Liquen escleroso extragenital inducido por radioterapia / Extragenital Lichen Sclerosus Induced by Radiotherapy

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The impact of electromagnetic radiation (2.45 GHz, Wi-Fi) on the female reproductive system: The role of vitamin C.

The present study investigated the effects of applied continuous 2.45 GHz electromagnetic radiation (EMR), which might cause physiopathological or morphological changes in the ovarian, fallopian tubal, and uterine tissues of rats. We proposed that the addition of vitamin C (Vit C) may reduce these severe effects. Eighteen female Sprague Dawley rats were randomly divided into three groups with six animals in each: Sham, EMR (EMR, 1 h/day for 30 days), and EMR + Vit C (EMR, 1 h/day for 30 days 250 mg/kg/daily). Total oxidant status (TOS) and oxidative stress index (OSI) levels increased ( p = 0.011 and p = 0.002, respectively) in the EMR-only group in ovarian tissues. In all tissues, TOS and OSI levels significantly decreased in the Vit C-treated group in ovarian, fallopian tubal, and uterine tissues ( p < 0.05). Anti-müllerian hormone levels significantly increased in the EMR group ( p < 0.05) and decreased in the Vit C-treated groups. Estrogen (E2) levels were unchanged in the EMR group, as the differences were not statistically significant. Immunohistochemical examination of the ovaries revealed significant increases in Caspase-3 expressions in the epithelial cells of the EMR group ( p < 0.05). In the EMR group, hyperemia was observed in uterine tissues. Also, Caspase-3 and Caspase-8 were significantly increased in the EMR group ( p < 0.001). Caspase-3 was significantly diminished with Vit C application in the ovarian and uterine tissues ( p < 0.05). Caspase-8 was significantly diminished only in uterine tissues ( p < 0.05). These results indicate that prolonged EMR exposure induced physiopathological changes in the ovarian, fallopian tubal, and uterine tissues due to oxidative damage. Under the conditions of this study, Vit C may have protective effects on female reproductive system against oxidative damage.

Effect of different light sources on reproductive anatomy and physiology of Japanese quail (Coturnix coturnix japonica).

Artificial lights are essential for controlling the reproductive tract development of birds during puberty and therefore influence reproductive quality. The aim of this study was to evaluate the effect of different light sources on reproductive anatomic and physiological characteristics of female Japanese quail (Coturnix coturnix japonica). A total of 270 birds from one day of age were housed in a masonry shed divided into six rooms with light isolation. Each room was equipped with a different type of light bulb and contained seven cages with five birds in each. The light bulbs tested were: incandescent; compact fluorescent; and light-emitting diode (LED) in the colors white, blue, red and green. The experimental design was completely randomized with six treatments and seven replications of individual birds each. The anatomic and physiological condition of the birds was evaluated at four, eight and 12 weeks of age. The white LED bulb advanced (P<0.05) the sexual maturity by one week, resulted (P<0.05) in higher live weights and greater weight and relative percentage of ovarian stroma, oviduct and ovarian tissue at eight weeks of age. Higher plasma concentrations of estradiol and lipids were also observed (P<0.05) at eight weeks under the white LED bulb. At 12 weeks of age, the magnum and isthmus folding characteristics were better (P<0.05) with the red LED bulb. In conclusion, the photostimulation with the white LED bulb was more efficient at activating the reproductive cycle, hastening the onset of sexual maturity and increasing the development of reproductive organs after puberty.

Reproducibility and genital sparing with a vaginal dilator used for female anal cancer patients.

PURPOSE: Acute vulvitis, acute urethritis, and permanent sexual dysfunction are common among patients treated with chemoradiation for squamous cell carcinoma of the anal canal. Avoidance of the genitalia may reduce sexual dysfunction. A vaginal dilator may help delineate and displace the vulva and lower vagina away from the primary tumor. The goal of this study was to evaluate the positional reproducibility and vaginal sparing with the use of a vaginal dilator. MATERIALS AND METHODS: Ten female patients treated with IMRT for anal cancer were included in this study. A silicone vaginal dilator measuring 29 mm in diameter and 114 mm in length was inserted into the vagina before simulation and each treatment. The reproducibility of dilator placement was investigated with antero-posterior and lateral images acquired daily. Weekly cone beam CT (CBCT) imaging was used to confirm coverage of the GTV, which was typically posterior and inferior to the dilator apex. Finally, a planning study was performed to compare the vaginal doses for these 10 patients to a comparable group of 10 female patients who were treated for anal cancer with IMRT without vaginal dilators. RESULTS: The absolute values of the location of the dilator apex were 7.0 ± 7.8mm in the supero-inferior direction, 7.5 ± 5.5 mm in the antero-posterior, and 3.8 ± 3.1mm in the lateral direction. Coverage of the GTV and CTV was confirmed from CBCT images. The mean dose to the vagina was lower by 5.5 Gy, on average, for the vaginal dilator patients, compared to patients treated without vaginal dilators. CONCLUSION: The vaginal dilator tended to be inserted more inferiorly during treatment than during simulation. For these ten patients, this did not compromise tumor coverage. Combined with IMRT treatment planning, use of a vaginal dilator could allow for maximum sparing of female genitalia for patients undergoing radiation therapy for anal cancer.

