation-induced brachial plexopathy with omentoplasty

Radiation-induced brachial plexus neuropathy (RIBPN) is a rare and delayed non-traumatic injury to the brachial plexus, which occurs following radiation therapy to the chest wall, neck, and/or axilla in previously treated patients with cancer. The incidence of RIBPN is more common in patients treated for carcinoma of the breast and Hodgkin lymphoma. With the improvement in radiation techniques, the incidence of injury to the brachial plexus following radiotherapy has dramatically reduced. The currently reported incidence is 1.2% in women irradiated for breast cancer. The progression of symptoms is gradual in about two-thirds of cases; the patients may initially present with paresthesia followed by pain, and later progress to motor weakness in the affected limb. We present the case of a 68-year-old female patient with breast cancer submitted to surgery, chemotherapy, and radiotherapy in the year 2000. Eighteen years later, she developed symptoms and signs compatible with RIBPN and was successfully submitted to omentoplasty for pain control. Omentoplasty is an alternative treatment for RIBPN refractory to conservative treatment, which seems to be effective in improving neuropathic pain. However, postoperative worsening of the motor strength is a real possibility, and all candidates for this type of surgery must be informed about the risk of this complication.

Manejo actual de la xerostomía / Current management of xerostomia

La xerostomía es la sensación de boca seca producto de una alteración del funcionamiento de las glándulas salivales. No es una enfermedad propiamente tal, pero sí una manifestación común a una serie de patologías alterando considerablemente la calidad de vida de los pacientes. Es una complicación frecuente de los pacientes oncológicos de cabeza y cuello que han sido irradiados, por lo que el otorrinolaringólogo juega un rol importante en su manejo. El objetivo de esta revisión es actualizar el manejo de la xerostomía, haciendo énfasis en la prevención de ésta en el paciente oncológico.

Xerostomia is the sensation of dry mouth and is usully caused by an altered functioning of the salivary glands. It is not a disease itself, but it is a common manifestation of a number of pathologies altering the quality of life of patients. It is a common complication of head and neck cancer patients that have been irradiated, so the otolaryngologist plays an important role in its management. The objective ofthis review is to update the management of xerostomia, with emphasis on preventing this in cancer patients.

Supervised physical therapy in women treated with radiotherapy for breast cancer / Fisioterapia supervisionada nas mulheres em radioterapia para o câncer de mama / Terapia física supervisada en mujeres tratadas con radioterapia debido a cáncer de mama

ABSTRACT Objective: to evaluate the effect of physical therapy on the range of motion of the shoulders and perimetry of the upper limbs in women treated with radiotherapy for breast cancer. Methods: a total of 35 participants were randomized into two groups, with 18 in the control group (CG) and 17 in the study group (SG). Both of the groups underwent three evaluations to assess the range of motion of the shoulders and perimetry of the upper limbs, and the study group underwent supervised physical therapy for the upper limbs. Results: the CG had deficits in external rotation in evaluations 1, 2, and 3, whereas the SG had deficits in flexion, abduction, and external rotation in evaluation 1. The deficit in abduction was recovered in evaluation 2, whereas the deficits in all movements were recovered in evaluation 3. No significant differences in perimetry were observed between the groups. Conclusion: the applied supervised physical therapy was effective in recovering the deficit in abduction after radiotherapy, and the deficits in flexion and external rotation were recovered within two months after the end of radiotherapy. Registration number of the clinical trial: NCT02198118.

RESUMO Objetivo: avaliar o efeito da fisioterapia na amplitude de movimento do ombro e na perimetria do membro superior, aplicada durante o período da radioterapia nas mulheres em tratamento para o câncer de mama. Métodos: 35 voluntárias foram randomizadas em dois grupos, 18 para o grupo controle e 17 para o grupo de estudo. Os dois grupos foram submetidos a três avaliações da amplitude de movimento do ombro e perimetria do membro superior, sendo o grupo de estudo também submetido à fisioterapia supervisionada para os membros superiores. Resultados: o grupo controle apresentou déficit entre os membros para o movimento de rotação externa nas avaliações 1, 2 e 3. O grupo de estudo apresentou déficit entre os membros para os movimentos de flexão, abdução e rotação externa na avaliação 1. Houve recuperação do déficit de movimento de abdução na avaliação 2 e, na avaliação 3, os déficits de todos os movimentos estavam recuperados. Na análise da perimetria não foi observada diferença significativa. Conclusão: o protocolo fisioterapêutico supervisionado aplicado foi efetivo na recuperação do déficit de abdução pós-radioterapia e de flexão e rotação externa quando avaliados até 2 meses após o término da radioterapia. Número do registro do ensaio clínico: NCT02198118.

