Classification of chronic radiation-induced ulcers in the chest wall after surgery in breast cancers.
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ABSTRACT:
SUBMITTER: Ma X
PROVIDER: S-EPMC5558728 | biostudies-other | 2017 Aug
REPOSITORIES: biostudies-other
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Project description:Oncoplastic breast conservation is classically divided into two approaches: volume displacement and volume replacement (VR). These approaches are important to use when more than 20% of the breast is removed to avoid deformity. Smaller, nonptotic breasts require VR strategies from flaps based off of local chest wall perforators. When larger volumes are required, a flap based off the thoracodorsal artery can be used. Although this flap can replace larger volumes, it usually requires a position change with increased operative time, patient morbidity, and longer recovery while also exhausting a major reconstructive modality. In an effort to avoid this increased operative complexity, we have found that combining a local chest wall perforator flap and bioabsorbable implant, which has been previously shown to be safe and effective in reconstructing partial mastectomy defects, allows for a simpler VR strategy in patients who might otherwise require a more extensive thoracodorsal artery-based flap surgery or a mastectomy. Here, we present 10 cases where we combined flaps based off the lateral, anterior or medial intercostal artery perforators or lateral thoracic artery perforator with a bioabsorbable implant to successfully perform oncoplastic breast conservation in patients who might otherwise be marginal candidates for VR using a local chest wall perforator flap.
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Project description:To determine the role of patient/tumor characteristics, radiation dose, and fractionation using the linear-quadratic (LQ) model to predict stereotactic body radiation therapy-induced grade ? 2 chest wall pain (CWP2) in a larger series and develop clinically useful constraints for patients treated with different fraction numbers.A total of 316 lung tumors in 295 patients were treated with stereotactic body radiation therapy in 3 to 5 fractions to 39 to 60 Gy. Absolute dose-absolute volume chest wall (CW) histograms were acquired. The raw dose-volume histograms (?/? = ? Gy) were converted via the LQ model to equivalent doses in 2-Gy fractions (normalized total dose, NTD) with ?/? from 0 to 25 Gy in 0.1-Gy steps. The Cox proportional hazards (CPH) model was used in univariate and multivariate models to identify and assess CWP2 exposed to a given physical and NTD.The median follow-up was 15.4 months, and the median time to development of CWP2 was 7.4 months. On a univariate CPH model, prescription dose, prescription dose per fraction, number of fractions, D83cc, distance of tumor to CW, and body mass index were all statistically significant for the development of CWP2. Linear-quadratic correction improved the CPH model significance over the physical dose. The best-fit ?/? was 2.1 Gy, and the physical dose (?/? = ? Gy) was outside the upper 95% confidence limit. With ?/? = 2.1 Gy, VNTD99Gy was most significant, with median VNTD99Gy = 31.5 cm(3) (hazard ratio 3.87, P<.001).There were several predictive factors for the development of CWP2. The LQ-adjusted doses using the best-fit ?/? = 2.1 Gy is a better predictor of CWP2 than the physical dose. To aid dosimetrists, we have calculated the physical dose equivalent corresponding to VNTD99Gy = 31.5 cm(3) for the 3- to 5-fraction groups.
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Project description:Pneumocephalus can be seen after head injury with fracture of the skull-base or in cerebral neoplasm, infection, or after intracranial or spinal surgery. We report on a 69-year-old male patient with pneumocephalus after right-sided lobectomy and en bloc resection of the chest wall for non-small-cell lung cancer. Postoperatively, the patient showed a reduced vigilance level with no response to pain stimuli and anisocoria. The CCT scan revealed an extensive pneumocephalus; following which, the patient underwent neurosurgery with laminectomy and ligature of the transected nerve roots. After operation the patient returned to his baseline mental status.
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Project description:Background:Radiation-induced chest wall pain (cwp) and rib fracture (rf) are late adverse effects after stereotactic body radiation therapy (sbrt) for stage i non-small-cell lung cancer (nsclc); however, the literature about their incidence and risk factors shows variability. We performed a systematic review to determine the pooled incidence of cwp and rf in the relevant population. Methods:A literature search using the prisma (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines considered English publications in medline and embase from January 1996 to August 2017. Abstracts were screened, followed by full-text review and data extraction. Results:The database searches identified 547 records. Twenty-eight publications comprising 3892 patients met the inclusion criteria. Median reported ages and follow-up durations fell into the ranges 67-82 years and 12-84 months. Prescriptions fell into the range of 40-70 Gy in 3-10 fractions. Despite study heterogeneity, the pooled incidences of cwp and rf were estimated to be 8.94% and 5.27% respectively. Nineteen studies reported cwp grade: 58 of 308 patients (18.8%) experienced grades 3-4 cwp (no grade 5 events reported). Thirteen studies reported rf grade: grades 3-4 rf were observed in 9 of 113 patients (7.96%). A high chest wall V 30 was an important predictor of cwp and rf. Conclusions:In patients with stage i nsclc, rates of cwp and rf after sbrt are low; however, tumour location, accurate toxicity reporting, and dose-fractionation schemes might alter those rates. Prospective correlation with dosimetry and quality of life assessment will further improve the understanding of cwp and rf after sbrt.
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Project description:PurposeTo investigate the contribution of radiation therapy to acute and late toxicity in pediatric chest wall sarcoma patients and evaluate dosimetric correlates of higher incidence toxicities such as scoliosis and pneumonitis.Methods and materialsThe data from 23 consecutively treated pediatric patients with chest wall sarcomas of various histologies (desmoid, Ewing, rhabdomyosarcoma, nonrhabdomyosarcoma-soft tissue sarcomas) were reviewed to evaluate the relationship between end-organ radiation dose, clinical factors, and the risk of subsequent late effects (scoliosis, pneumonitis). Cobb angles were used to quantify the extent of scoliosis. Doses to the spine and lung were calculated from the radiation treatment plan.ResultsThe range of scoliosis identified on follow-up imaging ranged from -47.6 to 64° (median, 2.95°). No relationship was identified between either radiation dose to the ipsilateral or contralateral vertebral body or tumor size and the degree or direction of scoliosis. The extent of surgical resection and number and location of resected ribs affected the extent of scoliosis. The dominant predictor of extent of scoliosis at long-term follow-up was the extent of scoliosis following surgical resection. Radiation pneumonitis was uncommon and was not correlated with mean dose or volume of lung receiving 24 Gy; however, 1 of 3 surviving patients who received whole pleural surface radiation therapy developed significant restrictive lung disease.ConclusionsAcute and late radiation therapy-associated toxicities in pediatric chest wall sarcoma patients are modest. The degree of scoliosis following resection is a function of the extent of resection and of the number and location of ribs resected, and the degree of scoliosis at the last follow-up visit is a function of the extent of scoliosis following surgery. Differential radiation therapy dose across the vertebral body does not increase the degree of scoliosis. Severe restrictive pulmonary disease is a late complication of survivors after whole pleural surface radiation therapy.
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