[The health of children born after cancer treatments]. / Syöpähoitojen jälkeen syntyneiden lasten terveys.

With the development of cancer treatments an increasing number of patients having contracted cancer at a young age will survive. Those who have recovered from cancer will, however, have children almost twice more infrequently than their siblings. Women who have received radiotherapy especially in the abdominal and pelvic region possess an increased risk of premature delivery. Progeny of the patients have been shown not to possess an increased risk of intrauterine death, death during the neonatal period or embryonic deaths. According to current knowledge, cancer treatments do not have transgenerational effects and do not increase the risk of cancer among the progeny.

Organ and effective dose reduction in adult chest CT using abdominal lead shielding.

OBJECTIVES: The purpose of this study was to evaluate and compare organ and effective dose savings that could be achieved using conventional lead aprons and a new, custom-designed shield as out-of-plane shielding devices during chest CT scans. METHODS: Thermoluminescent dosimeters were used to measure doses throughout the abdomen and pelvis during CT scans of the chest of a RANDO phantom. Dose measurements were made with no shielding, with lead aprons and with the new shield around the abdomen and pelvis in order to quantify the achievable organ and effective dose reductions. RESULTS: Average dose savings in the 10 phantom sections ranged from 5% to 78% with the highest point dose saving of 93% being found in the mid-pelvis. When shielding was used, the maximum measured organ dose reduction was a 72% dose saving to the testes. Significant dose savings were found throughout the abdomen and pelvis, which contributed to an effective dose saving of 4% that was achieved over and above the dose savings obtained through conventional optimisation strategies. This could yield significant population dose savings and reductions in collective radiation risk. CONCLUSION: In this study significant organ and effective dose reductions have been achieved through the use of abdominal shielding during chest CT examinations and it is therefore recommended that out-of-plane patient shielding devices should be used for all chest CT scans and potentially for every CT scan, irrespective of body part.

Impacto da radioterapia e da quimioterapia sobre o aparelho genital feminino: procedimentos terapêuticos / Radiotherapy and chemotherapy impact on female genital apparatus: therapeutic procedures

No presente estudo apresentamos os diversos procedimentos terapêuticos existentes com o intuito de obter-se proteção e melhoria dos danos induzidos por radioterapia e quimioterapia no aparelho genital feminino.

The aim of this study is obtain a convenient analysis of different therapeutic methods to improve better conditions before and after radiotherapy and chemotherapy in the female genital apparatus.

O impacto da radioterapia e da quimioterapia no aparelho genital feminino / Radiotherapy and chemotherapy impact on female genital apparatus

O tratamento de diversos tipos de câncer poderá muitas vezes condicionar as pacientes a redução no seu potencial reprodutivo. As pacientes com diferentes neoplasias deverão ser informadas das opções terapêuticas e também das medidas necessárias para preservar sua fertilidade, dos possíveis danos no aparelho reprodutor feminino e das possibilidades futuras quanto à reprodução, antes de receberem qualquer orientação terapêutica. Esse foi o propósito deste estudo.

Treatment of several types of cancer, in many cases, lead to a reduction of the patients' reproductive potential. Such patients must be informed of different therapeutic options and possible resulting damage to the female reproductive tract, as well as all measures necessary for preserving their fertility and future possibilities to reproduce, prior to receiving any therapeutic orientation geared toward this goal. This was the basic purpose of this study.

