PURPOSE: To investigate the difference in rectal complications rate following prostate low dose rate (LDR) brachytherapy based on prostate-rectum distance and prostate longitudinal length among early prostate cancer patients. MATERIALS AND METHODS: From March 2008 to February 2013, 245 prostate cancer patients with a Gleason score < or =7 were treated with 125-I LDR brachytherapy. Among them, 178 patients with prostate volume 20-35 mL and a follow-up period > or =6 months were evaluated for radiation proctitis. Magnetic resonance imaging (MRI) was performed for a prebrachytherapy evaluation, and prostate-rectum distance and prostate longitudinal length were measured. The radiation proctitis was confirmed and graded via colonoscopy based on the radiation therapy oncology group (RTOG) toxicity criteria. RESULTS: Twenty-three patients received a colonoscopy for proctitis evaluation, and 12 were identified as grade 1 on the RTOG scale. Nine patients were diagnosed as grade 2 and 2 patients were grade 3. No patient developed grade 4 proctitis. The rectal-complication group had a mean prostate-rectum distance of 2.51+/-0.16 mm, while non-rectal-complication control group had 3.32+/-0.31 mm. The grade 1 proctitis patients had a mean prostate-rectum distance of 2.80+/-0.15 mm, which was significantly longer than 2.12+/-0.31 mm of grades 2 and 3 patient groups (p=0.045). All 11 patients of grades 2 and 3 had a prostate longitudinal length of 35.22+/-2.50 mm, which was longer than group 1, but the difference was not statistically significant (p=0.214). CONCLUSIONS: As the prostate-rectum distance increased, fewer postimplantation rectal symptoms were observed. Patients with a shorter prostate-rectum distance in MRI should receive modified implantation techniques or radical prostatectomy.
Aged ; Brachytherapy/*adverse effects ; Carcinoma/*radiotherapy ; Colonoscopy ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Organ Size ; Proctitis/diagnosis/*etiology ; Prostate/*pathology ; Prostatic Neoplasms/*radiotherapy ; Radiation Injuries/diagnosis/*etiology ; Severity of Illness Index

OBJECTIVETo summarize the clinical presentation, pathogenesis, neuroimaging, treatment, and outcome of stroke-like migraine attacks after radiation therapy (SMART) syndrome, and to propose diagnostic criteria for this disorder.

DATA SOURCESWe searched the PubMed database for articles in English published from 1995 to 2015 using the terms of "stroke-like AND migraine AND radiation." Reference lists of the identified articles and reviews were used to retrieve additional articles.

STUDY SELECTIONData and articles related to late-onset effects of cerebral radiation were selected and reviewed.

RESULTSSMART is a rare condition that involves complex migraines with focal neurologic deficits following cranial irradiation for central nervous system malignancies. The recovery, which ranges from hours to days to weeks, can be partial or complete. We propose the following diagnostic criteria for SMART: (1) Remote history of therapeutic external beam cranial irradiation for malignancy; (2) prolonged, reversible clinical manifestations mostly years after irradiation, which may include migraine, seizures, hemiparesis, hemisensory deficits, visuospatial defect, aphasia, confusion and so on; (3) reversible, transient, unilateral cortical gadolinium enhancement correlative abnormal T2 and fluid-attenuated inversion recovery signal of the affected cerebral region; (4) eventual complete or partial recovery, the length of duration of recovery ranging from hours to days to weeks; (5) no evidence of residual or recurrent tumor; (6) not attributable to another disease. To date, no specific treatment has been identified for this syndrome.

CONCLUSIONSSMART is an extremely rare delayed complication of brain irradiation. However, improvements in cancer survival rates have resulted in a rise in its frequency. Hence, awareness and recognition of the syndrome is important to make a rapid diagnosis and avoid aggressive interventions such as brain biopsy and cerebral angiography.

Central Nervous System Neoplasms ; therapy ; Female ; Humans ; Male ; Migraine Disorders ; diagnosis ; etiology ; Radiation Injuries ; complications ; diagnosis ; Stroke ; diagnosis

Postradiation nasopharyngeal necrosis is an important late effect of radiotherapy that affects prognosis in patients with nasopharyngeal carcinoma. In the present study, we reviewed the clinical and imaging features of 67 patients with pathologically diagnosed postradiation nasopharyngeal necrosis who were treated at Sun Yat-sen University Cancer Center between June 2006 and January 2010. Their clinical manifestations, endoscopic findings, and imaging features were analyzed. Early nasopharyngeal necrosis was limited to a local site in the nasopharyngeal region, and the tissue defect was not obvious, whereas deep parapharyngeal ulcer or signs of osteoradionecrosis in the basilar region was observed in serious cases. Those with osteoradionecrosis and/or exposed carotid artery had a high mortality. In conclusion, Postradiation nasopharyngeal necrosis has characteristic magnetic resonance imaging appearances, which associate well with clinical findings, but pathologic examination is essential to make the diagnosis.
Adult ; Aged ; Carcinoma ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Nasopharynx ; pathology ; radiation effects ; Necrosis ; Osteoradionecrosis ; diagnosis ; etiology ; Radiation Injuries ; diagnosis ; etiology ; Radiotherapy, Intensity-Modulated ; adverse effects

No abstract available.
Aged ; Colitis, Ischemic/complications/*diagnosis/therapy ; Cystitis/*diagnosis/etiology ; Dehydration/etiology ; Diarrhea/etiology ; Female ; Fluid Therapy ; Humans ; Hydronephrosis/*diagnosis/etiology ; Oliguria/etiology ; Predictive Value of Tests ; Radiation Injuries/*diagnosis/etiology ; Tomography, X-Ray Computed

OBJECTIVETo investigate risk factors associated with prognosis in patients with radiation proctitis (RP).

METHODSBetween August 2007 and February 2010, 33 patients diagnosed with radiation proctitis were identified. Data pertaining to treatments and quality of life(QOL) were analyzed retrospectively.

RESULTSIndication for radiation included cervical cancer(n=22), prostate cancer (n=3), ovary cancer (n=2), rectal cancer (n=2), endometrial cancer(n=2), cervical cancer (n=1), and vaginal cancer(n =1). Data regarding radiation were available in 18 patients, and the mean dose was (61.3±12.9) Gy with a median dose of 61 Gy. Eleven were treated with enema therapy, 9 formalin dab, 12 surgical operations. Clinical improvement was noticed in 75% of the patients with a mean QOL score of 63.79±20.92. Prognosis was favorable in 75% of the patients. Surgical treatment was effective in 91.7% of the patients with severe complications. Univariate analysis showed that gender was associated with the prognosis of RP, while the severity of RP and treatment method were not predictive for RP prognosis.

CONCLUSIONSGender but not disease severity is associated with the prognosis of radiation proctitis. Surgery may be beneficial to RP patients with severe complications.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Proctitis ; diagnosis ; etiology ; therapy ; Prognosis ; Radiation Injuries ; complications ; Retrospective Studies ; Risk Factors ; Treatment Outcome

PURPOSE: To evaluate the inhibitory effect of chlorogenic acid on laser-induced choroidal neovascularization (CNV) in a rat model. METHODS: Intraperitoneal injection of chlorogenic acid (10 mg/kg) was inititated one day prior to laser photocoagulation and continued for eight days. Eyes were removed 14 days after laser photocoagulation. Fluorescein angiography was employed at seven and 14 days to assess the CNV lesions, and histological examination was performed. Quantification of CNV size and leakage were performed both in histological sections and fluorescein angiography in order to compare the inhibitory effects of chlorogenic acid on CNV with the results of the control. RESULTS: Histological analysis showed no significant difference in CNV size between the treated and control groups. However, CNV leakage on fluorescein angiography had significantly decreased in the chlorogenic acid-treated group at 14 days after laser photocoagulation compared with that of the control group. In addition, CNV size on fluorescein angiography had significantly decreased in the treated group at seven and 14 days. CONCLUSIONS: These results suggest that chlorogenic acid has anti-angiogenic effects on CNV and may be useful as an inhibitor in the treatment or prevention of neovascular age-related macular degeneration.
Angiogenesis Inhibitors/*administration & dosage ; Animals ; Capillary Permeability/drug effects ; Chlorogenic Acid/*administration & dosage ; Choroid/pathology ; Choroidal Neovascularization/diagnosis/etiology/*physiopathology ; Fluorescein Angiography ; Injections, Intraperitoneal ; Laser Coagulation ; Radiation Injuries ; Rats ; Rats, Inbred BN

A 37-year-old female, who had received modified radical mastectomy for cancer of her right breast, presented with decreased visual acuity in the left eye after radiation therapy for the management of the metastasis to her right brain 14 months ago. After ocular examination, we diagnosed her as radiation retinopathy. At the time of the first visit, the corrected best visual acuity was 0.4 in the left eye, and fundus examination revealed cotton wool spots and cystoid macular edema (CME). The findings in the right eye were normal except for cotton wool spots in the superior major arch. Fluorescein angiography (FA) showed marked telangiectasia and microaneurysms in her left eye but tiny microaneurysms in her right eye. Subsequent optical coherent tomography (OCT) showed CME. We injected intravitreal triamcinolone acetonide (TA). Two weeks after treatment, the visual acuity was improved to 0.6 and the retinal thickness was decreased. Three months later, the visual acuity in the left eye was dropped to 0.3 due to the recurrence of CME, so we injected intravitreal TA again. Five months later, visual acuity was improved to 0.5 and OCT revealed the improvement of CME. The incidence of radiation retinopathy is higher in the side nearer to radiation, but careful radiation blocking is also required on the opposite side of irradiation site considering the possibility of radiation retinopathy and careful observation is required on both sides of the eyes when performing fundus examination.
Adult ; Brain Neoplasms/*radiotherapy/secondary ; Breast Neoplasms/pathology/radiotherapy/surgery ; Diagnosis, Differential ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glucocorticoids/administration & dosage ; Humans ; Radiation Injuries/diagnosis/drug therapy/*etiology ; Retina/pathology/*radiation effects ; Retinal Diseases/diagnosis/drug therapy/*etiology ; Tomography, Optical Coherence ; Triamcinolone Acetonide/administration & dosage

Here, we report the case of a patient who sustained Nd: YAG laser macular injury with subsequent 6 year follow-up evaluation. A 23-year-old female was accidentally exposed to a Q-switched Nd: YAG laser without protective goggles. Upon initial evaluation, the best-corrected visual acuity of her affected eye was 20/100 OD. Fundoscopic examination revealed a macular laser burn and vitreous hemorrhage. Corticosteroids, in the form of 60 mg prednisolone, were administered orally with a 10 mg per week taper. Nineteen days following exposure, fundoscopic examination revealed a distinct epiretinal membrane which resolved within six months. The best-corrected visual acuity of the affected eye remained 20/100 OD. This clinical course is similar to those of previously reported cases including vitreous hemorrhage and subsequent epiretinal membrane formation. However, visual acuity did not recover despite spontaneous regression of the epiretinal membrane and at 6 year follow-up, there was neither choroidal neovascularization nor macular hole formation.
Accidents ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glucocorticoids/therapeutic use ; Humans ; Lasers, Solid-State/*adverse effects ; Macula Lutea/*injuries ; Prednisolone/therapeutic use ; *Radiation Injuries/complications/diagnosis/drug therapy/physiopathology ; Treatment Outcome ; Visual Acuity/radiation effects ; Vitreous Hemorrhage/etiology/pathology ; Young Adult

OBJECTIVETo investigate positron-emission tomography-computed tomography (PET/CT) findings of radiation encephalopathy (RE) following radiotherapy for nasopharyngeal carcinoma (NPC), observe the metabolic changes of the compromised brain tissues, and postulate the clinical classification of RE to provide reference for its diagnosis.

METHODSThis study included 53 pathologically confirmed NPC patients who received previous radical radiotherapy, and the diagnosis of RE was established according to the clinical manifestations and CT/PET findings. All the patients underwent PET/CT whole-body and head scans, and the image data were evaluated along with the clinical data of the patients.

RESULTSRE most frequently involved the lateral or bilateral inferior temporal lobes. PET identified hypometabolic changes in the bilateral temporal lobes of 35 patients (70 lobes) and in the lateral temporal lobe of 18 patients (18 lobes). According to the PET/CT findings, the lesions were classified into 3 types, namely the oedema type (56 temporal lobes), liquefactive necrosis type (10 temporal lobes), and atrophic calcification type (22 temporal lobes). One patient with oedema type lesion received neurotrophic treatment and recovered completely with normal brain tissue density and metabolism, but the oedema type lesions in 2 patients progressed into to atrophic calcification type; the liquefactive necrotic lesions in another 2 patients also progressed into atrophic calcification type.

CONCLUSIONRE patients exhibit significant hypometabolic changes in the inferior temporal lobe on PET. According to the findings by PET/CT, RE can be classified into the oedema type, liquefactive necrosis type, and atrophic calcification type, and lesions of the former two types may progress into the third type.

Adult ; Aged ; Brain ; diagnostic imaging ; radiation effects ; Brain Diseases ; classification ; diagnosis ; etiology ; Carcinoma, Squamous Cell ; radiotherapy ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Positron-Emission Tomography ; methods ; Radiation Injuries ; classification ; diagnosis ; etiology ; Radiotherapy ; adverse effects ; Tomography, X-Ray Computed ; methods

OBJECTIVETo understand the metabolic patterns of NAA, Cr and Cho in radiation encephalopathy (RE) induced by radiotherapy for nasopharyngeal carcinoma detected by proton magnetic resonance spectroscopy (1H-MRS), and provide useful evidence for early diagnosis of this disease.

METHODSChemical shift imaging 1H-MRS was performed for 10 healthy volunteers (control group) and 21 patients with pathologically confirmed nasopharyngeal carcinomas, who developed RE after radical radiotherapy as diagnosed on the basis of clinical symptoms and imaging findings. The contents of NAA, Cr and Cho in the pixels were observed, the metabolic maps generated, and NAA/Cr and NAA/Cho ratios calculated for all the subjects.

RESULTSThe concentrations of NAA, Cr and Cho were rarely observed in the necrosis and liquefaction foci in the patients, nor were any signals displayed on their metabolic maps. In the visible lesions, with the exception of the necrosis and liquefaction foci, the content of NAA increased slightly, whereas that of Cr or Cho decreased obviously or even became absent. An area around the lesion was identified where NAA content decreased but Cr or Cho increased. The signal in the metabolic maps appeared indistinguishable. The NAA/Cr and NAA/Cho ratios were less than 1. Farther away from the visible lesions, the NAA, Cr and Cho contents remained normal with NAA/Cr and NAA/Cho ratios of less than 1.

CONCLUSION1H-MRS is capable of displaying the patterns of metabolite changes in RE induced by radiotherapy, and identifying larger area of abnormal metabolism in RE than the visible lesion in MRI, which suggests the possibility of earlier detection of RE with 1H-MRS.

Adult ; Aged ; Aspartic Acid ; analogs & derivatives ; metabolism ; Brain Diseases ; diagnosis ; etiology ; metabolism ; Choline ; metabolism ; Creatine ; metabolism ; Female ; Humans ; Magnetic Resonance Spectroscopy ; methods ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Radiation Injuries ; complications ; diagnosis ; Sensitivity and Specificity