RESUMEN

PURPOSE: This article aims to describe and list the clinical trials that have changed our practices in breast cancer, urological cancer, gynecological cancer, cancer of the upper aerodigestive tract and digestive cancer in the last ten years. MATERIAL AND METHODS: We listed and selected the studies published between 2010 and 2020. The articles were identified on the basis of a Medline search with PubMed and knowledge of the authors. RESULTS: Five to six trials were selected in breast cancer, urological cancers, gynecological cancers, cancers of the upper aerodigestive tract and digestive cancers asking the different fundamental questions in radiotherapy. CONCLUSION: Depending on the pathologies, the questions raised over the past 10 years remain fundamental questions such as the place of neoadjuvant treatment, the place of hypofractionation or the type of chemotherapy concomitant with radiotherapy.

Asunto(s)

Ensayos Clínicos como Asunto , Neoplasias/radioterapia , Pautas de la Práctica en Medicina/tendencias , Neoplasias de la Mama/radioterapia , Femenino , Neoplasias Gastrointestinales/radioterapia , Neoplasias de los Genitales Femeninos/radioterapia , Humanos , Masculino , Neoplasias del Sistema Respiratorio/radioterapia , Factores de Tiempo , Neoplasias Urológicas/radioterapia

Asunto(s)

Epiglotis/diagnóstico por imagen , Melanoma/diagnóstico por imagen , Melanosis/diagnóstico por imagen , Neoplasias del Sistema Respiratorio/diagnóstico por imagen , Femenino , Humanos , Laringoscopía , Melanoma/complicaciones , Melanoma/radioterapia , Melanosis/etiología , Persona de Mediana Edad , Cuidados Paliativos , Neoplasias del Sistema Respiratorio/complicaciones , Neoplasias del Sistema Respiratorio/radioterapia , Tomografía Computarizada por Rayos X

RESUMEN

PURPOSE OF REVIEW: Malignant tracheoesophageal or bronchoesophageal or, less commonly, esophageal-lung parenchyma fistulas are late developments of advanced cancer of the esophagus, lung or mediastinum. Patients present mainly with intractable cough and repeated respiratory infections. Rapid deterioration and death results if this condition is left untreated. RECENT FINDINGS: The use of the antiangiogenesis drug bevacizumab along with radiation therapy have been linked to the development of malignant tracheoesophageal fistula/malignant bronchoesophageal fistula in patients treated for both small-cell and nonsmall-cell lung carcinoma. Three case series have been published during 2009 presenting characteristics, treatment options and associated complications. The best palliation for this malignant condition is achieved with endoscopic placement of esophageal, respiratory or parallel stenting (esophagus and airway). Dual stenting appears to work better than single prosthesis both for palliation and safety. There were also some reports of unusual complications related to prosthesis placement as treatment of this condition. Particular attention has to be paid to tracheal compression/erosion secondary to esophageal stents. SUMMARY: Respiratory-digestive fistulas are devastating complications of advanced cancer. Research has brought new understanding relevant to clinical practice.

Asunto(s)

Fístula Bronquial/etiología , Fístula Bronquial/terapia , Fístula Esofágica/etiología , Fístula Esofágica/terapia , Neoplasias Esofágicas/complicaciones , Neoplasias del Sistema Respiratorio/complicaciones , Stents , Fístula Traqueoesofágica/etiología , Fístula Traqueoesofágica/terapia , Inhibidores de la Angiogénesis/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados , Bevacizumab , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/radioterapia , Gastrostomía , Humanos , Cuidados Paliativos/métodos , Calidad de Vida , Radioterapia/efectos adversos , Neoplasias del Sistema Respiratorio/tratamiento farmacológico , Neoplasias del Sistema Respiratorio/radioterapia , Stents/efectos adversos