Radioterapia lumboaórtica en pacientes con cáncer de cuello uterino: experiencia del Instituto Nacional del Cáncer / Paraortic radiotherapy in patients with uterine cervical carcinoma: Instituto Nacional del Cáncer experience

Antecedentes: El cáncer de cérvicouterino continúa siendo una enfermedad prevalente en Chile. Es frecuente recibir pacientes en etapas IIB y IIIB donde el riesgo de compromiso ganglionar pelviano y lumbo-aórtico es elevado y el tratamiento es radioquimioterapia. Objetivo: Análisis retrospectivo de pacientes con cáncer cérvicouterino que recibieron radioterapia que incluía los territorios lumboaórticos. Método: Revisión de pacientes con cáncer cérvicouterino tratadas entre 1995 y 2007 en el Instituto Nacional del Cáncer, Santiago, Chile. En 39 pacientes el tratamiento incluyó las cadenas lumboaórticas. Se analizó toxicidad y evolución. Se utilizaron dos técnicas de radioterapia: la primera durante la década del 90, donde se empleaban dos campos paralelos y opuestos (anterior y posterior) y una segunda actual, donde se irradian en conjunto la pelvis y los lumboaórticos a través de 4 campos (laterales y AP-PA). Resultados: El análisis dosimétrico de las dos técnicas confirma un mayor volumen irradiado de tejidos normales con la técnica de dos campos, fundamentalmente intestino delgado. La toxicidad fue significativamente diferente, siendo la que utilizamos hoy menos tóxica y con bajas complicaciones gastrointestinales, a pesar de recibir un tratamiento de radio-quimioterapia concomitante (55 por ciento vs 0 por ciento). Conclusión: La radioterapia lumboaórtica es un tratamiento con una tolerancia aceptable incluso con quimioterapia concomitante. Esta revisión nos obliga a elaborar un nuevo trabajo para evaluar si la radioterapia lumboaórtica reduce el riesgo de recidiva y aumenta la sobrevida.

Background: Uterine cancer is still a prevalent disease in Chile. Is common to treat patients with tumors in stages IIB and IIIB where the risk of pelvic and paraortic limph node involvement is very high. Its treatment is radio-chemotherapy. Objective: To present a retrospective analysis of patients that suffered cervix-uterine cancer who were treated with radiotherapy including the aortic-lumbar area. Methods: From the revision of patients who were treated of cervix-uterine cancer between the years 1995 and 2007, 39 were treated including aortic-lumbar chains. Evolution and toxicity were analyzed. Two radiotherapy techniques were used. The first one, during the nineties, included two parallel previous and later and opposed fields, and a second technique, currently used, where pelvis and paraortic are radiated at the same time through four lateral (AP-PA) fields. Results: The dosimeter analysis of both techniques shows that there is a higher volume of radiated normal tissue with the two fields techniques, mainly in the small bowel. On the other hand, the toxicity was significantly different being today's technique less toxic and showing low gastrointestinal side effects, despite receiving a simultaneous radio-chemotherapy (55 percent vs 0 percent). Conclusion: The paraortic radiotherapy treatment has an acceptable level of tolerance even under simultaneous radio-chemotherapy. Given the results of this study, we see the need for undergoing a new research project in order to evaluate if the aortic-lumbar radiotherapy may reduce the risk of relapse and increase in survival rate.

[DNA adducts in human female genital organs]. / Addukty DNA w narzadach plciowych kobiety.

DNA adducts, one of genetic damages markers, precede and finally can lead to oncogenic mutations. They appear in genome as a result of DNA bases damages caused by various and numerous environmental factors eg. ultraviolet light, ionic radiation, toxins and also endogenic substances, for example estrogens. It is believed that the creation of DNA adducts is a necessary but insufficient process for the neoplastic transformation of the cell. The following review presents concise knowledge about the DNA adducts creation and their sequels served in healthy and cancerous tissues of the female genital organs, on the base of the available data.

Female survivors of childhood cancer: preterm birth and low birth weight among their children.

BACKGROUND: Improved survival after childhood cancer raises concerns over the possible long-term reproductive health effects of cancer therapies. We investigated whether children of female childhood cancer survivors are at elevated risk of being born preterm or exhibiting restricted fetal growth and evaluated the associations of different cancer treatments on these outcomes. METHODS: Using data from the Childhood Cancer Survivor Study, a large multicenter cohort of childhood cancer survivors, we studied the singleton live births of female cohort members from 1968 to 2002. Included were 2201 children of 1264 survivors and 1175 children of a comparison group of 601 female siblings. Data from medical records were used to determine cumulative prepregnancy exposures to chemotherapy and radiotherapy. Logistic regression was used to estimate odds ratios (ORs) for the association between quantitative therapy exposures and preterm (<37 weeks) birth, low birth weight (<2.5 kg), and small-for-gestational-age (SGA) (lowest 10th percentile) births. All statistical tests were two-sided. RESULTS: Survivors' children were more likely to be born preterm than the siblings' children (21.1% versus 12.6%; OR = 1.9, 95% confidence interval [CI] = 1.4 to 2.4; P<.001). Compared with the children of survivors who did not receive any radiotherapy, the children of survivors treated with high-dose radiotherapy to the uterus (>500 cGy) had increased risks of being born preterm (50.0% versus 19.6%; OR = 3.5, 95% CI = 1.5 to 8.0; P = .003), low birth weight (36.2% versus 7.6%; OR = 6.8, 95% CI = 2.1 to 22.2; P = .001), and SGA (18.2% versus 7.8%; OR = 4.0, 95% CI = 1.6 to 9.8; P = .003). Increased risks were also apparent at lower uterine radiotherapy doses (starting at 50 cGy for preterm birth and at 250 cGy for low birth weight). CONCLUSIONS: Late effects of treatment for female childhood cancer patients may include restricted fetal growth and early births among their offspring, with risks concentrated among women who receive pelvic irradiation.

