Successful surgical treatment of intractable post-radiation rectal bleeding

Patients will typically present symptoms of chronic post-radiation colitis and proctitis 8-12 months after finishing their treatment. Endoscopic methods play the main role the treatment of bleeding caused by post-radiation colitis and proctitis. Surgical treatment is required for remained approximately 10% of patients. Here we present a 64 year old female with metastatic breast cancer, who was referred to us for intractable rectal bleeding. Total colonoscopy and rigid rectosigmoidoscopy revealed proctitis, rectal and sigmoidal telangiectasis, multiple necrotic ulcers between 15 to 30 cm from the anal verge, and also huge ishemic ulcer with patchy necrotic areas about 10 cm from the anal verge. This abnormal irradiated part was resected and then mucosectomy of the remnant rectum, both transabdominally and transanally was done. We performed pull-through technique of normal proximal colon to anal region through the remnant rectal wall and finally did coloanal anastomosis. Diverting stoma was not made because of anastomosis in anal region. With this technique we can achieve benefits such as avoidance of harsh dissection in a frozen pelvis and its consequences, we can avoid intra-abdominal anastomosis, there is no need to a diverting stoma and, most important of all, definite bleeding control.

Исследование влияния облучения ускоренными электронами на физические свойства полиэтилентерефталата

The influence of irradiation with accelerated electrons (energy 8.5 MeV, dose 5 kGy) on the physical properties of medical devices made of polyethylene terephthalate (PET) by infrared (IR) spectroscopy was studied. The revealed post-radiation changes in the IR spectra can be used to justify the choice of the dose of irradiation of PET products with electrons during the radiation sterilization procedure.

An integrative chemometric approach and correlative metabolite networking of LC-MS and 1H NMR based urine metabolomics for radiation signatures

A comprehensive overview of combining data from LC-MS and NMR using multiblock-OPLSDA analysis, correlation networking and pathway enrichment. This provided novel avenues for understanding biological perturbations post radiation injury.

A lyophilized form of xenogeneic total RNA stimulates hematopoiesis in post-radiation myelosuppression