RESUMEN Objetivo: evaluar el efecto de la terapia física en el rango de movimiento de los hombros y la perimetría de las extremidades superiores en mujeres tratadas con radioterapia debido a cáncer de mama. Métodos: un total de 35 participantes fueron aleatorizadas en dos grupos, 18 en el grupo control y 17 en el grupo de estudio. Ambos grupos fueron sometidos a tres evaluaciones para evaluar el rango de movimiento de los hombros y la perimetría de las extremidades superiores, y el grupo de estudio fue sometido a terapia física supervisada de las extremidades superiores. Resultados: el grupo de control tuvo déficits en la rotación externa en la evaluación 1, 2, y 3, mientras que el grupo de estudio tuvo déficits en la flexión, abducción y rotación externa en la evaluación 1. El déficit en la abducción fue recuperado en la evaluación 2, mientras que los déficits en todos los movimientos fueron recuperados en la evaluación 3. No se observaron diferencias significativas en la perimetría. Conclusión: la terapia física supervisada aplicada fue efectiva en la recuperación del déficit en la abducción después de la radioterapia y los déficits en flexión y rotación externa fueron recuperados dos meses después de terminada la radioterapia. Número de registro del ensayo clínico: NCT02198118.

Antimicrobial and cytotoxic effects of phosphoric acid solution compared to other root canal irrigants

Phosphoric acid has been suggested as an irrigant due to its effectiveness in removing the smear layer. Objectives : The purpose of this study was to compare the antimicrobial and cytotoxic effects of a 37% phosphoric acid solution to other irrigants commonly used in endodontics. Material and Methods : The substances 37% phosphoric acid, 17% EDTA, 10% citric acid, 2% chlorhexidine (solution and gel), and 5.25% NaOCl were evaluated. The antimicrobial activity was tested against Candida albicans, Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Actinomyces meyeri, Parvimonas micra, Porphyromonas gingivalis, and Prevotella nigrescens according to the agar diffusion method. The cytotoxicity of the irrigants was determined by using the MTT assay. Results : Phosphoric acid presented higher antimicrobial activity compared to the other tested irrigants. With regard to the cell viability, this solution showed results similar to those with 5.25% NaOCl and 2% chlorhexidine (gel and solution), whereas 17% EDTA and 10% citric acid showed higher cell viability compared to other irrigants. Conclusion : Phosphoric acid demonstrated higher antimicrobial activity and cytotoxicity similar to that of 5.25% NaOCl and 2% chlorhexidine (gel and solution). .

Is there a role for hyberbaric oxygen as primary treatment for grade IV radiation-induced haemorrhagic cystitis? a prospective pilot-feasibility study and review of literature

Purpose To examine the safety and efficacy of hyperbaric oxygen as the primary treatment for Grade IV radiation-induced haemorrhagic cystitis. Materials and Methods Hyperbaric oxygen was prospectively applied as a primary treatment option in 11 patients with Grade IV radiation cystitis. Primary endpoint was the incidence of complete and partial response to treatment. Secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival. Results All patients completed therapy without complications for a mean follow-up of 17.82 months (range 3 to 34). Mean number of sessions needed was 32.8 (range 27 to 44). Complete and partial response rate was 81.8% and 18.2%, respectively. However, in three patients the first treatment session was not either sufficient or durable giving a 72.7% rate of durable effect. Interestingly, all 9 patients with complete response received therapy within 6 months of the haematuria onset compared to the two patients with partial response who received therapy at 8 and 10 months from the haematuria onset, respectively (p = 0.018). The need for blood transfusion (p = 0.491) and the total radiation dose (p = 0.259) were not correlated to success-rate. One patient needed cystectomy, while all patients were alive at the end of follow-up. Conclusions Early primary use of hyperbaric oxygen to treat radiation-induced grade IV cystitis is an effective and safe treatment option. .

