Abstract Radiotherapy is used in the treatment of breast cancer in order to reduce local recurrence rate. However, radiation is known to cause both acute and delayed side-effects on normal tissues. A common late complication of radiotherapy is fibrosis of skin and other organs. Fibrosis has been described as excessive accumulation of extracellular matrix components, especially collagens. Collagens are a group of extracellular matrix proteins that provide connective tissues with tensile strength. Type I and III collagens are the major structural proteins in skin. Alterations in collagen synthesis occur in various pathological conditions, during ageing and in association with diverse medical therapies. Collagens are degraded by matrix metalloproteinase enzymes (MMPs). The activity of MMPs is restrained by their specific tissue inhibitors (TIMPs). Elastic fibres constitute about 2–4% of skin dry weight. Despite their low quantity, elastic fibres are responsible for the resilient and elastic properties of skin. Dermal elastic fibres may be affected by intrinsic ageing, by extrinsic reasons such as photodamage and in several connective tissue diseases. The effect of radiotherapy on human skin type I and III collagen synthesis was investigated in a group of women who had been treated for breast cancer surgically and with radiotherapy. The levels of MMP-9, MMP-2/TIMP-2 complex, TIMP-1 and TIMP-2 in irradiated skin were also analysed. The effect of radiotherapy on elastic fibres was analysed using skin samples. The physio-mechanical properties of radiotherapy-treated skin were studied using ultrasound and elastometer devices, and compared with those of non-treated skin. In addition, skin samples were stained for haematoxylin-eosin, tenascin and mast cells. Factor VIII immunostaining was performed to visualize dermal blood vessels. Wound regeneration in irradiated skin was also studied using suction blister as a model. The synthesis of type I and III collagens was markedly increased as a result of radiotherapy. An increased amount of cross-linked type I collagen was detected in irradiated skin, and collagen turnover was also increased in irradiated skin. No difference in the amount or structure of the elastic fibres could be found between radiotherapy-treated and non-treated skin. A slight increase of skin thickness and stiffness was found in irradiated skin compared to non-treated skin. Increased tenascin expression was found in irradiated skin. The number of dermal blood vessels visualized by FVIII immunostaining was slightly higher in irradiated than in control skin. The amount of mast cells positive for tryptase, Kit receptor and chymase was increased in the upper dermis of irradiated skin. No difference in epidermal regeneration was found between irradiated and non-treated skin. The results of this study suggest that alteration of collagen metabolism contributes to dermal side effects of therapeutic irradiation.