RESUMEN

This study investigated dosimetric changes in a water phantom when a small air cavity was presented at the central axis of a clinical electron beam. We used 6-, 9-, and 16-MeV electron beams with a 10 x 10 cm(2) applicator and cutout produced by a Varian 21 EX linear accelerator. Percentage depth doses (PDDs) for different depths (0.5-7 cm), thicknesses (2-10 mm), and widths (1-5 cm) of air cavities were calculated using Monte Carlo simulations (EGSnrc code) validated by film measurements. By comparing PDDs of phantoms with and without the air cavity, it was found that when the depth or thickness of cavity was changed, the PDD curve below the cavity was shifted with a distance equal to the thickness of the cavity. However, when the width of the air cavity was changed, both the PDD curve and its slope within and below the cavity were changed. A larger width of the air cavity resulted in a shallower PDD curve within the cavity. The slope of the PDD curve below the cavity tended towards a value as the width of the air cavity was increased to 3-5 cm for the 6-, 9-, and 16-MeV electron beams. The dependence of the depth dose on the width of the air cavity is a result of the contribution of the electron side scattering in the water surrounding the cavity. The change in depth dose resulting from the presence of an air cavity can cause discrepancies between the calculated and actual dose during radiotherapy, unless the effects of the air cavity are properly characterized during treatment planning. From the dosimetry data in this study, neglecting an air cavity of 1-cm thickness in the build-up region of a 6-MeV electron beam resulted in a delivered dose 10-12% larger than the original prescription. Delivered doses 3% and 6% higher than the prescribed dose were observed when doses were prescribed at R(80) for a 16-MeV electron beam. These results were obtained by neglecting air cavities with thicknesses equal to 2 and 4 mm, respectively, at a depth of 5 cm.

Asunto(s)

Radiocirugia , Neoplasias del Sistema Respiratorio/radioterapia , Dosimetría por Película , Humanos , Modelos Biológicos , Método de Montecarlo , Dosificación Radioterapéutica , Dispersión de Radiación

Asunto(s)

Radioterapia/métodos , Niño , Neoplasias del Sistema Digestivo/radioterapia , Femenino , Neoplasias de Cabeza y Cuello/radioterapia , Física Sanitaria , Humanos , Linfoma/radioterapia , Masculino , Planificación de Atención al Paciente , Embarazo , Garantía de la Calidad de Atención de Salud , Traumatismos por Radiación/etiología , Traumatismos por Radiación/prevención & control , Oncología por Radiación , Protección Radiológica , Radiobiología , Radioterapia/instrumentación , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador , Radioterapia Asistida por Computador , Neoplasias del Sistema Respiratorio/radioterapia , Factores de Riesgo , Gestión de Riesgos , Sarcoma/radioterapia , Tecnología Radiológica , Neoplasias Urogenitales/radioterapia

RESUMEN

In rare pulmonary tumors, the choice of local and systemic therapy is frequently dictated by the histologic cell type and (generally) by extrapolation from the existing therapeutic literature for that cell type's more common presentation; however, this approach might change. We are in the midst of a new biological and technological era in how approach and treat cancer. In a phase I trial for non-small-cell lung cancer, Hayman et al safely treated with radiation doses as high as 102.9 Gy (to limited volumes) using three-dimensional, conformal radiation [100]. Such techniques facilitate radiation dose escalation for thoracic neoplasms while minimizing normal tissue toxicity, potentially enhancing the therapeutic ratio. Furthermore, the entire human genome has been sequenced recently, and scientists are now in the process of discovering the functions of previously unknown sequences and their protein products. DNA microarrays can be used to analyze small tissue samples for the presence of gene variations or mutations (genotyping), performing the equivalent of several thousand "Southern blot" experiments in only a few days. In the future, patients might receive individually tailored therapy based upon unique molecular-genetic alterations of the tumor.

