Refractory recurrent bleeding as a late mortal complication of chest wall irradiation (original) (raw)
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Chest Irradiation Associated Cardio-Vascular Disease
World Journal of Cardiovascular Diseases, 2016
Background: The heart and great vessels were once thought to be relatively resistant to the damaging effect of radiation therapy. There is now clear evidence that thoracic irradiation may cause acute inflammation and progressive fibrosis of different structures, including the heart valves, the myocardium and the pericardium, the coronary arteries and the conduction system. As new therapies have improved survival, many patients with cancer (mostly Hodgkin's disease and breast cancer) are now at risk of cardiovascular (CV) complications following radiation therapy. Objectives: To raise awareness of CV complications following chest irradiation. Method: We present 5 patients that we treated during a short period of time (between June 2013 (6/2013) and February 2015 (2/2016)), who suffered CV involvement that needed therapy, following chest irradiation. Conclusions: Patients after chest irradiation should be followed periodically, in order to diagnose and treat CV complications, in time.
International Journal of Radiation Oncology*Biology*Physics, 2012
Background: This study was performed to evaluate the outcome after hemostatic radiotherapy (RT) of significant bleeding in incurable cancer patients. Methods: Patients treated by hemostatic RT between November 2006 and February 2010 were retrospectively analyzed. Bleeding was assessed according to the World Health Organization (WHO) scale (grade 0 = no bleeding, 1 = petechial bleeding, 2 = clinically significant bleeding, 3 = bleeding requiring transfusion, 4 = bleeding associated with fatality). The primary endpoint was bleeding at the end of RT. Key secondary endpoints included overall survival (OS) and acute toxicity. The bleeding score before and after RT were compared using the Wilcoxon signed rank test. Time to event endpoints were estimated using the Kaplan Meier method. Results: Overall 62 patients were analyzed including 1 patient whose benign cause of bleeding was pseudomyxoma peritonei. Median age was 66 (range, 37-93) years. Before RT, bleeding was graded as 2 and 3 in 24 (39%) and 38 (61%) patients, respectively. A median dose of 20 (range, 5-45) Gy of hemostatic RT was applied to the bleeding site. At the end of RT, there was a statistically significant difference in bleeding (p < 0.001); it was graded as 0 (n = 39), 1 (n = 12), 2 (n = 6), 3 (n = 4) and 4 (n = 1). With a median follow-up of 19.3 (range, 0.3-19.3) months, the 6-month OS rate was 43%. Forty patients died (65%); 5 due to bleeding. No grade 3 or above acute toxicity was observed. Conclusions: Hemostatic RT seems to be a safe and effective treatment for clinically and statistically significantly reducing bleeding in incurable cancer patients.
Long-Term Radiotherapy-Induced Cardiac Complications: A Case Report
American Journal of Case Reports
Unusual or unexpected effect of treatment Background: Tumor disease has improved survival due to therapeutic advances and early diagnosis. However, anti-neoplastic treatment involves generating harmful side effects in the body, both in the short-term and in the long-term. One of the most important side effects is cardiovascular disease after radiotherapy, which in addition to being influenced by classic cardiovascular risk factors, can be also be influenced by anti-neoplastic therapy, and represents the main cause of death after a second cancer. We present a case that synthesizes the most relevant and determining aspects of radiotherapy-induced heart disease. Case Report: We present the case of a 48-year-old male with a personal history of mediastinal Hodgkin lymphoma who was treated with local radiotherapy 20 years ago, and who was admitted to hospital due to dyspnea and oppressive chest pain with efforts. He was diagnosed with severe aortic stenosis, and a coronary angiography confirmed the existence of coronary disease. Two years before, he had been admitted to hospital due to syncope and a pacemaker had been implanted. This patient experienced several cardiovascular complications that could be attributed to the radiotherapy treatment received in his past. Conclusions: Radiotherapy shows multiple cardiological complications, especially when applied at the thoracic level. This fact is very relevant, and this report can help determine the aspects of radiotherapy-induced heart disease affecting the mortality and morbidity of these patients.
Endovascular Treatment for Carotid Blowout Syndrome after Radiation: A Case Report
Journal of Cancer Science & Therapy, 2017
Carotid blowout syndrome is one of the most complex bleeding complications that may occur in head and neck cancers patients. The purpose of this paper is to report the clinical manifestations and endovascular management of a case of patient with neck malignancies and a history of radiotherapy. The patient underwent immediate covered stent deployment which resulted in the successful control of bleeding.