Subcutaneous extravasation of Sr-89: usefulness of bremsstrahlung imaging in confirming Sr-89 extravasation and in the decision making for the choice of treatment strategies for local radiation injuries caused by Sr-89 extravasation

A male patient in his 20s presented at our clinic with pain caused by bone metastases of the primitive neuroectodermal tumor, and Sr-89 was administrated to palliate the pain. After receiving the injection, the patient complained of a slight burning pain at the catheterized area. Slight reddening and small circular swelling [diameter, 0.5 cm] were observed at the catheterized area. Sr-89 extravasation was suspected. To estimate the amount of subcutaneous Sr-89 leakage, bremsstrahlung imaging was immediately performed. We speculated that the skin-absorbed dose from the subcutaneous Sr-89 leakage was 1.78 Gy. The mildest clinical sign of local radiation injury was erythema. The received dose was higher than 3 Gy, and the time of onset was from 2 to 3 weeks. In our patient, local radiation injuries [LRIs] did not occur. Though requiring further verification, subsequent bremsstrahlung imaging and estimation of the skin-absorbed dose from the subcutaneous Sr-89 leakage are useful in confirming Sr-89 extravasation and in the decision making for the choice of treatment strategies for LRIs caused by Sr-89 extravasation

Prevención y tratamiento de la enteritis actínica / Prevention and treatment of radiation enteritis

Chronic actinic enteritis is a severe complication that ocurrs in oncological patients under radiation therapy. It is associated with significant morbidity and mortality rates. This article is focused on the acute and chronic actinic enteritis and their predisposing factors. Due to the multifactorial etiology of the gastrointestinal symptoms in these patients, it is important to have a diagnostic approach based on clinical background information and tests, that will allow to establish one etiology and rule out differential diagnoses. As for the treatment, drugs with variable effectiveness and validity are mentioned. In more complex patients successful treatment with better results has been achieved, but these have a higher cost and are less available. In severe cases, parenteral nutrition and/or surgery have been used. From the point of view of prevention, the utility of the drugs has been documented for acute enteritis. However, in order to reduce the risk of chronic enteritis it is critical to take actions resulting in less toxicity during the radiation therapy. The participation of a multidisciplinary team is very important both in the management and prevention of actinic enteritis.

La enteritis actínica crónica es una complicación grave y creciente que se presenta en pacientes oncológicos sometidos a radioterapia. Se asocia a morbilidad y mortalidad significativas. El presente artículo está enfocado en las formas aguda y crónica de la enteritis actínica y sus factores predisponentes. Dada la etiología multifactorial de los síntomas gastrointestinales en estos pacientes, es importante una aproximación diagnóstica basada en los antecedentes clínicos y exámenes que permitan definir una etiología y excluir diagnósticos diferenciales. En cuanto al tratamiento, se mencionan fármacos con efectividad variable y validez limitada. En pacientes más complejos se han realizado tratamientos con resultados más exitosos, pero de mayor costo y de difícil disponibilidad. En casos graves se debe recurrir a la nutrición parenteral y/o cirugía. Desde el punto de vista de la prevención, se ha documentado la utilidad de fármacos en la enteritis aguda. Sin embargo, para reducir el riesgo de la enteritis crónica es fundamental adoptar medidas que conduzcan a una menor toxicidad durante la radioterapia. Tanto en el manejo como en la prevención de la enteritis actínica es importante el enfoque de un equipo multidisciplinario.

Oral adverse effects of head and neck radiotherapy: literature review and suggestion of a clinical oral care guideline for irradiated patients

Radiotherapy, alone or associated with surgery or chemotherapy, produces a significant increase in cure rates for many malignancies of the head and neck region. However, high doses of radiation in large areas, including the oral mucosa, may result in several undesired reactions that manifest during or after the completion of therapy. The multidisciplinary management is the best alternative to minimize or even prevent such reactions, and the dentist has a fundamental role in this context. This paper reviews the literature related to the main oral sequelae from head and neck radiotherapy and establishes clinical oral management protocol for these irradiated patients.