Asunto(s)

Neoplasias del Sistema Respiratorio/tratamiento farmacológico , Neoplasias del Sistema Respiratorio/radioterapia , Neoplasias de los Bronquios/tratamiento farmacológico , Neoplasias de los Bronquios/radioterapia , Carcinoma Adenoide Quístico/tratamiento farmacológico , Carcinoma Adenoide Quístico/radioterapia , Carcinoma Neuroendocrino/tratamiento farmacológico , Carcinoma Neuroendocrino/radioterapia , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundario , Dosificación Radioterapéutica , Radioterapia Adyuvante , Sarcoma/tratamiento farmacológico , Sarcoma/radioterapia , Neoplasias de la Tráquea/tratamiento farmacológico , Neoplasias de la Tráquea/radioterapia , Resultado del Tratamiento

RESUMEN

The cure rate of operable lung cancer and locally advanced head and neck cancer remains suboptimal, with a limited rate of local control despite improvements in the surgical removal of primary tumors and in methods for mediastinal lymph node dissection, in particular. The efficacy of adjuvant therapy, such as EBRT, has improved, and the immediate efficacy of new chemotherapeutic drugs is increasingly significant, although local recurrences remain frequent. Locoregional failure is not uncommon in upper aerodigestive tract cancers. Factors limiting radiocurability for locally advanced (stage III) lung cancer include mediastinal intolerance of irradiation (high risk of mediastinal fibrosis, which increases exponentially when levels of much more than 50 Gy are administered to the whole mediastinum) and the very high radiosensitivity of the healthy lung, which can develop fibrosis with relatively small or moderate doses starting at 18 to 20 Gy, and even more frequently when larger volumes are irradiated. Head and neck neoplasms are less difficult sites in which to administer doses of up to 70 Gy of external beam radiotherapy initially, but, like locoregionally recurrent lung cancers, they are not easily reirradiated with tumoricidal doses of EBRT. For these reasons, IORT seems to be a good option for increasing local control, because areas of [figure: see text] residual microscopic disease may be irradiated using IOERT approaches without affecting critical organs to the same extent. In addition, careful patient selection is paramount. Combined modality treatment regimens incorporating IORT may benefit patients with locally advanced disease. The ability of IORT to sterilize microscopic residual disease can enhance the "completeness" of resection and thus, theoretically, improve local control. Although distant disease dissemination remains by far the overriding issue, as newer effective agents emerge, local failure will continue to be a problem. Preliminary studies have demonstrated that IORT can be administered to patients who have locally advanced NSCLC and head and neck cancer, in the context of aggressive combined modality therapy, and is generally well tolerated. Long-term efficacy and benefit can only be determined in the setting of carefully designed clinical trials. (See the article by Thomas and Merrick elsewhere in this issue for further discussion of this topic.) Several relatively small, single-institution pilot studies exploring the utility and benefit of IORT for locally advanced upper aerodigestive tract cancers have been conducted. Clear conclusions have been difficult to determine because of the mixing of disease stages, varying degrees and completeness of surgical resection, varying radiation doses, different schemas, and other factors. Yet, given the major morbidity and mortality associated with locally recurrent lung cancer, methods of improving local control need to be pursued and refined. Encouraging preliminary data suggest that IOERT can be safely administered and may benefit local control. Based on several centers' expertise in the combined modality treatment of locally advanced lung cancer and familiarity with IORT, the UCSF Thoracic Oncology Program has proposed a multicenter phase 2 study incorporating IORT in a combined multimodality treatment schema for patients who have completely resected locally advanced stage IIIA and IIIB NSCLC (nonpleural effusion, non-N3) (Fig. 1). It is hoped that this study will commence in the upcoming year.

Asunto(s)

Neoplasias del Sistema Digestivo/radioterapia , Neoplasias de Cabeza y Cuello/radioterapia , Radioterapia Adyuvante/métodos , Neoplasias del Sistema Respiratorio/radioterapia , Terapia Combinada , Neoplasias del Sistema Digestivo/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Periodo Intraoperatorio , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirugía , Traumatismos por Radiación/etiología , Radioterapia Adyuvante/efectos adversos , Neoplasias del Sistema Respiratorio/cirugía