Radiation-associated cardiovascular disease: manifestations and management
Seminars in Radiation Oncology, 2003
As the number of cancer survivors grows because of advances in therapy, it has become more important to understand the longterm complications of these treatments. This article presents the current knowledge of adverse cardiovascular effects of radiotherapy to the chest. Emphasis is on clinical presentations, recommendations for follow-up, and treatment of patients previously exposed to irradiation. Medline TM literature searches were performed, and abstracts related to this topic from oncology and cardiology meetings were reviewed. Potential adverse effects of mediastinal irradiation are numerous and can include coronary artery disease, pericarditis, cardiomyopathy, valvular disease and conduction abnormalities. Damage appears to be related to dose, volume and technique of chest irradiation. Effects may initially present as subclinical abnormalities on screening tests or as catastrophic clinical events. Estimates of relative risk of fatal cardiovascular events after mediastinal irradiation for Hodgkin's disease ranges between 2.2 and 7.2 and after irradiation for left-sided breast cancer from 1.0 to 2.2. Risk is life long, and absolute risk appears to increase with length of time since exposure. Radiation-associated cardiovascular toxicity may in fact be progressive. Long-term cardiac follow-up of these patients is therefore essential, and the range of appropriate cardiac screening is discussed, although no specific, evidencebased screening regimen was found in the literature. #
Cardiovascular sequelae of radiation therapy
Clinical Research in Cardiology, 2014
Radiotherapy (RT) is one of the main therapeutic options for malignancy treatment; nevertheless, RT is not free from side effects, including an increased risk for secondary neoplasms and other organs injury. Cardiovascular complications are the second most frequent fatal post-RT sequelae, which physicians should be aware of and ready to diagnose early and cure. This review therefore aims to examine epidemiology, pathogenesis and clinical dose-correlated manifestations of RT-induced cardiovascular disease. Future perspectives on screening, prevention and treatment are also provided.
Arterial occlusive disease after radiotherapy: a report of fourteen cases
Radiotherapy and Oncology, 1990
Fourteen cases of arterial occlusion or severe narrowing following radiotherapy are studied in order to assess the possible etiological role of such therapy in arterial lesion. Surgical results are also discussed in terms of long-term efficacy. The average time of occurrence after radiotherapy was 8 years post-radiotherapy. This series includes 7 supra-aortic trunk stenoses and 7 abdominal aorta trunk stenoses. The doses received in the volumes irradiated ranged from 47 to 70 Gy with standard fractionation. Association of atherosclerotic risk factors (smoking, hyperlipidemia, diabetes, high blood pressure) was present in 12 patients, but stenoses were usually confined to irradiated areas, and at times occurred in uncommon sites. Surgical management included 11 by-passes, 2 endarterectomies and one percutaneous transluminal angioplasty. All patients experienced immediate and satisfactory functional improvements. Three patients were re-operated on because of the re-occlusion of the by-pass (2 cases) and graft infection (1 case). On the whole, stenoses in previously irradiated areas showed no particular di#iculties for surgical treatment. It was concluded that radiotherapy seems to be a definite risk factor for arterial occlusion or narrowing, especially in association with atherosclerotic risk factors.
Endovascular stents in arterial injury after radiotherapy
Journal of Tongji Medical University, 1998
We evaluated preliminary success and patency of stenting for the treatment of radiation--induced arterial diseases. Thirteen stents were placed in 8 patients to treat occlusion (n = 3), aneurysm (n ~ 1), residual stenosis (n = 2), multiple stenoses (n= 1), and delayed resten0sis ~ifter previous balloon angioplasty (n=l). Interventional procedurewas successfully performed in 8 patients for their arterial lesions after radiotherapy. Six patients underwent interventional procedure once or twice. Two patients underwent PTA 4 times. Five of these patients demonstrated primary patency with relief of clinical symptoms with a mean follow-up of 2 years (range: 8--60 months). Clinical improvement was noted in the other patients. Our results suggest that stent placement by single or multiple techniques may have immediate effect on arterial lesions caused by radiation and can be considered as a therapeutic option of choice in these cases.
Management of arterial occlusive radiation therapy
Cardiovascular Surgery, 1996
Clinicatly significant arterial occlusive disease developed in 26 patients at between 5 months and 44 years (mean(s.d.) 10.7(12.0) years) following radiation therapy. Therapeulzic radiation was associated with lesions of the carotid artery (nine pal&~&~), subclavianartefies (seven) and the abdominal aorta and its branches (IO). Clinical presentations inclu&!d tr@miieti ischemic attack, stroke, vettebrobasilar insufficiency, carotid bruit, upper-o ischemia and renovascular hypertension. Surgery for cerebrovasculaf insu carotid endarterectomy with vein patch, interposition grafting or sub&Man-to-carotid bypass.