scholarly journals Maxillofacial rehabilitation in a case of osteoradionecrosis refractory to hyperbaric oxygen treatments

2019 ◽  
Vol 2 ◽  
pp. 9-13
Author(s):  
Caroline Tram Nguyen ◽  
Mark S Chambers
Keyword(s):  
Hyperbaric Oxygen ◽  
Multidisciplinary Approach ◽  
External Beam Radiation ◽  
Clinical Report ◽  
Oral Tongue ◽  
Beam Radiation ◽  
Oxygen Treatment ◽  
Fibula Free Flap ◽  
Left Neck ◽  
Treatment Considerations

This clinical report describes a multidisciplinary approach in maxillofacial rehabilitation of a 61-year-old Caucasian male diagnosed with squamous cell carcinoma of the oral tongue. Following external beam radiation therapy, brachytherapy and a left neck dissection, the patient presented with bilateral osteoradionecrosis of the mandibular rami refractory to hyperbaric oxygen treatment. A subtotal mandibulectomy with a fibula free flap osteocutaneous reconstruction was subsequently performed. Prosthodontic planning and treatment considerations in a case of osteoradionecrosis refractory to hyperbaric oxygen with a reconstructed mandible is presented in this case report. (Int J Maxillofac Prosthetics 2019;1:9-13)

scholarly journals The use of hyperbaric oxygen to treat actinic rectal fistula after SpaceOAR use and radiotherapy for prostate cancer: a case report

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tairo Kashihara ◽  
Koji Inaba ◽  
Motokiyo Komiyama ◽  
Hiroki Nakayama ◽  
Kotaro Iijima ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Hyperbaric Oxygen ◽  
External Beam Radiation ◽  
Perineal Pain ◽  
Rectal Perforation ◽  
Beam Radiation ◽  
High Risk Prostate Cancer ◽  
Risk Prostate Cancer ◽  
Magnetic Resonance Imaging Mri

Abstract Background In definitive radiation therapy for prostate cancer, the SpaceOAR® System, a hydrogel spacer, is widely used to decrease the irradiated dose and toxicity of rectum. On the other hand, periprostatic abscesses formation and rectal perforation are known as rare adverse effects of SpaceOAR. Nevertheless, there is a lack of reports clarifying the association between aggravation of abscesses and radiation therapy, and hyperbaric oxygen therapy (HBOT) is effective for a peri-SpaceOAR abscess and rectal perforation. Case presentation We report a case of a 78-year-old high-risk prostate cancer patient. After SpaceOAR insertion into the correct space, he started to receive external beam radiation therapy (EBRT). He developed a fever, perineal pain and frequent urination after the completion of EBRT, and the magnetic resonance imaging (MRI) revealed a peri-SpaceOAR abscess. Scheduled brachytherapy was postponed, administration of antibiotics and opioid via intravenous drip was commenced, and transperineal drainage was performed. After the alleviation of the abscess, additional EBRT instead of brachytherapy was performed with MRI-guided radiation therapy (MRgRT). On the last day of the MRgRT, perineal pain reoccurred, and MRI and colonoscopy detected the rectal perforation. He received an intravenous antibiotics drip and HBOT, and fully recovered from the rectal perforation. Conclusions Our report indicates that EBRT can lead to a severe rectum complication by causing inflammation for patients with a peri-SpaceOAR abscess. Furthermore, HBOT was effective for the peri-SpaceOAR abscess and rectal perforation associated with EBRT.

Multidisciplinary approach to endobronchial HDR brachytherapy as an alternative to external beam radiation for palliating malignant airway obstruction.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 132-132
Author(s):  
Hani AL-Halabi ◽  
Rabih Bechara ◽  
Will Snyder ◽  
Kristyn Harpool ◽  
Patricia Schantz ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
General Anesthesia ◽  
Multidisciplinary Approach ◽  
High Dose Rate ◽  
External Beam Radiation ◽  
Fistula Formation ◽  
High Dose ◽  
External Beam ◽  
Beam Radiation ◽  
Pulmonary Airway