RESUMEN

Advances in diagnostic and therapeutic radiology and a better understanding of cell biology are being applied in practical ways to modulate treatment morbidity. Conformal radiotherapy targets the cancer precisely and can be combined with new systemically administered radiosensitizers. The successes of conventional chemoradiation programs support continued study of newer ways to deliver systemic radiosensitizing chemotherapy. However, chemoradiation creates a narrower therapeutic window compared to irradiation alone and increased treatment intensity, even with conformal chemoradiation techniques, can potentially result in frequent complications, detrimental treatment delays, and decreased quality of life. Treatment schedules employing a "best tolerated time" modelfor systemic administration of radiosensitizing chemotherapy, based on the concept of chronotolerance, offer attractive ways to address the challenging problem of normal tissue toxicity associated with conformal chemoradiation. This approach may be beneficial in the elderly and those medically unfit to tolerate traditional dose-intense combined-modality schedules. Further evaluation of this concept is warranted, based on existing data.

Asunto(s)

Antineoplásicos/uso terapéutico , Neoplasias del Sistema Digestivo/tratamiento farmacológico , Neoplasias del Sistema Digestivo/radioterapia , Neoplasias del Sistema Respiratorio/tratamiento farmacológico , Neoplasias del Sistema Respiratorio/radioterapia , Antineoplásicos/efectos adversos , Quimioterapia Adyuvante , Ensayos Clínicos como Asunto , Humanos , Calidad de Vida , Dosificación Radioterapéutica , Radioterapia Adyuvante , Radioterapia Conformacional/efectos adversos , Radioterapia Conformacional/métodos , Resultado del Tratamiento

Asunto(s)

Recurrencia Local de Neoplasia/radioterapia , Papiloma/radioterapia , Neoplasias del Sistema Respiratorio/radioterapia , Compresión de la Médula Espinal/etiología , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/complicaciones , Papiloma/complicaciones , Radioterapia de Alta Energía , Neoplasias del Sistema Respiratorio/complicaciones

RESUMEN

Surgery for primary multiple malignant tumors of the respiratory system was carried out in 141 patients. Reconstruction, plastic operations and sparing resections were performed in 79 cases (68.5%). Five-year survival after radical surgery was 43.8%.

Asunto(s)

Neoplasias Primarias Múltiples/radioterapia , Neoplasias Primarias Múltiples/cirugía , Neoplasias del Sistema Respiratorio/radioterapia , Neoplasias del Sistema Respiratorio/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonectomía/métodos , Radioterapia Adyuvante , Procedimientos de Cirugía Plástica , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento

RESUMEN

In this article, a significant number of neurologic conditions have been presented that have importance to the thoracic surgeon. The most important point, however, is that most of the neurologic complications are avoidable by careful surgical technique and preoperative and postoperative care.

Asunto(s)

Enfermedades del Sistema Nervioso/etiología , Complicaciones Posoperatorias , Procedimientos Quirúrgicos Torácicos , Humanos , Miastenia Gravis/etiología , Neoplasias del Sistema Respiratorio/tratamiento farmacológico , Neoplasias del Sistema Respiratorio/radioterapia , Toracotomía

RESUMEN

From 1992 to 1993, 46 patients with very locally advanced (74% T4) head and neck carcinomas and extensive cervical involvement (82% N2-3) were treated at the Institute Gustave Roussy with a very accelerated radiotherapy regimen: 62 Gy in three weeks with two daily 1.75 Gy fractions. Early mucosal reactions were severe but manageable in this population of patients with frequent alteration of initial performance status. Nearly every patient experienced a grade 3 or 4 (WHO) mucositis and 80% required tube feeding. Follow-up is not sufficient to draw firm conclusion about late reactions but they do not seem different from those induced by conventional radiotherapy. The overall 2-year survival rate of 49.4% and loco-regional control rate of 67% seem superior to the results of conventional radiotherapy for such advanced tumors. These results have led to a multi-center randomized controlled trial comparing this regimen of accelerated radiotherapy with conventional fractionated radiotherapy.