Laser phototherapy as a treatment for radiotherapy-induced oral mucositis

Oral mucositis is a harmful side effect of radiotherapy (RT) on the head and neck region. There are encouraging reports on the beneficial aspects of the use of laser light on the treatment of oral mucositis. This paper reports the efficacy of laser phototherapy (LPT) on the treatment of oral mucositis in a patient undergoing RT after surgical removal of a squamous cell carcinoma with osseous invasion of the maxilla. Palatal and commissural lesions were treated with λ660 nm, 40 mW, ∅=4 mm², in contact mode, 5 x 2.4 J/cm² per point, 14.4 J/cm² per session. For treating the lesion on the patient's nasal mucosa, LPT (∅=4 mm², λ780 nm, 70 mW, 3 x 2.1 J/cm² per point, 6.3 J/cm² per session, contact mode) was used on the external area of the nose. A single dose (2.4 J/cm²) with the λ660 nm laser, as described before, was applied on the entrance of each nostril. LPT was used 3 times/week during 4 weeks. Treatment results indicate that the use of LPT on oral mucositis was effective and allowed the patient to carry on the RT without interruption. However, long-term and controlled clinical trials are necessary to establish both preventive and curative protocols using LPT.

A mucosite oral é um efeito colateral prejudicial da radioterapia na região de cabeça e pescoço. Existem estudos que evidenciam o efeito benéfico do uso da luz laser no tratamento da mucosite oral. O objetivo deste caso clínico foi o de avaliar a eficácia da fototerapia laser no tratamento da mucosite oral em um paciente sendo submetido a radioterapia, após a remoção cirúrgica de um carcinoma escamocelular, com invasão óssea da maxila. As lesões do palato e das comissuras labiais foram tratadas com λ660 nm, 40 mW, ∅=4 mm², em contato, 5 x 2.4 J/cm² por ponto, 14.4 J/cm² por sessão. Na lesão existente na mucosa nasal a fototerapia laser (∅=4 mm², λ780 nm, 70 mW, 3 x 2.1 J/cm² por ponto, 6.3 J/cm² por sessão, em contato) foi utilizada na área externa do nariz. Uma dose única (2.4 J/cm²) com o laser λ660 nm e os parâmetros descritos anteriormente foi aplicado na entrada de cada narina. A fototerapia laser foi utilizada 3 vezes por semana, durante 4 semanas. Os resultados do tratamento são indicativos de que o uso da fototerapia laser em mucosite oral foi efetiva e permitiu ao paciente continuar o tratamento radioterápico sem interrupções. Entretanto, estudos clínicos controlados são necessários para se estabelecer os protocolos, para tratamento e prevenção da mucosite oral, utilizando fototerapia laser.

Physiotherapy treatments for breast cancer-related lymphedema: a literature review / Tratamientos fisioterapéuticos para el linfedema después de la cirugía de cáncer de seno: una revisión de literatura / Tratamentos fisioterapêuticos para o linfedema pós-câncer de mama: uma revisão de literatura

Breast cancer is the second most frequent cancer among women. Surgery is part of the therapeutic process to prevent metastases, but it can also cause some complications, including lymphedema. Physiotherapy contributes to its treatment, using different techniques that have been developed over the years. This systematic literature review aims to present physiotherapy modalities applied for lymphedema therapy. The literature review was conducted using textbooks and Lilacs, Pubmed and Scielo databases, from 1951 to 2009. Physiotherapy resources used for lymphedema treatment include complex decongestive therapy (CDT), pneumatic compression (PC), high voltage electrical stimulation (HVES) and laser therapy. The analyzed literature shows that better results are obtained with combined techniques. CDT is the most used protocol, and its association with PC has demonstrated efficacy. The new techniques HVES and laser present satisfactory results.

El cáncer de seno es el segundo tipo de cáncer más común entre las mujeres. La cirugía es parte del proceso terapéutico en la prevención de la diseminación de la enfermedad, sin embargo, puede ser causa de algunas complicaciones como el linfedema. La fisioterapia contribuye para su tratamiento con diferentes técnicas que vienen siendo desarrolladas a lo largo de los años. El objetivo de esta revisión sistemática de la literatura es presentar las modalidades fisioterapéuticas aplicadas en el tratamiento del linfedema. La revisión bibliográfica fue efectuada en libros textos y en las bases de datos LILACS, PubMed y SciELO, en el período de 1951 a 2009. Entre los recursos fisioterapéuticos utilizados en el tratamiento del linfedema están la terapia compleja descongestiva (TCD), compresión neumática (CN), estimulación eléctrica de alto voltaje (EVA) y láserterapia. Los trabajos analizados muestran que los resultados son mejores con las técnicas combinadas. La TCD es el protocolo más utilizado, y su asociación con la CN se muestra eficaz. Las nuevas técnicas EVA y láser presentan resultados satisfactorios.