132 Background: Concerns over the safety of high-dose-rate (HDR) endobronchial brachytherapy (EBB) has limited its widespread use in palliating pulmonary airway obstruction. Morbidity following EBB is commonly attributed to fatal hemoptysis and fistula formation. We implemented a procedure to deliver EBB under general anesthesia to minimize procedure risks, while maintaining treatment effectiveness. We hereby report outcomes of consecutive patients treated using this approach to palliate airway obstruction. Methods: We retrospectively reviewed charts of consecutive patients treated with EBB. Treated patients had obstructive lesions >2cm distal to the carina and central structures, who were deemed candidates for EBB by a multidisciplinary team of interventional pulmonologists (IP) and radiation oncologists (RO). All patients were treated under general anesthesia. Bronchoscopy and localization of target lesions was performed by IP. HDR catheters carrying a marker wire were advanced past obstructive lesion. CT simulation was performed to confirm catheter placement, and perform CT-based 3D treatment planning. A dose of 6 -7 Gy/fraction was prescribed at 1 cm from catheter surface. Results: 25 patients (ages 29 -71, mean 52 years) were treated with EPP. 5 had previously received external beam radiation (EBRT) and 3 had concurrent EBRT and EPP. Overall, a total of 76 EBB treatments were performed, with a median of 3 weekly fractions per patient (range 1-6) to total dose of 18Gy. There were no incidences of major bleeding (>50 mL) or fatal hemoptysis in the 30 days following EPP. Moreover, there were no cases of severe (Grade 3 or higher) CTCAE toxicity reported. After a median follow up of 30 months (range 4-42) only 1 out of 17 patients treated with EPP alone required additional EBRT for airway obstruction, 12 months following EPP. Conclusions: Our data suggest the safety and efficacy of an expert multidisciplinary approach to palliating pulmonary airway obstruction using EPP. This approach provides effective palliation of airway obstruction and decreased the need for additional EBRT in majority of treated patients.

1141: A Randomized Controlled Trial Comparing External Beam Radiation and Cryoablation in Localized Prostate Cancer

2007 ◽  
Vol 177 (4S) ◽  
pp. 376-377 ◽  
Author(s):  
Bryan J. Donnelly ◽  
John C. Saliken ◽  
Penny Brasher ◽  
Scott Ernst ◽  
Harold Lau ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Randomized Controlled

Spinal laser interstitial thermal therapy: single-center experience and outcomes in the first 120 cases

2020 ◽  
pp. 1-10
Author(s):  
Dhiego C. A. Bastos ◽  
Rafael A. Vega ◽  
Jeffrey I. Traylor ◽  
Amol J. Ghia ◽  
Jing Li ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Control ◽  
Thoracic Spine ◽  
Adjuvant Radiotherapy ◽  
Neurological Complications ◽  
Thermal Therapy ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Laser Interstitial Thermal Therapy ◽  
Hazard Ratios

OBJECTIVEThe objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors.METHODSThe electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications.RESULTSThere were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non–small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine.CONCLUSIONSsLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

Combined stereotactic split-course fractionated gamma knife radiosurgery and conventional radiation therapy for unfavorable gliomas: a phase I study

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 37-41 ◽  
Author(s):  
William F. Regine ◽  
Roy A. Patchell ◽  
James M. Strottmann ◽  
Ali Meigooni ◽  
Michael Sanders ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Disease Progression ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
External Beam Radiation ◽  
Low Grade ◽  
Beam Radiation ◽  
Content Type ◽  
Group B ◽  
Fine Print

Object. This investigation was performed to determine the tolerance and toxicities of split-course fractionated gamma knife radiosurgery (FSRS) given in combination with conventional external-beam radiation therapy (CEBRT). Methods. Eighteen patients with previously unirradiated, gliomas treated between March 1995 and January 2000 form the substrate of this report. These included 11 patients with malignant gliomas, six with low-grade gliomas, and one with a recurrent glioma. They were stratified into three groups according to tumor volume (TV). Fifteen were treated using the initial FSRS dose schedule and form the subject of this report. Group A (four patients), had TV of 5 cm3 or less (7 Gy twice pre- and twice post-CEBRT); Group B (six patients), TV greater than 5 cm3 but less than or equal to 15 cm3 (7 Gy twice pre-CEBRT and once post-CEBRT); and Group C (five patients), TV greater than 15 cm3 but less than or equal to 30 cm3 (7 Gy once pre- and once post-CEBRT). All patients received CEBRT to 59.4 Gy in 1.8-Gy fractions. Dose escalation was planned, provided the level of toxicity was acceptable. All patients were able to complete CEBRT without interruption or experiencing disease progression. Unacceptable toxicity was observed in two Grade 4/Group B patients and two Grade 4/Group C patients. Eight patients required reoperation. In three (38%) there was necrosis without evidence of tumor. Neuroimaging studies were available for evaluation in 14 patients. Two had a partial (≥ 50%) reduction in volume and nine had a minor (> 20%) reduction in size. The median follow-up period was 15 months (range 9–60 months). Six patients remained alive for 3 to 60 months. Conclusions. The imaging responses and the ability of these patients with intracranial gliomas to complete therapy without interruption or experiencing disease progression is encouraging. Excessive toxicity derived from combined FSRS and CEBRT treatment, as evaluated thus far in this study, was seen in patients with Group B and C lesions at the 7-Gy dose level. Evaluation of this novel treatment strategy with dose modification is ongoing.

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