Asunto(s)

Neoplasias del Sistema Digestivo/radioterapia , Neoplasias del Sistema Respiratorio/radioterapia , Adulto , Anciano , Neoplasias del Sistema Digestivo/mortalidad , Neoplasias del Sistema Digestivo/patología , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Neoplasias del Sistema Respiratorio/mortalidad , Neoplasias del Sistema Respiratorio/patología , Factores de Tiempo

Asunto(s)

Carcinoma de Células Escamosas/terapia , Neoplasias del Sistema Digestivo/terapia , Recurrencia Local de Neoplasia/terapia , Neoplasias del Sistema Respiratorio/terapia , Terapia Recuperativa , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Neoplasias del Sistema Digestivo/tratamiento farmacológico , Neoplasias del Sistema Digestivo/radioterapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/radioterapia , Neoplasias del Sistema Respiratorio/tratamiento farmacológico , Neoplasias del Sistema Respiratorio/radioterapia , Factores de Tiempo

RESUMEN

PURPOSE: Lhermitte's sign is a relatively infrequent sequela of irradiation of the cervical spinal cord. In this study, we sought to determine whether various treatment parameters influenced the likelihood of developing Lhermitte's sign. METHODS AND MATERIALS: Between October 1964 and December 1987, 2901 patients with malignancies of the upper respiratory tract were treated at the University of Florida. The dose of radiation to the cervical spinal cord was calculated for those patients who had a minimum 1-year follow-up. A total of 1112 patients who received a minimum of 3000 cGy to at least 2 cm of cervical spinal cord were included in this analysis. RESULTS: Forty patients (3.6%) developed Lhermitte's sign. The mean time to development of Lhermitte's sign after irradiation was 3 months, and the mean duration of symptoms was 6 months. No patient with Lhermitte's sign developed transverse myelitis. Several variables were examined in a univariate analysis, including total dose to the cervical spinal cord, length of cervical spinal cord irradiated, dose per fraction, continuous-course compared with split-course radiotherapy, and once-daily compared with twice-daily irradiation. Only two variables proved to be significant. Six (8%) of 75 patients who received > or = 5000 cGy to the cervical spinal cord developed Lhermitte's sign compared with 34 (3.3%) of 1037 patients who received < 5000 cGy (p = .04). For patients treated with once-daily fractionation, 28 (3.4%) of 821 patients who received < 200 cGy per fraction developed Lhermitte's sign compared with 6 (10%) of 58 patients who received > or = 200 cGy (p = .02). CONCLUSION: An increased risk of developing Lhermitte's sign was demonstrated for patients who received either > or = 200 cGy per fraction (one fraction per day) or > or = 5000 cGy total dose to the cervical spinal cord.

Asunto(s)

Neoplasias Pulmonares/radioterapia , Traumatismos por Radiación/epidemiología , Radioterapia/efectos adversos , Neoplasias del Sistema Respiratorio/radioterapia , Médula Espinal/efectos de la radiación , Carcinoma/radioterapia , Estudios de Seguimiento , Humanos , Linfoma/radioterapia , Traumatismos por Radiación/etiología , Radioterapia/métodos , Dosificación Radioterapéutica , Estudios Retrospectivos , Factores de Riesgo , Sarcoma/radioterapia , Factores de Tiempo

RESUMEN

Twenty-five patients were treated with whole-lung irradiation for symptomatic pulmonary KS. Treatment was most often given four days per week, 150 cGy per fraction, to 1050-1500 cGy (mean 1224 cGy). No acute toxicity was observed. 89% of patients completing therapy reported improvement in dyspnea. All patients responding symptomatically could reduce (and 78% could eliminate) oxygen use. Chest x-rays showed concurrent improvement in 78% of cases, although this was > or = 50% clearance of infiltrate in only 28%. Symptomatic improvement was prompt, always occurring during the 2-2 1/2 week therapy course. Clinical response was transient in some patients, but 12 weeks after therapy 56% remained symptomatically improved. Pulmonary KS indicated an advanced stage of AIDS and survival was short (mean: 15.7 weeks after completion of therapy). Patients with poor performance status (Karnovsky: < or = 30%) and progression of disease despite chemotherapy had very short survival (mean: 3.2 weeks). For such patients, a supportive care only approach without radiotherapy is suggested. For others, whole-lung irradiation provides prompt symptomatic improvement for most patients, and offers a simple treatment approach with little toxicity for often debilitated patients.

