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Significance of endothelial dysfunction in the pathogenesis of early and delayed radiation enteropathy

World Journal of Gastroenterology 2007年第22期13卷 3047-3055页

作者： Junru Wang Marian Boerma Qiang Fu Martin Hauer-Jensen Department of Surgery University of Arkansas for Medical Sciences United States Department of Pharmaceutical Sciences University of Arkansas for Medical Sciences United States Department of Microbiology and Immunology University of Arkansas for Medical Sciences United States Department of Surgery University of Arkansas for Medical Sciences Surgical Service Central Arkansas Veterans Healthcare System4 Little Rock AR United States

This review summarizes the current state of knowledge regarding the role of endothelial dysfunction in the pathogenesis of early and delayed intestinal radiation toxicity and discusses various endothelial-oriented interventions aimed at reducing the risk of radiation enteropathy. Studies published in the biomedical literature during the past four decades and cited in PubMed, as well as clinical and laboratory data from our own research program are reviewed. The risk of injury to normal tissues limits the cancer cure rates that can be achieved with radiation therapy. During treatment of abdominal and pelvic tumors, the intestine is frequently a major close-limiting factor. Microvascular injury is a prominent feature of both early （inflammatory）, as well as delayed （fibroproliferative） radiation injuries in the intestine and in many other normal tissues. Evidence from our and other laboratories suggests that endothelial dysfunction, notably a deficiency of endothelial thrombomodulin, plays a key role in the pathogenesis of these radiation responses. Deficient levels of thrombomodulin cause loss of vascular thromboresistance, excessive activation of cellular thrombin receptors by thrombin, and insufficient activation of protein C, a plasma protein with anticoagulant, anti-inflammatory, and cytoprotective properties. These changes are presumed to be critically involved in many aspects of early intestinal radiation toxicity and may sustain the fibroproliferative processes that lead to delayed intestinal dysfunction, fibrosis, and clinical complications. In conclusion, injury of vascular endothelium is important in the pathogenesis of the intestinal radiation response. Endothelial-oriented interventions are appealing strategies to prevent or treat normal tissue toxicity associated with radiation treatment of cancer.

关键词： Endothelial cells Thrombomodulin Proteinase-activated receptors radiation injuries radiation enteropathy

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Practical approaches to effective management of intestinal radiation injury:Benefit of resectional surgery

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World Journal of Gastroenterology 2011年第35期17卷 4013-4016页

作者： Nikolaos Perrakis Evangelos Athanassiou Dimitra Vamvakopoulou Maria Kyriazi Haris Kappos Nikolaos C Vamvakopoulos Iakovos Nomikos Department of Surgery Metaxa Cancer Memorial HospitalPiraeus 11522Greece Department of Surgery University of Thessalia Medical SchoolLarissa 41110Greece Department of Biology and Genetics University of Thessalia Medical SchoolLarissa 41110Greece

AIM:To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative ***:During a 7-year period we operated on 17 cases (5 male,12 female) admitted to our surgical department with intestinal radiation injury (IRI).They were originally treated for a pelvic malignancy by surgical resection followed by postoperative *** follow-up,they developed radiation enteritis requiring surgical treatment due to failure of conservative ***:IRI was located in the terminal ileum in 12 patients,in the rectum in 2 patients,in the descending colon in 2 patients,and in the cecum in one *** patients had resection of the affected region(s).There were no postoperative deaths,while 3 cases presented with postoperative complications (17.7%).All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range,6-96 mo).CONCLUSION:We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.

关键词： Pelvic neoplasms Bowel radiation injuries Surgery

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Rupture of carotid artery pseudoaneurysm in the modern era of definitive chemoradiation for head and neck cancer:Two case reports

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World Journal of Clinical Cases 2020年第20期8卷 4858-4865页

作者： Myungsoo Kim Ji Hyung Hong Sang Kyu Park Sook Jung Kim Jung Hwi Lee JH Byun Yoon Ho Ko Department of radiation Oncology Incheon St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaIncheon 403720South Korea Department of Internal Medicine Incheon St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaIncheon 21431South Korea Department of Neurosurgery Gangnam Severance HospitalYonsei University College of MedicineSeoul 06273South Korea Department of Internal Medicine Incheon St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 03312South Korea Department of Radiology Incheon St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 03312South Korea Department of Internal Medicine Eun-pyeoung St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 03312South Korea

BACKGROUND Carotid blowout syndrome(CBS)is a rupture of the carotid artery and is mainly caused by radiation and resection of head and neck cancers or direct tumor invasion of the carotid artery *** is a life-threatening clinical *** is no established and effective mode of management of ***,there is no established preceding sign or symptom;therefore,preventive efforts are not clinically *** SUMMARY We described two cases of CBS that occurred in patients with head and neck cancer after definitive chemoradiotherapy(CRT)using three-dimensional conformal intensity-modulated radiation *** men aged 61 and 56 years with locally advanced head and neck cancer were treated with definitive *** completing CRT,both of them achieved complete ***,they had persistent severe pain in the oropharyngeal mucosal region and the irradiated neck despite the use of opioid analgesics and rehabilitation for relief of contracted ***,continuous follow-up imaging studies showed no evidence of cancer *** to twelve months after completing CRT,the patients visited the emergency room complaining about massive oronasal *** showed rupture of carotid artery pseudoaneurysms on the irradiated *** attempting to secure hemostasis with carotid arterial stent insertion and coil embolization,both patients died because of repeated bleeding from the *** In patients with persistent pain in irradiated sites,clinicians should be suspicious of progressing or impending CBS,even in the three-dimensional conformal intensity-modulated radiation therapy era.