O câncer de mama é o segundo tipo de câncer mais comum entre as mulheres. A cirurgia é parte do processo terapêutico na prevenção da disseminação da doença, porém, pode ser causa de algumas complicações como o linfedema. A fisioterapia contribui para seu tratamento com diferentes técnicas que vêm sendo desenvolvidas ao longo dos anos. O objetivo desta revisão sistemática da literatura é apresentar as modalidades fisioterapêuticas aplicadas no tratamento do linfedema. A revisão bibliográfica foi efetuada em livros textos e nas bases de dados LILACS, PubMed e SciELO, no período de 1951 a 2009. Entre os recursos fisioterapêuticos utilizados no tratamento do linfedema estão a terapia complexa descongestiva (TCD), compressão pneumática (CP), estimulação elétrica de alta voltagem (EVA) e laserterapia. Os trabalhos analisados mostram que os resultados são melhores com as técnicas combinadas. A TCD é o protocolo mais utilizado, e sua associação com a CP se mostra eficaz. As novas técnicas EVA e laser apresentam resultados satisfatórios.

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

Overexposure of radiation therapy patients in Panama: problem recognition and follow-up measures / La sobreexposición de pacientes tratados con radioterapia en Panamá: reconocimiento del problema y medidas de seguimiento

This report summarizes and analyzes the responses of various organizations that provided assistance to the National Oncology Institute (Instituto Oncológico Nacional, ION) of Panama following the overexposure of 28 radiation therapy patients at the ION in late 2000 and early 2001. The report also looks at the long-term measures that were adopted at the ION in response to the overexposure incident, as well as implications that the incident has for other cancer treatment centers worldwide. In March 2001, the director of the ION was notified of serious overreactions in patients undergoing radiation therapy for cancer treatment. Of the 478 patients treated for pelvic cancers between August 2000 and March 2001, 3 of them had died, possibly from an overdose of radiation. In response, the Government of Panama invited international experts to carry out a full investigation of the situation. Medical physicists from the Pan American Health Organization (PAHO) were among those invited. They ascertained that 56 patients treated with partially blocked teletherapy fields for cancers of the uterine cervix, endometrium, prostate, or rectum, had had their treatment times calculated using a computerized treatment planning system. PAHO's medical physicists calculated the absorbed doses received by the patients and found that, of these 56 patients, only 11 had been treated with acceptable errors of ±5 percent. The doses received by 28 of the 56 patients had errors ranging from +10 to +105 percent. These are the patients identified by ION physicists as overexposed. Twenty-three of the 28 overexposed patients had died by September 2005, with at least 18 of the deaths being from radiation effects, mostly rectal complications. The clinical, psychological, and legal consequences of the overexposures crippled cancer treatments in Panama and prompted PAHO to assess radiation oncology practices in the countries of Latin American and the Caribbean. ION clinicians...

Este informe resume y analiza la respuesta de varias organizaciones que brindaron asistencia al Instituto Oncológico Nacional (ION) de Panamá después de la sobreexposición de 28 pacientes sometidos a radioterapia que ocurrió en el ION a finales de 2000 y principios de 2001. Además, se examinan las medidas de largo plazo adoptadas en el ION en respuesta al accidente de sobreexposición y las implicaciones que tiene este accidente para todos los centros de tratamiento oncológico en el mundo. En marzo de 2001 se le comunicaron al director del ION las reacciones adversas graves sufridas por algunos pacientes sometidos a radioterapia contra el cáncer. De los 478 pacientes tratados entre agosto de 2000 y marzo de 2001 por cánceres localizados en la región pélvica, tres habían fallecido, presumiblemente por sobredosis de radiación. A raíz de ello, el Gobierno de Panamá invitó a expertos internacionales a realizar una investigación a fondo de la situación. Entre los especialistas invitados se encontraban físicos médicos de la Organización Panamericana de la Salud (OPS), quienes comprobaron que 56 pacientes con cáncer cérvico-uterino, de endometrio, de próstata o de recto tratados mediante campos de teleterapia parcialmente bloqueados recibieron dosis calculadas mediante un sistema computarizado de planificación de tratamientos. Los físicos médicos de la OPS comprobaron que solo 11 de esos 56 pacientes recibieron una dosis absorbida dentro de los límites aceptables de ±5 por ciento. Veintiocho de los 56 pacientes recibieron dosis con errores entre +10 y +105 por ciento. De esos 28 pacientes que fueron sobreexpuestos, según los físicos del ION, 23 murieron antes de septiembre de 2005; de ellos, 18 murieron a causa de los efectos de las radiaciones, principalmente complicaciones rectales. Las consecuencias clínicas, psicológicas y jurídicas de esta sobreexposición menoscabaron gravemente los tratamientos contra el cáncer en Panamá y llevaron...