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida/complicaciones , Neoplasias Pulmonares/radioterapia , Sarcoma de Kaposi/radioterapia , Adulto , Humanos , Neoplasias Pulmonares/etiología , Masculino , Persona de Mediana Edad , Radioterapia/métodos , Dosificación Radioterapéutica , Neoplasias del Sistema Respiratorio/etiología , Neoplasias del Sistema Respiratorio/radioterapia , Sarcoma de Kaposi/etiología , Análisis de Supervivencia

RESUMEN

Clindamycin (2.7 g/day) and netilmicin (5.6 mg/kg) were used for 6-10 days in 27 patients with laryngeal and oral cancer versus beta-lactam antibiotics and aminoglycosides received by 56 matched patients to prevent infection of the operative wound. Suppuration was observed in 11.1 and 41.4% of the patients, respectively (p < 0.05), the temperature rose over 38 degrees C in 22.2% and 42.9% of the patients, respectively (p < 0.05). The regimens showed similar toxicity. The findings proved high efficacy of clindamycin combination with netilmicin in infection prophylaxis in patients operated on for upper respiratory and digestive tract cancer.

Asunto(s)

Neoplasias del Sistema Digestivo/complicaciones , Quimioterapia Combinada/administración & dosificación , Cuidados Posoperatorios , Neoplasias del Sistema Respiratorio/complicaciones , Infección de la Herida Quirúrgica/prevención & control , Carbenicilina/administración & dosificación , Carbenicilina/efectos adversos , Cefotaxima/administración & dosificación , Cefotaxima/efectos adversos , Clindamicina/administración & dosificación , Clindamicina/efectos adversos , Terapia Combinada , Neoplasias del Sistema Digestivo/radioterapia , Neoplasias del Sistema Digestivo/cirugía , Evaluación de Medicamentos , Quimioterapia Combinada/efectos adversos , Gentamicinas/administración & dosificación , Gentamicinas/efectos adversos , Humanos , Netilmicina/administración & dosificación , Netilmicina/efectos adversos , Cuidados Preoperatorios , Neoplasias del Sistema Respiratorio/radioterapia , Neoplasias del Sistema Respiratorio/cirugía , Infección de la Herida Quirúrgica/epidemiología , Factores de Tiempo

RESUMEN

Analysis of the diagnostic potentialities of MR-tomography in the assessment of radiotherapeutic efficacy was performed in 11 patients (malignant tumors of the upper respiratory tract in 10 and juvenile nasopharyngeal angiofibroma in one). Repeated investigation was performed after abatement of local radiation reactions (usually after 4-8 weeks). MR-tomography permitted the assessment of the state of the accessory sinuses of nose, the detection of a residual tumor, and the differentiation between tumors and inflammatory changes of the mucosa. In one case radiotherapy resulted in the regeneration of posterolateral wall of the maxillary sinus.

Asunto(s)

Imagen por Resonancia Magnética , Sistema Respiratorio/patología , Neoplasias del Sistema Respiratorio/diagnóstico , Estudios de Evaluación como Asunto , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/instrumentación , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Radiografía , Sistema Respiratorio/diagnóstico por imagen , Neoplasias del Sistema Respiratorio/radioterapia

RESUMEN

A prospective study of mandibular alveolar bone resorption has been achieved on 49 patients with upper aerodigestive tract tumor and treated by radiation therapy and/or a chemotherapy, on 30 patients who were not treated. All these patients were subjected to dental extractions followed by X rays in coronal and sagittal view, during at least one year, at the rate of one X ray every three months. The comparative study enabled to show a quite similar resorption for the two population, a slightly more important resorption on incisor and canine regions, and a stopping of the resorption about five months later according to dental extractions. Radiation therapy and chemotherapy (therapeutic doses) may not have significant influence on alveolar bone resorption after dental extractions.