Chan Mok-wah, Paul. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1993. / Includes bibliographical references (leaves [219-231]). / ACKNOWLEDGEMENTS / SUMMARY / LIST OF ABBREVIATIONS / Chapter CHAPTER 1. --- INTRODUCTION / Chapter 1.1 --- HISTORY --- p.1 / Chapter 1.2 --- RADIATION EXPOSURES OF THE POPULATION --- p.1 / Chapter 1.2.1 --- Introduction --- p.1 / Chapter 1.2.1 --- The Projected Expansion of Medical Exposures --- p.2 / Chapter 1.3 --- RADIATION HAZARDS --- p.6 / Chapter 1.3.1 --- Deterministic Effects --- p.6 / Chapter 1.3.2 --- Stochastic Effects --- p.7 / Chapter 1.3.3 --- Pre-natal Irradiation --- p.9 / Chapter 1.4 --- THE LOCAL SITUATION --- p.9 / Chapter 1.5 --- JUSTIFICATION OF THE STUDY OF LOCAL PATIENT DOSE --- p.10 / Chapter CHAPTER 2. --- THE MEDICAL EXPOSURES IN HONG KONG / Chapter 2.1 --- INTRODUCTION --- p.11 / Chapter 2.2 --- MAN-MADE RADIATION IN HONG KONG --- p.11 / Chapter 2.2.1 --- Occupational Exposure --- p.11 / Chapter 2.2.2 --- Radioactive Fall-out --- p.12 / Chapter 2.2.3 --- Nuclear Medicine --- p.12 / Chapter 2.2.4 --- Diagnostic Radiology --- p.12 / Chapter 2.3 --- THE FUTURE TREND --- p.13 / Chapter 2.4 --- THE CURRENT STUDY --- p.15 / Chapter CHAPTER 3. --- METHODS OF OPTIMISATION / Chapter 3.1 --- INTRODUCTION --- p.17 / Chapter 3.2 --- JUSTIFICATION OF DIAGNOSTIC RADIATION EXPOSURE --- p.17 / Chapter 3.3 --- OPTIMISATION OF DIAGNOSTIC RADIATION EXPOSURE --- p.18 / Chapter 3.4 --- THE CONTROL OF EXPOSURES --- p.19 / Chapter 3.4.1 --- The Control of Occupational Exposure --- p.19 / Chapter 3.4.2 --- The Control of Public Exposure --- p.20 / Chapter 3.4.3 --- The Control of Patient Exposure --- p.20 / Chapter 3.5 --- A PRACTICAL APPROACH TO CONTROL PATIENT EXPOSURES --- p.23 / Chapter 3.5.1 --- Intrumental Approach --- p.23 / Chapter 3.5.2 --- Technical Approach --- p.24 / Chapter 3.5.3 --- Administrative Approach --- p.25 / Chapter 3.6 --- CONCLUSION --- p.26 / Chapter CHAPTER 4. --- METHOD OF STUDY / Chapter 4.1 --- INTRODUCTION --- p.27 / Chapter 4.2 --- A WORKING SCHEME --- p.27 / Chapter 4.3 --- THE MEASUREMENT OF ESD --- p.29 / Chapter 4.3.1 --- Thermoluminescent Dosimetry --- p.29 / Chapter 4.3.2 --- The TL Material Adopted --- p.30 / Chapter 4.3.3 --- Irradiated of TLDs --- p.32 / Chapter 4.3.4 --- Readout of the Exposed TLDs --- p.32 / Chapter 4.3.5 --- Accuracy of Readings --- p.35 / Chapter 4.4 --- MONTE CARLO SIMULATION --- p.36 / Chapter 4.4.1 --- Introduction --- p.36 / Chapter 4.4.2 --- History --- p.38 / Chapter 4.4.3 --- The Principle --- p.38 / Chapter 4.4.4 --- Photon History --- p.40 / Chapter 4.4.5 --- The Use of Monte Carlo simulation in Organ Doses Estimation --- p.47 / Chapter 4.4.6 --- The Electron-Gamma-Shower (EGS4) Code System --- p.51 / Chapter 4.5 --- A LOCAL MATHEMATICAL PHANTOM --- p.52 / Chapter 4.5.1 --- Introduction --- p.52 / Chapter 4.5.2 --- An Ideal Mathematical Phantom --- p.52 / Chapter 4.5.3 --- Choice of Mathematical Phantom Model --- p.53 / Chapter 4.5.4 --- The Development of a Chinese Mathematical Phantom --- p.55 / Chapter 4.5.5 --- Results --- p.56 / Chapter 4.5.6 --- A Comparison --- p.60 / Chapter 4.6 --- A SUMMARY --- p.62 / Chapter CHAPTER 5. --- POPULATION STUDIES / Chapter 5.1 --- INTRODUCTION --- p.63 / Chapter 5.2 --- FREQUENCY SURVEY --- p.63 / Chapter 5.2.1 --- Survey in Private Sectors --- p.63 / Chapter 5.2.2 --- Surveyin Government Sectors --- p.64 / Chapter 5.3 --- DOSE SURVEY --- p.66 / Chapter 5.3.1 --- Selection of Regions and Projections --- p.66 / Chapter 5.3.2 --- Selection of Hospitals and Laboratories --- p.66 / Chapter 5.4 --- SAMPLE SIZE --- p.67 / Chapter CHAPTER 6. --- RESULTS / Chapter 6.1 --- INTRODUCTION --- p.68 / Chapter 6.2 --- SAMPLE SIZE --- p.68 / Chapter 6.3 --- AGE BAND AND SEX DISTRIBUTION --- p.68 / Chapter 6.4 --- THE MEASURED ESD --- p.75 / Chapter 6.4.1 --- Histograms of ESDs by Projection --- p.75 / Chapter 6.4.2 --- A Comparison of ESDs by Projection --- p.89 / Chapter 6.4.3 --- A Comparison of ESDs by Centre --- p.93 / Chapter 6.4.4 --- A Comparison of Collective ESDs by Centre --- p.96 / Chapter 6.5 --- THE ESTIMATED ORGAN DOSES --- p.103 / Chapter 6.5.1 --- Introduction --- p.103 / Chapter 6.5.2 --- Method --- p.103 / Chapter 6.5.3 --- Normalised Organ Doses --- p.105 / Chapter 6.5.4 --- Organ doses per Projection --- p.105 / Chapter 6.5.5 --- A Computerised programme --- p.119 / Chapter 6.6 --- A COMPARISON OF ORGAN DOSES ESTIMATED ON LOCAL AND NRPB MODELS --- p.152 / Chapter CHAPTER 7. --- SOURCES OF UNCERTAINTY / Chapter 7.1 --- UNCERTAINTITIES IN COMPUTATION --- p.156 / Chapter 7.1.1 --- Inaccuracy of the Justaposition of Complex Human Anatomy and the X-ray Beam --- p.156 / Chapter 7.1.2 --- Statistical Uncertainties --- p.156 / Chapter 7.1.3 --- Attenuation Coefficient Uncertainties --- p.157 / Chapter 7.1.4 --- Anatomic Inexactitudes --- p.157 / Chapter 7.2 --- ERRORS CONTRIBUTED BY TLDs --- p.155 / Chapter 7.3 --- TOTAL POSSIBLE ERROR --- p.157 / Chapter 7.4 --- VERIFICATION OF THE RESULTS --- p.158 / Chapter 7.4.1 --- Verification of the Measured ESD --- p.158 / Chapter 7.4.2 --- Verification of the Estimated Organ Doses --- p.158 / Chapter CHAPTER 8. --- HEALTH IMPLICATIONS / Chapter 8.1 --- INTRODUCTION --- p.161 / Chapter 8.2 --- DATA SOURCE --- p.161 / Chapter 8.3 --- ASSUMPTIONS --- p.162 / Chapter 8.4 --- SOMATIC RISK --- p.162 / Chapter 8.4.1 --- Somatically Significant Dose (SSD) --- p.162 / Chapter 8.4.2 --- Results --- p.163 / Chapter 8.5 --- LEUKAEMIC RISK --- p.166 / Chapter 8.5.1 --- Leukaemically Significant Dose (LSD) --- p.166 / Chapter 8.5.2 --- Results --- p.167 / Chapter 8.6 --- GENETIC RISK --- p.170 / Chapter 8.6.1 --- Genetically Significant Dose (GSD) --- p.170 / Chapter 8.6.2 --- Results --- p.171 / Chapter 8.7 --- DISCUSSION --- p.174 / Chapter CHAPTER 9. --- DISCUSSION --- p.199 / Chapter 9.1 --- MEAN ESDs PER PROJECTION --- p.199 / Chapter 9.2 --- A COMPARISON OF MEAN ESDs BETWEEN LOCAL CENTRES --- p.200 / Chapter 9.3 --- A COMPARISON OF MEAN ESDs BETWEEN COUNTRIES --- p.202 / Chapter 9.4 --- EFFECTIVE DOSE PER EXAMINATION --- p.203 / Chapter 9.5 --- NEED FOR LOCAL ANTHROPOMORPHIC PHANTOM --- p.204 / Chapter 9.6 --- ORGAN DOSES WITH HIGH CANCER INDUCTION --- p.205 / Chapter 9.7 --- A DISTRIBUTION OF COLLECTIVE DOSES --- p.206 / Chapter 9.8 --- "A DISTRIBUTION OF SSD, LSD AND GSD" --- p.209 / Chapter 9.9 --- OVERALL RISK ESTIMATION --- p.212 / Chapter 9.10 --- POPULATION ORGAN DOSES --- p.213 / Chapter 9.11 --- SUMMARY --- p.214 / Chapter CHAPTER 