Введение. Аллогенная суммарная РНК, выделенная из клеток лимфоидных органов, стимулирует регенерацию кроветворной ткани после острого и хронического нарушения кроветворной функции. Цель исследования: 1) доказательство отсутствия ксеногенных ограничений механизмов лимфоцитарного контроля регенеративных процессов на примере гемостимулирующего действия суммарной РНК лимфоцитов бычьей селезенки в отношении кроветворения крыс, подвергшихся гамма-облучению в сублетальной дозе; 2) сравнительный анализ эффективности нативной и лиофилизированной форм указанной РНК. Методика. Работа выполнена на белых нелинейных крысах-самцах массой 200-220 г. Cуммарную РНК выделяли методом фенол - хлороформной экстракции из лимфоидных клеток бычьей селезенки. Для создания исходной миелосупрессии 30 крыс подвергли однократному общему воздействию гамма-излучения с источником 60Co в дозе 6 Гр при мощности дозы 0,1 Гр/с, после чего разделили их на 3 равные группы. Через 2 ч после облучения крысам контрольной группы внутрибрюшинно ввели по 0,5 мл 0,9% NaCl; крысам 2-й группы - нативную суммарную РНК в дозе 30 мкг/100г массы, крысам 3-й группы - лиофилизированную суммарную РНК в аналогичной дозе. На 3-и, 7-е и 12-е сут в периферической крови определяли количество ретикулоцитов, лейкоцитов и тромбоцитов, после чего крысы были выведены из эксперимента с целью исследования костномозгового кроветворения. Через 12 сут в костном мозге определяли количество эритроидных, лимфоидных, мегакариоцитарных и миелоидных клеток. Из костного мозга выделяли эритробластические островки (ЭО) и дифференцировали их на пролиферирующие (ЭО 1,2 классов и реконструирующиеся ЭО) и зрелые (ЭО 3 класса и инволюциирующие ЭО) морфо-функциональные клеточные ассоциации. Результаты. Под влиянием ксеногенной суммарной РНК в периферической крови крыс в 2-3 раза увеличилось количество лейкоцитов и в 1,6-1,75 раза возросло число ретикулоцитов. В костном мозге увеличилось количество пролиферирующих миелоидных и лимфоидных элементов, а также общее число клеток эритроидного ряда. Ксеногенная суммарная РНК стимулировала образование ЭО как на основе контакта свободных костномозговых макрофагов с молодыми эритроидными клетками (ЭО 1 и 2 классов), так и на базе реконструкции (ЭО реконструирующиеся). Сравнительный анализ эффектов нативной и лиофилизированной суммарной РНК не выявил различий между гемопоэтическими показателями у крыс, получивших эти препаратов. Заключение. Суммарная РНК, выделенная из лимфоидных клеток бычьей селезенки, активирует гемопоэз у крыс с постлучевой миелосупрессией, что свидетельствует об отсутствии ксеногенных ограничений у млекопитающих в механизмах лимфоцитарного контроля восстановительных процессов. Лиофилизированная суммарная РНК активирует костномозговое кроветворение в те же сроки и в том же объеме, что и нативная форма. Introduction. Allogeneic total RNA isolated from cells of lymphoid organs stimulates regeneration of hematopoietic tissue after acute and chronic disturbance of hematopoietic function. Aim. 1) To prove the absence of xenogeneic limitation for the lymphocytic regulation of regenerative processes using an example of the hemo-stimulating effect of total RNA from bovine spleen lymphocytes on hematopoiesis in rats exposed to sublethal gamma-irradiation; 2) To perform a comparative analysis of the effectiveness of the native and lyophilized forms of the total RNA. Methods. Experiments were performed on white outbred male rats weighing 200-220 g. Total RNA was isolated from bovine spleen lymphoid cells by phenol-chloroform extraction. To create the initial myelosuppression, 30 rats were exposed to a single general 60Co gamma radiation (6 Gy at 0.1 Gy/s). The rats were then divided into 3 equal groups. Two hrs after irradiation, the rats of the control group were injected intraperitoneally with 0.5 ml of 0.9% NaCl; rats of the second group received native total RNA, 30 μg/100 g body weight, and rats of the third group received lyophilized total RNA at a similar dose. On days 3, 7, and 12, the number of peripheral blood reticulocytes, leukocytes, and platelets was measured. The rats were then sacrificed, and bone marrow hematopoiesis was studied. After 12 days, the number of bone marrow erythroid, lymphoid, megakaryocytic, and myeloid cells was measured. Erythroblastic islets (EIs) were isolated from the bone marrow and differentiated into proliferating (class 1 and 2 EIs and reconstructing EIs) and mature (class 3 EIs and involving EIs) morpho-functional cell associations. Results. Under the influence of xenogeneic total RNA, the number of peripheral blood leukocytes increased by 2-3 times, and the number of reticulocytes increased by 1.6-1.75 times. In the bone marrow, the number of proliferating myeloid and lymphoid cells increased, as did the total number of erythroid cells. Xenogeneic total RNA stimulated formation of EIs, based both on the contact of free bone marrow macrophages with young erythroid cells (class 1 and 2 EIs) and on reconstruction (reconstructing EIs). Comparative analysis of the effects of native and lyophilized total RNA did not reveal differences between hematopoietic parameters in rats that received these agents. Conclusion. Total RNA isolated from bovine spleen lymphoid cells activates hematopoiesis in rats with post-radiation myelosuppression. This indicates the absence of mammalian xenogenic limitation of lymphocytic control of recovery processes. Lyophilized total RNA activates bone marrow hematopoiesis at the same rate and to the same extent as the native form.

Brachytherapy in organ-preserving treatment of choroidal melanoma: complications and the possibility of their prediction