Cervical cancer: MR imaging findings before, during, and after radiation therapy.

In this study, magnetic resonance (MR) imaging findings of patients with varying stages of cervical carcinoma are reviewed. The appearances of the postirradiation pelvis on MR images are also characterized and correlated with preradiation therapy staging. MR imaging findings of recurrent and metastatic disease are presented and discussed.

[Electromagnetic radiation of extra high frequency as a method of rehabilitation after surgical treatment of tubal-peritoneal infertility]. / Elektromagnitnoe izluchenie kraine vysokoi chastoty kak sredstvo vosstanovitel'noi terapii posle khirurgicheskogo lecheniia trubno-peritoneal'nogo besplodiia.

Seventy four patients entered the placebo-controlled study of rehabilitation EHF therapy 1 month after surgical laparoscopy for tubal-peritoneal infertility. It was found that early EHF therapy corrects hemodynamics in small pelvis vasculature characteristic for chronic inflammation of the uterine appendages thus raising the rate of impregnation.

Correlation of radiation tolerance dose of normal human organs with organ weight, blood, and water content.

The concerted effort to minimize the radiation exposure to normal human tissues while delivering a high radiation dose to the tumor often results in complications. This limits the efficacy of radiation treatment. Analysis of radiation tolerance dose with organ weight in 15 human organs yields a correlation coefficient of 0.62, whereas the correlation of radiation tolerance dose with blood and water content yields correlation coefficients of 0.82 and 0.60, respectively. Results indicate that as the organ weight and/or blood and water content increases, radiation tolerance dose decreases.

Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy.

BACKGROUND AND PURPOSE: There is still a concern that the use of HDR brachytherapy might result in an increase of late tissue damage. This restrospective study evaluates the incidence and severity of late complications in patients with carcinoma of the cervix who underwent combined external beam radiation (EBR) and Ir-192 HDR brachytherapy and attempts to identify pretreatment and treatment parameters correlating with late complications. MATERIAL AND METHODS: Between 1985 and 1992, 161 patients with carcinoma of the cervix (FIGO stages IB-IVB) received EBR to the pelvis (ave, max. dose 48.8 Gy) followed by 1-6 Ir-192 HDR placements (median 2). Doses to point A ranged from 8.5 to 38.7 Gy (median 17 Gy). Parameters examined included age, diabetes, obesity, history of inflammatory bowel disease or diverticulitis, prior surgery, hemoglobin level, FIGO stage, EBR dose, technique and daily dose fraction, number of HDR treatments and total dose to point A, maximum doses to bladder and rectum delivered by brachytherapy and cumulative dose to point A. Median follow-up for all patients was 37 months. Complications were rated using an in-house scoring system and according to the French-Italian Glossary (FIG). RESULTS: Actuarial 5-year survival was 93%, 57%, 46%, and 0% for stages IB, II, IIIB, and IV, respectively. Of 161 patients, 11% developed moderate and 3.7% severe sequelae (FIG: 2.5%, 3.7%). Since some patients experienced more than one complication, the overall incidence was 13.6% and 4.9% (FIG: 3.1%, 4.9%) with respective 5-year actuarial rates of 14% and 5% for moderate, and 2% and 8% for severe bowel and genitourinary tract complications (FIG: 3.5%, 0, and 2%, 8%). All severe bowel complications occurred within 1.5 years whereas urinary tract sequelae continued to develop throughout the follow-up period. FIGO stage was associated with a significant increase in late sequelae (P = 0.015). Analysis of the remaining pretreatment and treatment parameters failed to reveal any statistically significant correlation with moderate or severe sequelae. CONCLUSION: In our series using HDR brachytherapy, complication and survival rates were comparable with other series employing either LDR or HDR procedures. Of all parameters analysed, stage of disease was the only parameter significantly correlated with complications in univariate and multivariate analysis.