关键词： Carotid blow-out syndrome Carotid pseudoaneurysm Head and neck neoplasms radiation injuries Severe pain Case report

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Effectiveness of oxygen nebulization at preventing radiotherapy-induced mucositis in patients with nasopharyngeal cancer

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International Journal of Nursing Sciences 2014年第2期1卷 176-179页

作者： Juan Xu Rong Yan Pei-Ying Zhuo Ran-Ran Li Hong-Xia Ge Wen-Fang Lu Radiology Department Shandong Cancer HospitalJi’nanChina

Purpose:To evaluate the effectiveness of oxygen nebulization at preventing radiotherapyinduced mucositis in patients with nasopharyngeal ***:Sixty patients with nasopharyngeal cancer treated with simultaneous integrated boost intensity-modulated radiotherapy were randomly assigned to oxygen nebulization or ultrasonic nebulization groups;treatment was once daily for 20 *** patients received routine oral *** compared saliva pH and volume,food intake,and change in oral mucosa during radiotherapy,and dry mouth and sore throat after radiotherapy between the two ***:There were significant differences in the incidence of grade III or IV mucositis,saliva volume and pH,and dry mouth and sore throat between the two groups when the total dose was 33 Gy(p<0.05 or p<0.01).Conclusion:Oxygen nebulization reduces radiotherapy-induced mucositis and relieves symptoms such as dry mouth and sore throat in patients with nasopharyngeal cancer.

关键词： Mouth mucosa Oxygen atomization inhalation Radiotherapy radiation injuries

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A Survey of Researches on Synergy and Toxicity Abatement of Traditional Chinese Medicine in Radiotherapy of Nasopharyngeal Carcinoma

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Journal of Traditional Chinese Medicine 2001年第4期21卷 303-311页

作者：刘城林刘丽萍李佩文刘煜 Municipal Hospital of Traditional Chinese Medicine ZhaoqingGuangdong 526020 The First Municipal People's Hospital ZhaoqingGuangdong Sino-Japan Friendship Hospital Beijing 100029

Even though radiotherapy is a therapy of first choice in the treatment of nasopharyngeal carcinoma, its radiotoxicity is often difficult to bear for patients in addition to the unsatisfactory effect in some patients. Therefore, an important problem in the treatment of nasopharyngeal carcinoma is to abate radiotherapeutic toxicity and improve its effect. Some progresses in promoting the effect of radiotherapy and abating its toxicity have been made through application of traditional Chinese medicine (TCM) which is briefly reviewed as follows.

关键词： Combined Modality Therapy Drugs, Chinese Herbal Humans Nasopharyngeal Neoplasms radiation injuries

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Experimental studies on the treatment and pathological basis of combined radiation and burn injury

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Chinese Medical Journal 2002年第12期115卷 1763-1766页

作者：程天民陈宗荣阎永堂冉新泽粟永萍艾国平第三军医大学全军复合伤研究所重庆400038

OBJECTIVE: To investigate therapeutics for and the pathological basis of combined radiation and burn injuries. METHODS: Combined radiation and burn injuries on mice and rats were inflicted by gamma ray irradiation from a (60)Co source and thermal radiation from a 5 kW bromotungsten lamp. RESULTS: The dysfunction of myocardium played an important role in the development of early stage shock. Transfusion of irradiated (in vitro, 20 Gy) or stored (4 degrees C, 7 days) blood after irradiation was done to promote the success of allo-transplantation of bone marrow. Decrease of IL-4 mRNA expression was the molecular basis of depression of intestinal mucosa immune and intervention of IL-4 showed an antagonistic effect on enterogenic infection. A new lipid component extracted from burn eschar was documented for the first time and its toxic effects were elucidated. The survival rate of alloskin grafts after removal of burn eschar from the recipient animals was obviously increased in combined injury due to reduction of immune rejection activity by the radiation effect. In contrast, in animal models with simple burn, the alloskin grafts were all rejected within ten days after the procedure. A successful therapeutic result (survival rate: 92% for 30 days and 67% for 100 days) was obtained by comprehensive management of treated animals, while the untreated control animals all died within 3 - 7 days after injury. CONCLUSION: The pathogenesis of injury caused by simultaneous radiation and burn is extremely complicated and the treatment is very difficult. A comprehensive management program consisting of several therapeutic measures aimed at key links of the pathogenesis may achieve significantly improved results.

关键词： Animals Burns Calcium Heart Hematopoiesis Mice radiation injuries Rats Rats, Wistar Research Support, Non-U.S. Gov't

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Diagnosis and operative treatment of radiation-induced brachial plexopathy

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Chinese Journal of Traumatology 2002年第6期5卷 329-332页

作者：路来金宫旭刘志刚王东生张志新 Department of Hand Surgery First Hospital Affiliated to Jilin University Changchun 130021 China

To explore the diagnosis and operat ive treatment of radiation induced brachial plexopathy. Methods: Nine cases of radiation induced brachial plexopathy w ere divided into two groups, 4 cases undergoing neurolysis of brachial plexus as Group A and 5 cases undergoing transfer of myocutaneous flaps after neurolysis as Group B. In Group B, 4 cases were treated with latissimus dorsi myocutaneous flaps (about 20 cm×20 cm) and 1 case with pectoralis major myocutaneous flap (a bout 8 cm×6 cm). Results: All the 9 cases of radiation induced brachial plexopa thy were followed up for a period of 2 to 5 years, with an average of 2.3 ye ars. As far as pain relief and function recovery were concerned, the results of Group B were better than those of Group A. Conclusions: Based on the results of Group B in the series, we suggest that the procedure of covering the wounds with transferred myocutaneous flaps after neurolysis of the brachial plexus should be performed to those advan ced patients. The procedure may improve the blood supply of the fibrotic brachia l plexus by reestablishing a good nerve bed.

关键词： radiation injuries Brachial plexus Nervous system Musculocutaneous nerve Surgical flaps

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