Terapia de oxigenación hiperbárica en radionecrosis de cabeza y cuello / Hyperbaric oxygenation therapy in head and neck radio-necrosis

La terapia de oxigenación hiperbárica se ha utilizado en radionecrosis de cabeza y cuello, ya sea como indicación profiláctica o para su manejo terapéutico. El presente trabajo tiene como objetivo presentar la experiencia del Servicio de ORL del Hospital Clínico de la Universidad de Chile con el uso de la cámara hiperbárica en pacientes con radionecrosis de cabeza y cuello. Se presenta una casuística de 8 pacientes. En 5 casos la indicación de oxigenación hiperbárica fue terapéutica y, en 3 de ellos, profiláctica. En todos quienes fueron sometidos a oxigenación terapéutica se resolvió la radionecrosis. En los pacientes con indicación profiláctica no hubo radionecrosis del colgajo. Se concluye que la terapia de oxigenación hiperbárica es una herramienta coadyuvante terapéutica o profiláctica en la necrosis por radiación de cabeza y cuello.

Conservative therapies for hemorrhagic radiation proctitis: a review

Chronic radiation proctitis represents a challenging condition seen with increased frequency due to the common use of radiation for treatment of pelvic cancer. Hemorrhagic radiation proctitis represents the most feared complication of chronic radiation proctitis. There is no consensus for the management of this condition despite the great number of clinical approaches and techniques that have been employed. Rectal resection represents an available option although associated with high morbidity and risk of permanent colostomy. The effectiveness of nonoperative approaches remains far from desirable, and hemorrhagic recurrence represents a major drawback that leads to a need for consecutive therapeutic sessions and combination of techniques. We conducted a critical review of published reports regarding conservative management of hemorrhagic chronic radiation proctitis. Although prospective randomized trials about hemorrhagic radiation proctitis are still lacking, there is enough evidence to conclude that topical formalin therapy and an endoscopic approach delivering an argon plasma coagulation represent available options associated with elevated effectiveness for interruption of rectal bleeding in patients with chronic radiation proctitis

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

The impact of continuous supplementation vitamin B compounds against radiation in jury in rats

The influence of treatment of rats with vitamin B-compounds [daily successive doses of 168 micro g vitamin B1; 84 micro g vitamin B2; 84 micro g vitamin B6; 84 ng vitamin B12; 504 micro g nicotinamide and 214 micro g calcium Pantothenate for a period of 4 weeks] on certain biochemical parameters was examined. The variations in glycogen content and glucose-6 phosphatase activity in the liver as well as glucose, epinephrine and norepinephrine levels in the serum were indices selected in this study. No significant changes in the levels of all the studied parameters were recorded along the experimental period after treatment. Whole body gamma irradiation of rats at fractionated doses up to 8 Gy [4 equal fractions; 2 Gy weekly] caused significant increases in the liver glycogen, 1 and 7 days post exposure to the last radiation fraction followed by significant decreases, 14 and 30 days post irradiation . The activity of liver glucose-6- phosphatase and serum glucose level significantly increased 1,7 and 14 days post irradiation followed by a significant decrease after 30 days. The level of serum epinephrine significantly increased 1 and 7 days post irradiation. Conversely, the level of norepinephrine significantly decreased 1,7, and 14 days post irradiation. In rats treated with vitamin B compounds and exposed to fractionated gamma irradiation at the same above mentioned doses, certain amelioration in the radiation induced changes in the studied parameters was observed

Anestesia y cuidados críticos en pacientes con injuria por radiación / Anesthesia and critical care in patients with injury by radiation

La amenaza de una guerra o un accidente nuclear nos llena de curiosidad e indiferencia. En general esto se refleja a nivel mundial con muy poca bibliografía disponible que nos dé información sobre estos eventos y las conductas más aconsejadas para su control y tratamiento. Veremos en este trabajo las características de las distintas radiaciones, nociones de lo significativamente importante para el especialista que son los efectos sobre el individuo y los criterios para diagnóstico, pronóstico y tratamiento.