10. --- CONCLUSION --- p.217 / REFERENCES --- p.R 1 - 12 / APPENDICES / Chapter A. --- RADIATION QUANTITIES USED IN PATIENT DOSIMETRY --- p.A 1 - 12 / Chapter B. --- QUALITY ASSURANCE --- p.B 1 - 14 / Chapter C. --- DOSE REDUCTION --- p.C 1 - 11 / Chapter D. --- REJECT ANALYSIS --- p.D 1 - 15 / Chapter E. --- PUBLISHED WORK IN DOSE MEASUREMENT --- p.E 1 - 18 / Chapter F. --- THERMOLUMINESCENT DOSIMETRY --- p.F 1 - 27 / Chapter G. --- A STUDY ON ANTHROPOMORPHIC PHANTOM --- p.G 1 - 4

Lam Wai-man Wynnie. / "April 2002." / Thesis (M.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (p. 109-134). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

by Mei Chun Cheung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 34-41). / Abstract and questionare in English and Chinese. / ABSTRACT --- p.ii / ACKNOWLEDGEMENTS --- p.iii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.v / Chapter CHAPTER I - --- INTRODUCTION --- p.1 / Chapter CHAPTER II - --- METHOD --- p.7 / Chapter CHAPTER III - --- RESULTS --- p.17 / Chapter CHAPTER IV - --- DISCUSSION --- p.29 / REFERENCES --- p.34 / APPENDIX --- p.42

Ng Kenway. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 169-189). / Abstracts in English and Chinese ; questionnaire also in Chinese. / ABSTRACT --- p.I / 摘要 --- p.IV / ACKNOWLEDGEMENT --- p.V / TABLE OF CONTENTS --- p.VII / ABBREVIATION --- p.XI / LIST OF TABLES --- p.XIII / LIST OF FIGURES --- p.XIV / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.4 / Chapter 2.1 --- SIDE EFFECTS OF RADIATION THERAPY IN HEAD & NECK CACNER PATIENTS --- p.6 / Chapter 2.2 --- NUTRITIONAL ALTERATIONS IN CANCER PATIENTS --- p.9 / Chapter 2.3 --- FACTORS INFLUENCING ALTERATION IN CALORIE INTAKE IN CANCER PATIENTS --- p.12 / Chapter 2.3.1 --- Evidence for impaired calorie intake in cancer patients --- p.12 / Chapter 2.3.2 --- Anorexia --- p.13 / Chapter 2.3.2.1 --- Mucositis of upper food passage --- p.13 / Chapter 2.3.2.2 --- "Change in saliva and taste, food aversions" --- p.14 / Chapter 2.3.2.3 --- Psychological and emotional factors --- p.14 / Chapter 2.3.2.4 --- Cytokines --- p.15 / Chapter 2.4 --- FACTORS INFLUENCING ENERGY EXPENDITURE IN CANCER PATIETNS --- p.17 / Chapter 2.4.1 --- Introduction --- p.17 / Chapter 2.4.2 --- Components of total energy expenditure --- p.22 / Chapter 2.4.2.1 --- Measurement of Basal metabolic rate --- p.22 / Chapter 2.4.2.2 --- Energy cost of physical activity --- p.25 / Chapter 2.4.2.3 --- Thermic effect of food (TEF) --- p.26 / Chapter 2.5 --- METHODS FOR NUTRITIONAL ASSESSMENT --- p.27 / Chapter 2.5.1 --- Body weight and body composition --- p.27 / Chapter 2.5.2 --- Dietary intake --- p.30 / Chapter 2.6 --- METHODS FOR ENERGY EXPENDITURE MEASUREMENT --- p.35 / Chapter 2.7 --- CYTOKINES AND LEPTIN CHANGES IN CANCER PATIENTS --- p.40 / Chapter 2.7.1 --- Cytokines --- p.40 / Chapter 2.7.1.1 --- Tumor necrosis factor --- p.40 / Chapter 2.7.1.2 --- Interleukin 1 and interleukin 6 --- p.44 / Chapter 2.7.2 --- Leptin --- p.45 / Chapter 2.8 --- THE IMPACT OF MALNUTRITION ON CANCER SURVIVAL --- p.49 / Chapter CHAPTER 3 --- OBJECTIVES OF STUDY --- p.53 / Chapter CHAPTER 4 --- METHODS --- p.55 / Chapter 4.1 --- RETROSPECTIVE STUDY --- p.56 / Chapter 4.1.1 --- Patients --- p.56 / Chapter 4.1.2 --- Cancer staging --- p.56 / Chapter 4.1.3 --- Cancer treatment --- p.57 / Chapter 4.1.4 --- Outcome endpoints --- p.57 / Chapter 4.1.5 --- Determinants --- p.58 / Chapter 4.1.6 --- Statistical analysis --- p.58 / Chapter 4.2 --- PROSPECTIVE STUDY --- p.59 / Chapter 4.2.1 --- "Patients, oncological treatment, and assessment time points" --- p.59 / Chapter 4.2.2 --- Assessment of nutritional intake by food record --- p.60 / Chapter 4.2.3 --- Assessment of radiotherapy-induced symptoms --- p.61 / Chapter 4.2.4 --- Assessment of Basal metabolic rate --- p.62 / Chapter 4.2.5 --- Assessment of total energy expenditure and energy balance --- p.63 / Chapter 4.2.6 --- Assessment of body composition --- p.65 / Chapter 4.2.7 --- Measurement of cytokines --- p.68 / Chapter 4.2.7.1 --- Serum TNF-α --- p.69 / Chapter 4.2.7.2 --- Serum Human Leptin --- p.72 / Chapter CHAPTER 5 --- RESULTS --- p.80 / Chapter 5.1 --- RETROSPECTIVE STUDY --- p.81 / Chapter 5.1.1 --- The 5-year profile of bodyweight change during and after the end of radiotherapy --- p.81 / Chapter 5.1.2 --- Analysis on relation between weight loss and survival --- p.82 / Chapter 5.1.2.1 --- Patient and cancer stage --- p.82 / Chapter 5.1.2.2 --- Percentage of patients with weight loss at end of radiotherapy --- p.82 / Chapter 5.1.2.3 --- Cancer treatment outcome --- p.82 / Chapter 5.1.2.4 --- Univariate analysis --- p.82 / Chapter 5.1.2.5 --- Multivariate analysis --- p.83 / Chapter 5.2 --- PROSPECTIVE STUDY --- p.84 / Chapter 5.2.1 --- The profile of nutritional measurements during radiotherapy --- p.84 / Chapter 5.2.1.1 --- Bodyweight and body composition before and during RT --- p.84 / Chapter 5.2.1.2 --- Calorie intake before and during RT --- p.85 / Chapter 5.2.1.3 --- Energy expenditure before and during RT --- p.86 / Chapter 5.2.1.4 --- Energy balance before and during RT --- p.88 / Chapter 5.2.2 --- The profile of nutritional measurements during the 6-month period after radiotherapy --- p.88 / Chapter 5.2.2.1 --- Body weight and body composition during the 6 months after radiotherpay --- p.88 / Chapter 5.2.2.2 --- Calorie intake during the 6 months after radiotherapy --- p.90 / Chapter 5.2.2.3 --- Energy expenditure during the 6 months after radiotherapy --- p.91 / Chapter 5.2.2.4 --- Energy balance during the 6 months after radiotherapy --- p.92 / Chapter 5.2.3 --- Radiotherapy-induced Symptoms --- p.92 / Chapter 5.2.3.1 --- Profile of symptoms after RT --- p.92 / Chapter 5.2.3.2 --- Detailed profile of symptoms during RT --- p.95 / Chapter 5.2.4 --- The profile of cytokines during and after completion of RT --- p.95 / Chapter 5.2.4.1 --- SerumTNF-α --- p.96 / Chapter 5.2.5.2 --- Serum leptin --- p.96 / Chapter CHAPTER 6 --- DISCUSSION --- p.144 / Chapter 6.1 --- RETROSPECTIVE STUDY --- p.145 / Chapter 6.2 --- PROSPECTIVE STUDY --- p.147 / Chapter 6.2.1 --- The magnitude of the problem --- p.147 / Chapter 6.2.2 --- The potential determinants of weight loss --- p.147 / Chapter 6.2 3 --- Is weight loss due to the cancer or due to its treatment? --- p.148 / Chapter 6.2.4 --- "Is the weight loss influenced by pre-treatment factors, i. e. anthropometrical data?" --- p.148 / Chapter 6.2.5 --- "Is the pattern weight loss compatible with the model of calorie-protein malnutrition, similar to a starvation state?" --- p.149 / Chapter 6.2.6 --- Is the weight loss due to increased energy expenditure? --- p.150 / Chapter 6.2.7 --- Is the weight loss due to reduced calorie intake? --- p.151 / Chapter 6.2.8 --- Is weight loss during radiotherapy due to negative energy balance? --- p.151 / Chapter 6.2.9 --- What causes reduced calorie intake: Are radiotherapy-induced symptoms contributive? --- p.152 / Chapter 6.2.10 --- What are the observations on and implications of cytokine changes? --- p.155 / Chapter 6.2.11 --- What determines the recovery of body weight during 6 months after end of radiotherapy? --- p.158 / Chapter 6.2.12 --- Is the weight loss in the post RT recovery period due to negative energy balance? --- p.159 / Chapter 6.2.13 --- What are the implications on nutritional intervention? --- p.159 / Chapter 6.2.14 --- Limitations and future studies --- p.164 / Chapter CHAPTER 7 --- CONCLUSIONS --- p.166 / REFERENCES --- p.169 / APPENDIX 1 CONSENT FORM I (IN ENGLISH) --- p.190 / APPENDIX 2 CONSENT FORM I (IN CHINESE) --- p.193 / APPENDIX 3 CONSENT FORM II (IN ENGLISH) --- p.196 / APPENDIX 4 CONSENT FORM II (IN CHINESE) --- p.199 / APPENDIX 5 3-DAY DIET RECORD --- p.202 / APPENDIX 6 24-HOUR DIETARY RECALL --- p.206 / APPENDIX 7 SUBJECTIVE NUTRITIONAL ASSESSMENT --- p.208 / APPENDIX 8 PHYSICAL ACTIVITY QUESTIONNAIRE --- p.210 / APPENDIX 9 BONE SCAN REPORT --- p.215

Cheung Mei-chun. / "January 2003." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (p. 66-94). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

This report from Groote Schuur therefore sets out to review cases of postradiation sarcomas, including malignant mixed mullerian tumors (MMMT), presenting to the Radiation Oncology Departments of Groote Schuur Hospital and the affiliated hospitals (Frere Hospital, East London and Provincial Hospital, Port Elizabeth) or known to have occurred in patients initially treated in these hospitals. It aims [1] to establish the features of the initial malignancy as well as the latent period for the development of postradiation sarcoma, the type of postradiation tumor and the outcome of the disease; [2] to establish as accurately as possible dose levels at which the postradiation tumors have developed; and [3] to briefly describe possible risk factors such as a genetic predisposition to the development of malignancy, repeated courses of radiotherapy, surgery as part of the treatment of the initial tumor, and chemotherapy. Questions regarding the genesis of postradiation sarcomas cannot be answered by a review of 20 cases, even when combined with an analysis of literature. This review aims to add relevant information to the body of data from which the final answers may come. In view of the late diagnosis often made in cases of postradiation sarcoma (25, 94) the review also aims to heighten awareness of the condition so that it may be more often reported at a curable stage.