Asunto(s)

Pérdida de Hueso Alveolar/etiología , Antineoplásicos/efectos adversos , Enfermedades Mandibulares/etiología , Radioterapia/efectos adversos , Adulto , Anciano , Pérdida de Hueso Alveolar/inducido químicamente , Pérdida de Hueso Alveolar/diagnóstico por imagen , Pérdida de Hueso Alveolar/epidemiología , Proceso Alveolar/diagnóstico por imagen , Proceso Alveolar/efectos de los fármacos , Proceso Alveolar/efectos de la radiación , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/efectos de los fármacos , Mandíbula/efectos de la radiación , Enfermedades Mandibulares/inducido químicamente , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Mandibulares/epidemiología , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Dosificación Radioterapéutica , Neoplasias del Sistema Respiratorio/complicaciones , Neoplasias del Sistema Respiratorio/tratamiento farmacológico , Neoplasias del Sistema Respiratorio/radioterapia , Extracción Dental

Asunto(s)

Clavícula , Neoplasias del Sistema Digestivo/radioterapia , Osteorradionecrosis/etiología , Traumatismos por Radiación/etiología , Neoplasias del Sistema Respiratorio/radioterapia , Anciano , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/secundario , Diagnóstico Diferencial , Neoplasias del Sistema Digestivo/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteítis/diagnóstico , Osteorradionecrosis/diagnóstico , Osteosarcoma/diagnóstico , Neoplasias del Sistema Respiratorio/cirugía

RESUMEN

Polymorphic reticulosis (PMR) is a specific clinicopathological entity which commonly presents as an aggressive, necrotizing lesion of the upper airway. It is a separate nosologic entity from Wegener's granulomatosis, though its site and aggressive nature has lead to confusion in the distinction between these two different processes. Although radiotherapy has been acknowledged as the treatment of choice for limited upper airway PMR, little data exist to guide the radiation oncologist in the practical management of this disorder. We review our single institutional experience with PMR limited to the upper airway. Thirty-four patients (24 males, 10 females) with a median age of 44 years (range 19-80 years) are presented. Symptoms of nasal obstruction were present in 94%. Systemic symptoms such as fever, night sweats, and weight loss were noted in 62% and were often striking clinically. The nasal mucosa was most frequently involved (91%), although involvement of the paranasal sinuses (47%), palate (32%), as well as, other upper airway sites was not uncommon. Perforation of involved structures was recorded in 37%. All but 1 patient were treated with primary radiotherapy. Twelve relapsed with PMR and 3 additional patients manifested diffuse histiocytic lymphoma either within or adjacent to the original treatment field. The median survival relapse in these 15 patients was only 4 months, although 25% were salvaged at 5 years post-relapse. The overwhelming majority of relapses were noted within the first 3 years following treatment. An evaluation of radiotherapy parameters indicated that a minimum dose of 42 Gy or a TDF of 70 is necessary to achieve long-term local control. Pattern of failure analysis demonstrated in-field failure as the predominant failure site, and this problem should become much less significant with implementation of proper time-dose-fractionation schemes. Marginal failure was noted in 20% as a component of eventual failure sites suggesting the need for generous treatment volumes including clinically uninvolved adjacent structures at risk, such as palate, sinuses, and nasopharynx for nasal lesions. Finally, systemic failure occurred in 25%. Although this rate may be reduced by improved local treatment measures, ultimately effective systemic chemotherapy will be required to substantially impact on these patients' survival.

Asunto(s)

Enfermedades Linfáticas/radioterapia , Neoplasias Palatinas/radioterapia , Neoplasias Faríngeas/radioterapia , Neoplasias del Sistema Respiratorio/radioterapia , Adulto , Femenino , Estudios de Seguimiento , Humanos , Enfermedades Linfáticas/mortalidad , Masculino , Neoplasias Palatinas/mortalidad , Neoplasias Faríngeas/mortalidad , Pronóstico , Dosificación Radioterapéutica , Neoplasias del Sistema Respiratorio/mortalidad , Estudios Retrospectivos , Factores de Tiempo