This review analyzed the domestic and foreign literature on brachytherapy of choroidal melanoma using ruthenium ophthalmic applicators. The review highlights the historical aspects of radiation treatment, from the first experience of using ionizing radiation in the treatment of malignant neoplasms to modern methods of brachytherapy; presents the radiobiological foundations of radiation therapy; considers the issues of radiation pathomorphosis, reflecting the nature of pathological changes in the choroidal melanoma tissue during brachytherapy; shows the dependence of the effect of exposure ionizing radiation from the phase of the cycle of cell division; and also describes the presence of changes characteristic of the response to ionizing radiation in unirradiated tissues. The analysis of various post-radiation complications, both early and late, was carried out in some detail, with emphasis on the possibility of predicting and preventing them in real clinical practice. A comparison is made in terms of the frequency of development of various post-radiation complications in the works of domestic and foreign authors, as well as a comparison with the effect of ionizing radiation from other radioactive isotopes. Recommendations of experts are given regarding the correct calculation of the dose to the sclera and medication support, based on many years of experience in the use of ruthenium ophthalmic applicators for brachytherapy of choroidal melanoma. The risks of developing such late complications as radiation maculopathy and radiation neuropathy have been demonstrated, especially in pre-equatorial tumor localization. The possibilities of modern methods of instrumental diagnostics for studying the processes occurring in the area of the tumor, as well as changes in the surrounding tissues, are shown, which determines the feasibility and importance of further study of this issue.

Effect of Use of Antifungal (Clotrimazole) Drug in Reducing the Number of Colonies of Candida albicans and Its Correlation with Clinical Candidiasis in the Patients Undergoing Progressive Radiotherapy for the Cervicofacial Region

Aims: To evaluate the effect of topical antifungal Clotrimazole on candida colonies and its correlation with clinical candidiasis in patients undergoing radiotherapy. Study Design: Randomised Clinical Trial Place and Duration of Study: Rashtrasant Tukdoji Maharaj Cancer Institute, Nagpur between June 2020 and July 2021. Methodology: 64 patients (52 males and 12 females) undergoing Co60 teletherapy for cervicofacial malignancies were randomly divided in two groups. 32 patients referred to as study group were put on antifungal treatment (1% Clotrimazole) for topical application and other group was the control group and was not given antifungal medication. During the radiotherapy and 6 weeks after the completion of radiotherapy, patients were examined every week for possible oral changes for clinical candidiasis, and swabs were taken at every end of the week for determining candidal colonies. Results: The overall incidence of clinical oral candidiasis was 46.9% throughout RT in the control group and there was no incidence of clinical candidiasis in the study group. Patients with clinical candidiasis 6-week post-radiation therapy showed continuous symptoms of clinical candidiasis but with the reduction in candidal colonies.22% of patients were oral carriers for candidal colonies. Also, the study group showed not a single patient with clinical candidiasis. Conclusion: During radiotherapy, although with the use of clotrimazole some patients with negative culture may also become positive for Candida albicans and there may be some increase in the several colonies of Candida albicans (very less in number as compared to the control group), but its use prevents the development of clinical candidiasis. Antifungal prophylaxis is useful in combating clinical candidiasis.

Prevention and correction of radiation dermatitis with basic skin care: doctor and patient consensus

External beam radiation therapy is widely used by doctors around the world as one of the most common form of cancer treatment. The radiotherapy can help reduce the treatment aggression as compared with the surgical intervention in a large number of clinical situations, which ensures that the patient's quality of life will be decreased to a lesser extent in the after-treatment period. However, like the vast majority of anticancer treatments, the radiation therapy has a number of side effects, which are classified into acute radiation reactions and post-radiation injuries. Among them is radiation dermatitis, which is one of the most common adverse reactions to the radiotherapy. This complication manifests as erythema, as well as hyperpigmentation, dry and itchy skin, hair loss. In addition to the obvious negative impact on the patient's quality of life, some of the above factors can result in the development of a secondary skin infection. As one of the most frequent post-radiation complications, radiation dermatitis places radiotherapists before a challenge to reduce the incidence rates of this side effect, as well as to decrease the intensity of its clinical manifestations if it occurs. This challenge suggests the search for targeted drugs aimed to prevent and treat clinical symptoms. To date, dermatocosmetic products that are used to relieve skin manifestations of radiation treatment complications is an alternate option of the effective solution to the problem of radiation dermatitis. In the described clinical case, we assess the experience of using some of the dermatocosmetic products in a patient with a florid form of radiation dermatitis.