Made available in DSpace on 2015-07-22T20:50:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-24 / Introdução: A coloproctopatia actínica crônica (CAC) é uma complicação reconhecida da radioterapia. O sangramento retal (SR) é a queixa mais comum da CAC e a melhor modalidade de tratamento endoscópico para este sintoma permanece controversa. Objetivo: Comparar a eficácia e a segurança da eletrocauterização bipolar (EB) com a eletrocauterização com plasma de argônio (EPA) no tratamento do SR secundário à CAC. Pacientes e Métodos: Foram incluídos 30 pacientes com SR ativo proveniente da CAC, randomizados em 2 grupos (15 para EB e 15 para EPA) e classificados de acordo com escore de Saunders. A potência foi de 50 W para a EB e de 40 W para a EPA. Todos foram submetidos à colonoscopia inicial para o diagnóstico da lesão e sua extensão e exclusão de outras doenças. O sucesso do tratamento foi definido pela erradicação de todas as telangiectasias. Foram consideradas falhas de tratamento, os casos nos quais sete sessões não foram suficientes para o controle do sangramento. Complicações foram divididas em três diferentes grupos: sensitivas (dor anal, dor abdominal e febre), hemorrágicas (piora do sangramento durante o tratamento e sangramento por úlceras) e anatômico-motoras (afilamento das fezes, estenoses e pseudopólipos). Resultados: A média de idade foi de 67,4 anos (variação de 33 a 82 anos) com 14 mulheres e 16 homens. Não houve diferença estatística significante entre os grupos no número de sessões (p = 0,313). Não houve diferença significativa em relação às complicações sensitivas (p = 0,245), hemorrágicas (p = 0,169) ou anatômico-motoras (p = 0,700) entre os grupos. Entretanto, a incidência total de complicações foi significativamente maior no grupo EB. Somente uma falha terapêutica foi observada em cada grupo (p = 1,000). Também não houve diferença significativa na recidiva (p = 1,000). Pacientes em uso de aspirina necessitaram de um número maior de sessões para cessação do SR (p = 0,036) e para erradicação das telangiectasias (p = 0,047). Conclusões: A EPA e a EB apresentaram semelhanças em relação à eficácia no tratamento da coloproctopatia actínica crônica hemorrágica. Contudo, a EPA é mais segura que a EB. / Introduction: Chronic radiation coloproctopathy (CRCP) is a well-recognized complication of radiotherapy. Rectal bleeding is the most common symptom of radiation injury and the optimal endoscopic treatment of bleeding due to CRCP is still controversial. Aim: To compare the efficacy and safety of bipolar eletrocauterization (BEC) and argon plasma eletrocauterization (APE) in the management of bleeding from CRCP. Methods: Thirty patients with active bleeding from telangiectasias were enrolled, randomized into two groups (15 BEC and 15 APE) and classified according to Saunders score. Power settings were 50 W for BEC and 40 W for APE. Initial treatment was performed after a complete colonoscopy to rule out synchronous lesions and follow-up was performed with flexible sigmoidoscopies. Success was defined as eradication of all telangiectasias. Failure was defined whenever more than seven sessions or other therapies were necessary for treatment of bleeding. Complications were divided into three different groups: sensory (anal pain, abdominal pain and/or fever), hemorrhagic (worsening of bleeding during treatment, bleeding from ulcers) and anatomic/motor (tapered feces, stenosis and/or pseudopolyps). Results: Mean age was 67.4 years (range 33-82), with 14 women and 16 men. There was no significant difference regarding the number of sessions in both groups (p = 0.313). There were no significant differences regarding sensory (p = 0.245) hemorrhagic (p = 0.169) or anatomic/motor (p = 0.700) complications between both groups. However, the overall complication rate was significantly higher in EB group (p = 0.020). Only one failure was observed in each group (p = 1.000). There was also no significant difference regarding relapse (p = 1.000) Conclusions: BEC and APE are equally effective in patients with bleeding telangiectasias from CRCP. Nevertheless, APE is safer than EB. / TEDE / BV UNIFESP: Teses e dissertações

Chan Yu-leung. / "Nov 2003." / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 179-193). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

<p>Uvod: Učestalost neželjenih efekata uzrokovanih zračenjem kod pacijenata sa karcinomom glave i vrata zavisi od tehnike planiranja, sprovođenja radioterapije kao i primarne lokalizacije tumora. Cilj: Osnovna uloga na&scaron;eg istraživanja je da se utvrdi učestalost neželjenih efekata tokom zračne terapije kod pacijenata sa tumorom glave i vrata tretiranih 2D konvencionalnom radioterapijom, 3D konformalnom radioterapijom planiranoj samo na osnovu CT-a nasuprot 3D konformalnoj terapiji planiranoj na osnovu fuzije kompjuterizovane tomografije sa magnetno rezontnim imidžingom (CT-MRI). Metode: Prospektivno je analizirano 90 pacijenata sa karcinomom glave i vrata kod kojih je sprovedena zračna terapija. 30 pacijenata sa karcinomom glave i vrata je zračeno 2D konvencionalnom tehnikom, drugih 30 pacijenata je zračeno 3D konformalom tehnikom na osnovu CT-a, a preostalih 30 pacijenata sa fuzijom CT-MRI. Kod svih bolesnika je primenjena standardna frakcionacija sa 2 Gy dnevno, pet dana sedmično. Rezultati: Od ukupno 90 pacijenata lečenih primenom zračne terapije, kod 72 pacijenta (72/90; 64,8%) su zabeleženi neželjeni efekti zračne terapije a učestalost komplikacija je veća kod primene 2D tehnike zračenja (28/72; 38,9% for 2D RT vs 24/72; 33,3% for 3D CT RT vs 20/72; 27,8% for 3D CT-MRI; p=0,015). Zaključak: 3D tehnika radioterapije planirana samo na osnovu CT-a je povezana sa visokom stopom toksičnosti koje znatno utiču na kvalitet života zračenih pacijenata. 3D konformalna tehnika radioterapije planirana sa CT-MRI fuzijom smanjuje pojavu oralnih komplikacija. Slično razvijenim zemljama, trebalo bi razmotriti uvođenje ove tehnike kao standardnu metodu zračenja bolesnika sa tumorom glave i vrata. Za isporuku vi&scaron;ih tumorskih doza uz manju učestalost komplikacija je podesnija tehnika planiranja sa fuzionisanom tehnikom pomoću MR imidžinga. 2D tehnika radioterapije glave i vrata se preporučuje samo za palijativne zračne tretmane.</p> / <p>Introduction: The incidence of radiation-induced side effects in patients with head and neck cancer (H&amp;N) depends on technique of planning and the irradiation dose as well as primary tumor location within the H&amp;N region. Objective: The aim of our research is to establish the incidence of side effects in patients with head and neck cancer treated with 2D- conventional radiotherapy, 3D-conformal radiotherapy planning with computed tomography (CT) or computed tomography fusion with magnetic resonance imaging (CT-MRI fusion). Methods: Prospective analysis was performed on 90 patients with head and neck carcinoma prospectively followed after radiotherapy. 30 patients with H&amp;N cancer were irradiated by using 2D conventional radiotherapy, other 30 patients irradiated with 3D conformal radiotherapy planning with CT, while other 30 patients were treated using 3D conformal radiotherapy planning with CT-MRI fusion. In all cases standard fractionation was used at 2 Gy per day /5 days a week. Results: Of the total number (n=90) of treated patients, 72 patients (72/90; 64,8%) reported a side effect and the incidence of complications was higher in patients irradiated with 2D technique planning radiotherapy (28/72; 38,9% for 2D RT vs 24/72; 33,3% for 3D CT RT vs 20/72; 27,8% for 3D CT-MRI; p=0,015). Conclusion: 3D radiotherapy technique planned solely on the basis of CT is related to high incidence of toxicity which significantly affects the quality of life of irradiated patients. 3D conformal radiotherapy planned with CT-MRI fusion reduces the incidence of oral complications. Following the example of developed countries, this technique should be considered as a standard method for irradiating patients with head and neck cancer. Planning technique with fusion technique using MR imaging is more suitable for delivering higher doses to the tumor with fewer side effects. Recommendation 2D conventional radiotherapy is more for palliative treatments.</p>