On the Evaluation of a Novel Hypoxic 3D Pancreatic Cancer Model as a Tool for Radiotherapy Treatment Screening

Tissue engineering is evolving to mimic intricate ecosystems of tumour microenvironments (TME) to more readily map realistic in vivo niches of cancerous tissues. Such advanced cancer tissue models enable more accurate preclinical assessment of treatment strategies. Pancreatic cancer is a dangerous disease with high treatment resistance that is directly associated with a highly complex TME. More specifically, the pancreatic cancer TME includes (i) complex structure and complex extracellular matrix (ECM) protein composition; (ii) diverse cell populations (e.g., stellate cells), cancer associated fibroblasts, endothelial cells, which interact with the cancer cells and promote resistance to treatment and metastasis; (iii) accumulation of high amounts of (ECM), which leads to the creation of a fibrotic/desmoplastic reaction around the tumour; and (iv) heterogeneous environmental gradients such as hypoxia, which result from vessel collapse and stiffness increase in the fibrotic/desmoplastic area of the TME. These unique hallmarks are not effectively recapitulated in traditional preclinical research despite radiotherapeutic resistance being largely connected to them. Herein, we investigate, for the first time, the impact of in vitro hypoxia (5% O2) on the radiotherapy treatment response of pancreatic cancer cells (PANC-1) in a novel polymer (polyurethane) based highly macroporous scaffold that was surface modified with proteins (fibronectin) for ECM mimicry. More specifically, PANC-1 cells were seeded in fibronectin coated macroporous scaffolds and were cultured for four weeks in in vitro normoxia (21% O2), followed by a two day exposure to either in vitro hypoxia (5% O2) or maintenance in in vitro normoxia. Thereafter, in situ post-radiation monitoring (one day, three days, seven days post-irradiation) of the 3D cell cultures took place via quantification of (i) live/dead and apoptotic profiles and (ii) ECM (collagen-I) and HIF-1a secretion by the cancer cells. Our results showed increased post-radiation viability, reduced apoptosis, and increased collagen-I and HIF-1a secretion in in vitro hypoxia compared to normoxic cultures, revealing hypoxia-induced radioprotection. Overall, this study employed a low cost, animal free model enabling (i) the possibility of long-term in vitro hypoxic 3D cell culture for pancreatic cancer, and (ii) in vitro hypoxia associated PDAC radio-protection development. Our novel platform for radiation treatment screening can be used for long-term in vitro post-treatment observations as well as for fractionated radiotherapy treatment.

Radiological progression of extremity soft tissue sarcoma following preoperative radiotherapy predicts for poor survival

Objectives: To determine if radiological response to preoperative radiotherapy is related to oncologic outcome in patients with extremity soft tissue sarcomas (STS). Methods: 309 patients with extremity STS who underwent preoperative radiation and wide resection were identified from a prospective database. Pre-and post-radiation MRI scans were retrospectively reviewed. Radiological response was defined by the modified Response Evaluation Criteria in Solid Tumours (RECIST).Local recurrence-free (LRFS), metastasis-free (MFS) and overall survival (OS) were compared across response groups. Results: Tumour volume decreased in 106 patients (34.3%; PR- Partial Responders), remained stable in 97 (31.4%; SD- Stable Disease), increased in 106 (34.3%; PD- Progressive Disease). The PD group were older (p = 0.007), had more upper extremity (p = 0.03) and high grade tumours (p < 0.001). 81% of myxoid liposarcomas showed substantial decrease in size. There was no difference in initial tumour diameter (p = 0.5), type of surgery (p = 0.5), margin status (p = 0.4), or complications (p = 0.8) between the three groups. There were ten (3.2%) local recurrences with no differences between the three response groups (p = 0.06). Five-year MFS was 52.1% for the PD group versus 73.8 and 78.5% for the PR and SD groups respectively (p < 0.001). OS was similar (p < 0.001). Following multivariable analysis, worse MFS and OS were associated with higher grade, larger tumour size at diagnosis and tumour growth following preoperative radiation. Older age was also associated with worse OS. Conclusion: STS that enlarge according to RECIST criteria following preoperative radiotherapy identify a high risk group of patients with worse systemic outcomes but equivalent local control. Advances in knowledge: Post radiation therapy, STS enlargement may identify patients with potential for worse systemic outcomes but equivalent local control. Therefore, adjunct therapeutic approaches could be considered in these patients.

Modified Gap Arthroplasty for Temporomandibular Joint Ankylosis Following Radiotherapy for Rhabdomyosarcoma: Report of an Unusual Case and Brief Literature Review

Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient’s problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy.