Radiother Oncol 2001 Mar;58(3):295-301 
<b>Circulating atrial natriuretic peptide plasma levels as a marker for cardiac damage after radiotherapy.</b> 
Wondergem J, Strootman EG, Frolich M, Leer JW, Noordijk EM. Department of Clinical Chemistry, Leiden University Medical Centre, Leiden, The Netherlands. 
&&url PMID: 11230891 


Radiother Oncol 2001 Mar;58(3):287-94
<b>Left sided vocal cord paralysis: a newly recognized late complication of mediastinal irradiation.</b> 
Johansson S, Lofroth PO, Denekamp J. Department of Radiation Sciences, Translational Research Group, Umea University Hospital, Umea, S-901 85, Sweden. 
...: <b>A left-sided vocal cord paralysis of patients treated with mediastinal radiotherapy might not indicate only tumour recurrence but also mediastinal fibrosis. Small differences in patient positioning cannot be excluded as the cause of the difference in the two series. We postulate that other more subtle damage to the vagus nerve may occur without being recognized as late radiation injury.</b> 
&&url PMID: 11230890 


Catheter Cardiovasc Interv 2001 Feb;52(2):242-8
<b>Post mediastinal radiation coronary artery disease and its effects on arterial conduits.</b> 
Khan MH, Ettinger SM. Section of Cardiology, Penn State University-Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA. 
Therapeutic mediastinal radiation predisposes patients to an increased risk of developing premature coronary artery disease. Other structures surrounding the heart within the radiation field are also susceptible to injury. This case report highlights the importance of recognizing concurrent damage to the internal mammary artery that, in this particular group of patients, may not be the ideal arterial conduit for coronary artery bypass surgery. 
&&url PMID: 11170340


Minerva Cardioangiol 2000 Mar;48(3):79-87
<b>Cardiac damage following therapeutic chest irradiation. Importance, evaluation and treatment.</b> 
Vallebona A. ASL n. 4 Chiavarese, Ospedale di Rapallo, Genova. 
. ... Pericardial disease is the most well known expression of radiation induced heart disease, although the whole cardiac structure is compromised because of the structural and consequently functional impairment. Myocardial damage can lead to a congestive heart failure, typically due to a restrictive cardiomyopathy. Coronary artery obstructive disease frequently involves ostial coronary segments and the left main, for this reason it does appear particularly harmful. <b>All patients undergoing chest irradiation require serial cardiological evaluation.</b> Important risk factors of radiation induced heart disease are previous chemotherapy, radiation exposition exceeding 4000 Rad, administration next to the heart and on the left side of the chest must be taken into particular consideration. <b>The cardiac damage limitation basically is founded on prevention.</b> Significant results have been obtained with fractional exposition, high energy utilization and "split" zone covering. The radiotherapeutic technical improvement with the comprehensive individual patient risk evaluation will provide a substantial benefit for the future. The consultant cardiologist should cooperate with the oncologist and the radiotherapist, providing specific competence and continuative care. 
&&url PMID: 10838837 


Radiographics 2000 Jan-Feb;20(1):67-81 
<b>Unusual radiologic findings in the thorax after radiation therapy.</b> 
Mesurolle B, Qanadli SD, Merad M, Mignon F, Baldeyrou P, Tardivon A, Lacombe P, Vanel D. 
Department of Radiology, Institut Gustave-Roussy, Villejuif, France. 
... Radiation therapy produces dramatic effects in the lung. Pulmonary necrosis is an uncommon, severe, late complication of adjuvant postoperative radiation therapy. Bronchiolitis obliterans with organizing pneumonia is a distinct clinicopathologic entity characterized by patchy, migratory, peripheral air-space infiltrates. Radiation therapy can also cause spontaneous pneumothorax, mesothelioma, and lung cancer. In the mediastinum, radiation therapy may cause thymic cysts, calcified lymph nodes, and esophageal injuries. Cardiovascular complications of radiation therapy are often delayed and insidious. Premature coronary artery stenosis occurs after radiation therapy to the mediastinum. Radiation therapy may also give rise to calcifications of the ascending aorta, pericardial disease, valvular injuries, and conduction abnormalities. Women who undergo thoracic irradiation before the age of 30 years have a high risk of developing a second breast cancer. Radiation-induced sarcomas are an infrequent but well-recognized complication of radiation therapy. Other chest wall injuries due to radiation therapy are osteochondroma and rib or clavicle fractures. Knowledge of the imaging features of injuries caused by radiation therapy can prevent misinterpretation as recurrent tumor and may facilitate further treatment. 
&&url PMID: 10682772 


Radiographics 2000 Jan-Feb;20(1):83-98 
<b>Radiation-induced lung disease and the impact of radiation methods on imaging features.</b> 
Park KJ, Chung JY, Chun MS, Suh JH. Department of Radiology, Ajou University Medical Center, Paldal, Suwon, South Korea. 
... Irradiation with oblique beam angles results in unusual distribution of radiation-induced lung disease. ... use of tangential beam portals may induce radiation pneumonitis or fibrosis at the peripheral ... portals may produce lesions in the lung apex that appear similar to pulmonary tuberculosis...s. CT is more sensitive to radiation-induced lung disease than chest radiography and demonstrates related changes earlier. Furthermore, it more clearly depicts the precise distribution and pattern of disease. Familiarity with the imaging findings in radiation-induced lung disease produced by different radiation methods will help radiologists interpret abnormalities seen at chest radiography and CT in affected patients. Publication Types: Review Review, tutorial 
&&url PMID: 10682774 


Dig Surg 1998;15(3):224-6 
<b>Salvage esophagectomy after unsuccessful curative chemoradiotherapy for squamous cell cancer of the esophagus.</b> 
Meunier B, Raoul J, Le Prise E, Lakehal M, Launois B. Department of Digestive Surgery and Transplantation, Centre Hospitalier Universitaire Rennes, France. 
Surgery was performed on 6 patients after unsuccessful chemoradiotherapy for squamous cell cancer of the esophagus. <b>The operation was very difficult due to post-irradiation sequelae in 5....</b> 
&&url PMID: 9845589 


Nihon Kokyuki Gakkai Zasshi 1999 Feb;37(2):97-101
<b>[Quantitative analysis of pulmonary functional damage due to heavy ion particle irradiation therapy for lung cancer].</b> [Article in Japanese] 
Homma T, Ohtsu I, Tomioka S, Inoue M, Hasegawa S, Miyamoto T. Division of Respiratory Disease, University of Tsukuba, Ibaraki, Japan. 
Seventeen patients with clinical stage I lung cancer were given irradiation therapy with heavy ion radioactive rays at 73.1 +/- 11.2 GyE. Lung injury due to irradiation was evaluated by measuring routing parameters of pulmonary function. No statistically significant changes in these parameters were observed after irradiation, even in patients followed up for a period of 1 year. Chest X-ray examinations, including CT scan images, disclosed the development of nonsegmental consolidations in the irradiated areas, changing into minor fibrosis 1 year later. We concluded that heavy ion particle irradiation has minimal impact on pulmonary function, and is of therapeutic valve to elderly patients and patients with complications. 
&&url PMID: 10214036 


Respiration 1996;63(3):187-90Related 
<b>Bilateral diaphragmatic paralysis after mediastinal radiotherapy.</b> 
De Vito EL, Quadrelli SA, Montiel GC, Roncoroni AJ. Instituto de Investigaciones Medicas Alfredo Lanari, Universidad de Buenos Aires, Argentina. 
... <b>Radiation-induced neuropathy is well documented in other nerves as the brachial plexus.</b> The timing, the applied dose and the location of the nerve within the radiation field are suggestive of radiation-induced phrenic nerve damage. Partial recovery was achieved after 4 years' follow-up. 
&&url PMID: 8739491  


G Chir 1996 Jan-Feb;17(1-2):37-42 
<b>[Late radiation-induced injuries: breast carcinoma in post-actinic ulceration of the thoracic-breast region with infected osteoradionecrosis. A case report].</b> [Article in Italian] Sironi I, Crespi AM, Magnoni E, Mattioli M, Rossi R, Vai S, Russo A. Prima Divisione Chirurgia Generale Pizzamiglio, Ospedale Niguarda Ca' Granda, Milano. 

Severe skin reactions are commonly observed after breast irradiation. Chronic ulcerations, soft tissue damage and osteonecrosis are well-known though relatively rare long-term radiation-induced injuries. The ever-present possibility of recurrence or persistence of the primary malignant neoplasm within the irradiated tissue must be always suspected and adequately established by multiple biopsies before planning an eventual resective and or reconstructive strategy. In the present report a neoplastic recurrence arised from an extensive radiation-induced ulceration along the parasternal area with chest wall osteonecrosis complicated by infection ... 
&&url PMID: 8679412 


Gastrointest Endosc 1995 Feb;41(2):109-14 
<b>Assessment of sucralfate coating by sequential scintigraphic imaging in radiation-induced esophageal lesions.</b> 
Taal BG, Vales Olmos RA, Boot H, Hoefnagel CA. Department of Gastro-enterology and Nuclear Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoekhuis, Amsterdam. 
The value of mucosal protection with sucralfate in cases of gastric ulceration is well documented. <b>Although sucralfate is advocated as treatment of esophageal lesions, we found it to be of limited value in the management of radiation-induced esophagitis; .. These findings suggest that the inability of sucralfate to alleviate irradiation-induced odynophagia may be related to insufficient duration of adherence of this compound to damaged esophageal mucosa.</b> 
&&url PMID: 7720996 


Vopr Kurortol Fizioter Lech Fiz Kult 1995 Jan-Feb;(1):27-9
<b>[The rehabilitation of patients with secondary (radiation) injuries to the brachial plexus].</b> [Article in Russian] 
Bardychev MS, Pasov VV. 
A close control is needed over large nerve trunks and plexuses in the course of their area radiation in cancer patients to prevent radiation damage to peripheral nervous system. Rehabilitation of patients with radiation-induced plexitis and neuritis urges early diagnosis and treatment as essential conditions for adequate recovery of the limb function. Diagnosis of radiation damage to peripheral nervous system should rest on clinical electrophysiological findings defining the degree of the nerve fiber injury and predict treatment outcomes. 
&&url PMID: 7785217 


G Ital Cardiol 1994 Jul;24(7):817-23
<b>[Radiation-induced constrictive pericarditis. Associated cardiac lesions, therapy and follow-up].</b> [Article in Italian] 
Orzan F, Brusca A. Istituto di Medicina e Chirurgia Cardiovascolare, Universita di Torino. 
... Radiation therapy of the chest and mediastinum can damage all cardiac structures, the pericardium being the most frequently involved one. It is little appreciated, however, that radiation-induced constrictive pericarditis can be associated with significant involvement of coronary arteries, myocardium and valves. ... Retrospective evaluation of ... 8 patients, who had received 30-50 Gy to the chest ...7-23 years before the diagnosis of constrictive pericarditis. 
Six patients had symptoms related to the pericardial disease, one had angina and syncope, one was in congestive heart failure. ... All patients had mitral regurgitation, 5 had also tricuspid insufficiency and 5 had aortic regurgitation. The degree of the valvular regurgitation was > or = 3+ in four instances. Critical coronary arterial stenoses were discovered in 3 cases. The coronary ostia were involved in 5 cases (2 critical, 3 non critical). A diagnosis of restrictive cardiomyopathy was arrived at in 4 instances, always after pericardiectomy. Seven patients were operated on.... One patient died at surgery, two died 16 and 72 months thereafter. The remaining 5 have mild symptoms 11-60 months (mean 29) after the discharge from the hospital.
<b>Radiation-induced pericardial constriction is frequently associated with coronary artery disease, mostly silent, with valvular insufficiency, and with myocardial disease. Thorough cardiac evaluation in such patients is mandatory. Surgical treatment frequently uncovers an underlying restrictive myopathy that presents a serious diagnostic and therapeutic challenge.</b> 
&&url PMID: 7926379  


Dig Dis Sci 1994 Mar;39(3):655-60 
<b>Morphology and pathology of radiation-induced esophagitis. Double-blind study of naproxen vs placebo for prevention of radiation injury.</b> 
Soffer EE, Mitros F, Doornbos JF, Friedland J, Launspach J, Summers RW. Department of Medicine, University of Iowa Hospitals, Iowa City 52242. 
...<b>We conclude that acute radiation injury to the esophagus is observed in approximately half the patients receiving radiation therapy and can result in substantial morbidity.</b>  
&&url PMID: 8131705 


Cardiologia 1993 Mar;38(3):163-72 
[Cardiopathy due to therapeutic irradiation of the thorax. The diagnostic criteria]. [Article in Italian] 
Brusca A, Orzan F, Figliomeni MC. Istituto di Medicina e Chirurgia Cardiovascolare, Universita degli Studi, Torino. 
.... ... was established that radiation therapy was the cause of the cardiac problems in 19 cases: 4 with ischaemic symptoms, 8 with pericardial disease, 4 with complete atrioventricular block, and 3 with valvular disease and congestive heart failure. Coronary ostial lesions were found in all patients with angina, and in 8 of the 14 patients without angina (in 1 the coronary arteries were not investigated), and were critical in 4. .. 
&&url PMID: 8339305 


Br Heart J 1993 Jun;69(6):496-500
<b>Severe coronary artery disease after radiation therapy of the chest and mediastinum: clinical presentation and treatment.</b> 
Orzan F, Brusca A, Conte MR, Presbitero P, Figliomeni MC. Istituto di Medicina e Chirurgia Cardiovascolare, Universita degli Studi di Torino, Italy. 
...Coronary arterial disease can be reasonably ascribed to the effects of chest irradiation when the patients are young and free from risk factors, especially if the obstructions are ostial and there is important damage to other cardiac structures. In patients with damage to other cardiac structures angina and infarction are often absent and coronary angiography seems to be mandatory. Patients often require surgical treatment and postoperative complications are common. 
&&url PMID: 8343315 


Postgrad Med 1992 Feb 1;91(2):211-5
<b>Heart disease after mediastinal radiotherapy.</b> 
Arsenian MA. Cape Ann Medical Center, Gloucester, Massachusetts. 
The greatest risk for most cancer patients is inadequate treatment of their disease. Although mediastinal radiotherapy is a safer procedure than it was 20 years ago, it still may damage the thoracic viscera, including the heart. Cardiovascular problems tend to present subtly years later, when the patient may not recall the prior radiation or may not deem it significant. An awareness of this long latency period and of the wide spectrum of heart disease that may result from radiotherapy is essential for management of these patients. 
&&url PMID: 1738741 


Int J Radiat Oncol Biol Phys 1992;22(5):887-96 Comment in: Int J Radiat Oncol Biol Phys. 1992;22(5):1157-8 
<b>Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer.</b> Rutqvist LE, Lax I, Fornander T, Johansson H. Radiumhemmet, Karolinska Hospital, Stockholm, Sweden. 
One concern with adjuvant radiation therapy for early breast cancer is the potential risk of increasing intercurrent mortality due to radiation-induced damage of the myocardium. The paper presents an analysis of long-term survival among 960 patients with primary breast cancer included in a randomized trial of pre- or postoperative radiation therapy (45 Gy/5 weeks) versus surgery alone. All patients were treated with a modified radical mastectomy. The mean follow-up was 16 years (range: 13-19 years). During the entire follow-up period there was an overall survival difference in favor of the irradiated patients that was of borderline significance (p = 0.09). There was no increase in intercurrent mortality due to any cause. <b>However, when the results were analyzed according to estimated doses of radiation to the myocardium, the subset of patients who received the highest doses, that is, those treated with tangential 60Co fields for left-sided tumors, were found to have a significantly increased risk of death due to ischemic heart disease compared to the surgical controls (relative hazard: 3.2, p less than 0.05).</b> No such increase was observed among the patients who received less radiation to the myocardium, that is, whose chest wall and internal mammary nodes were treated with electrons or those with right-sided tumors, irrespective of the treatment technique. <b>It is concluded that cardiovascular mortality associated with radiation therapy for early breast cancer is correlated with the biological dose of radiation to the heart and the irradiated volume. All of the following factors are thus important: laterality of the tumor, portal arrangements, radiation energy, fractionation, and total dose. The study illustrates that an increased cardiovascular mortality can be avoided by the use of appropriate techniques and avoidance of excessive treatment.</b> Publication Types: Clinical trial Randomized controlled trial 
&&url PMID: 1555981   


Ann Chir 1992;46(8):725-31Related Articles, Books, LinkOut
<b>[Radiation-induced sternal tumors: value of myocutaneous flap of the latissimus dorsi].</b> [Article in French] 
Riquet M, Bellamy J, Houel R, de Gramont A, Zittoun R, Debesse B. Service de Chirurgie Thoracique, Hopital Laennec, Paris. 
Two patients treated by radiotherapy, one 13 years previously for Hodgkin's thymoma and the other 10 years previously for breast cancer, presented with a radiation-induced sternal tumour. ... These tumours are rare, but the radiation-induced skin damage requires wide excision.... 
&&url PMID: 1285612 


Pediatr Hematol Oncol 1991 Apr-Jun;8(2):187-92 
<b>Dactinomycin potentiation of radiation pneumonitis: a forgotten interaction.</b> 
Cohen IJ, Loven D, Schoenfeld T, Sandbank J, Kaplinsky C, Yaniv Y, Jaber L, Zaizov R. Sambur Center for Pediatric Hematology/Oncology, Beilinson Medical Center, Petah Tiqva, Israel. 
<b>No mention of dactinomycin potentiation of pulmonary radiation was found in a review of the literature of the past 12 years. Before that, this complication was well described and investigators had calculated that dactinomycin increased the toxic effect of lung radiation by a factor of 1.3 and reduced the radiation tolerance of the lung by at least 20%.</b> An example of such a toxic effect is described in the treatment of a 7-year-old girl with lung metastases from Ewing's sarcoma. The chemotherapy protocol followed contained cyclophosphamide, vincristine, dactinomycin, adriamycin, cisplatinum, VP16, and radiotherapy. The treatment was associated with fatal pulmonary fibrosis following the reintroduction of dactinomycin after radiotherapy. Our experience suggests that there is clinical significance to this complication in sarcoma therapy when dactinomycin-containing protocols are used with radiation in the treatment of pulmonary metastases. 
&&url PMID: 1863544


Ned Tijdschr Geneeskd 1991 Jul 27;135(30):1363-6 
<b>[Radiation injury presenting as tumor recurrence following irradiation for non-small-cell bronchus carcinoma].</b> [Article in Dutch] 
van der Planken HJ, Njo KH, Karim AB. Academisch Ziekenhuis Vrije Universiteit, afd. Radiotherapie, Amsterdam. 
Case records of two irradiated patients, each with an inoperable non-small cell carcinoma of the bronchus, are presented. After an initial period of 1.3 and 2.3 years, respectively, of regression of the tumour ...[there occurred] severe pain due to multiple rib fractures in one and a superior vena cava syndrome in the other, suggestive of tumour regrowth. Careful comparison of results of all radiographic images and radiotherapy data suggested osteoradionecrosis as the cause of the rib fractures in one patient. The long time interval and the stabilization of the symptoms in the other made tumour regrowth unlikely. The so-called late tissue reaction after radiotherapy as a possible cause of symptoms in both patients is discussed. 
&&url PMID: 1650923  


Eur J Surg Oncol 1990 Oct;16(5):430-5 
<b>Radiation therapy for locally advanced breast cancer: prognostic factors and complication rate.</b> 
Weshler Z, Brufman G, Sulkes A, Warner-Efraty E, Ben-Baruch N, Biran S, Fuks Z. Department of Radiation and Clinical Oncology, Hadassah University Hospital, Jerusalem, Israel. 
A retrospective analysis was carried out in 100 patients with locally advanced breast cancer without distant metastases treated by radiotherapy between 1960 and 1979. The primary tumor was irradiated to a total dose of 60 Gy in 76 patients and to doses ranging between 60 and 80 Gy in 24 patients. The regional lymphatics were treated with doses between 50 and 60 Gy. Following radiotherapy, chemotherapy was administered to 58 patients and hormonal therapy to 29, while 13 patients received no further therapy. Locoregional recurrences were documented in 29% and distant metastases in 49% of patients. The actuarial survival was 56% at 5 years, 21% at 10 years and 14% at 15 years. At 10 years 90% of the surviving patients had some degree of radiation damage. 
&&url PMID: 2209839 


Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1990 Jun;152(6):662-6 
<b>[Plexus neuropathy: tumor infiltration or radiation damage].</b> [Article in German] 
Ebner I, Anderl H, Mikuz G, Frommhold H. Universitatsklinik fur Strahlentherapie, Innsbruck. 
Plexus neuropathies often occur in patients with breast cancer after varying periods following surgery and postoperative radiotherapy. In most cases this has been ascribed to radiation fibrosis. The attempt to arrive at a clinical diagnosis fails because of the similarity of symptoms in both cases namely pain and the absence of motoric and sensory reflexes. But a clear diagnosis is of fundamental importance for further treatment. Only a surgical intervention can verify the diagnosis. In this study, the results of operative findings are presented and compared with a second group of patients who had died of breast cancer having undergone surgery and radiotherapy. The findings brought a surprising fact to light: a considerably high percentage of all patients suffered from large scale tumour infiltration in the plexus. The morphology and histopathology of these lesions are described. Possible explanations are given for the difference in lesion patterns, so that a clinical diagnosis might be derived therefrom. 
&&url PMID: 2163070 


Rev Pneumol Clin 1989;45(2):86-9
<b>[Aspergillosis and radiation-induced pneumonia. What relationship? Apropos of 2 cases].</b>[Article in French] 
Bellamy J, Broquie G, Leroy-Terquem E, Verdoux P. Centre chirurgical Val d'Or-Saint-Cloud. 
The authors report the cases of 2 patients who underwent lobectomy followed by irradiation for lung cancer and subsequently developed an aspergillus-infected cavity in the irradiated lung parenchyma. It is far from certain that aspergillosis must always develop in a pre-existing cavity. In cases where it developed on post-radiotherapy lung lesions, our 2 patients and a review of the literature encline us to believe that the fungus itself is responsible for the formation of cavities in lesions of radiation pneumonia. Treatment of such disease can only be surgical, and in spite of post-irradiation and post-surgery sclerosis, elective excision of the lesions is the best solution. 
&&url PMID: 2799225


Can Assoc Radiol J 1987 Mar;38(1):27-31
<b>Pulmonary complications of multimodality therapy for esophageal carcinoma.</b> 
Duprat G Jr, Chalaoui J, Sylvestre J, Robidoux A, Duranceau A.   
&&url PMID: 2438284 


Int J Radiat Oncol Biol Phys 1987 Feb;13(2):179-88
<b>Acute radiation-induced pulmonary damage: a clinical study on the response to fractionated radiation therapy.</b> 
Mah K, Van Dyk J, Keane T, Poon PY. 
Acute radiation-induced pulmonary damage can be a significant cause of morbidity in radiation therapy of the thorax. A prospective, clinical study was conducted to obtain dose-response data on acute pulmonary damage caused by fractionated radiation therapy. ... Over the linear portion of the dose-response curve, a 5% increase in ED (or total dose if N and T remain constant), predicts a 12% increase in the incidence of acute radiation-induced pulmonary damage. 
&&url PMID: 3818385 


Int J Tissue React 1987;9(6):509-13
<b>Proposed evaluation scale for damage to healthy tissues as a result of radiotherapy of chest, head and neck cancers.</b> 
Stucchi F, Bertoni F, Bignardi M, Ciottoli GB, Bardelli D. Department of Radiotherapy, Regional Hospital, Varese, Italy. 
The authors present, as a criterion of side-effect damage, an evaluation scheme based on the qualitative grading of the acute, intermediate and late effects of the therapeutic irradiation of chest, head and neck cancers. The choice of individual qualitative clinical criteria is complex and arbitrary, although the parameters used are currently found in the literature on radiotherapy. Nevertheless the classifications they have proposed, applied clinically in cases of head and neck cancers, have proved useful in assessing the risk factors of acute and late radiation effects according to the doses delivered. The gradings here described constitute a useful tool for the preliminary assessment of radiation damage and will facilitate the comparative analysis of different case series. 
&&url PMID: 3448028 


J Comput Assist Tomogr 1986 Sep-Oct;10(5):736-43 
<b>Assessment of acute radiation-induced pulmonary changes using computed tomography.</b> 
Mah K, Poon PY, Van Dyk J, Keane T, Majesky IF, Rideout DF. 
... CT scans of 54 patients were performed before and at preselected times during the 6 months following fractionated radiation therapy of the thorax. ... 36 patients were scored as having postirradiation pulmonary findings. ... All 36 patients demonstrated lung opacities in an irregular, homogeneous, or nonhomogeneous pattern within the radiation beam boundaries. In addition, the following characteristics were observed at various frequencies in these 36 patients: extension of the changes across anatomic tissue boundaries (50%), air bronchograms (25%), loss of lung volume (15%), and pleural thickening (15%). Confinement of the findings within the irradiated volume was the only specific characteristic of postirradiation changes. ... 
&&url PMID: 3745541 


Int J Radiat Oncol Biol Phys 1985 Jun;11(6):1127-36
<b>Influence of thorax irradiation on the survival of mice with spontaneous or artificial lung metastases from a transplantable mammary adenocarcinoma.</b> 
Wondergem J, Haveman J, van der Schueren E. 
The effect of thorax irradiation on lung metastases...was studied. Increasing the interval between the moment at which lung metastases are supposed to originate and the thorax irradiation resulted in a rapid decrease of the effectiveness of this treatment in preventing the development of lung metastases. Early treatment of the mice not only resulted in a considerable number of animals that were cured, but also in a significant decrease in the number of tumor localizations in the lung of those animals still developing metastases. Thorax irradiation performed later was much less effective; at autopsy the lung showed a large number of small metastases. Increasing the radiation dose led to an increased number of cures; however, an increased number of mice dying of lethal lung damage was also observed. ... 
&&url PMID: 3997595   


Gan No Rinsho 1984 Jul;30(9 Suppl):1225-30
<b>[Complication of radiation therapy].</b> [Article in Japanese] 
Imajo Y, Suematsu T, Narabayashi I, Gose K, Takimoto S, Kimura S, Matsuura S. 
The radiation pneumonitis is a major complication for patients receiving thoracic irradiation. This report describe the radiographic recognition, pathological change and impaired pulmonary functions of radiation pneumonitis. The 57 patients with lung cancer treated with radiation are analyzed on the pneumonitis by chest X-P. Among these, 50 patients (88%) develop radiation pneumonitis. Repeated CT scans give more detailed information than conventional radiograms as to exudative changes. The pathological analysis are made on the 35 patients of which affected lungs are resected after pre-operative irradiation. Three phases are recognized in the evolution of pneumonitis, the congestive, the degenerative, and the fibrotic. Adding to the morphological damage, pulmonary functions also deteriorate both in ventilation and perfusion scans. 
&&url PMID: 6471424 


Cancer 1984 Dec 1;54(11):2319-23
<b>Late effects of adjuvant radiotherapy for breast cancer.</b> 
Ferguson DJ, Sutton HG Jr, Dawson PJ. 
Complications requiring in-hospital treatment were observed in 24 of 221 consecutively treated patients (11%) who were followed from 8 to 42 years after postmastectomy irradiation. There were four sarcomas of the treated chest wall, three squamous carcinomas (two in the esophagus), two angiosarcomas of the swollen homolateral arm, nine chronic ulcers, five respiratory insufficiencies, six pathologic fractures of the radiated shoulder or ribs, two fatal cardiomyopathies, one persisting leukopenia with fatal brain abscess, and one severe neurovascular impairment of the arm. In a comparable group of 394 consecutive postmastectomy patients who were not irradiated, one similar event, a myxosarcoma of an unswollen arm, was observed. Only long-term follow-up can determine the ultimate risks of radiotherapy. 
&&url PMID: 6498728 


Ann Cardiol Angeiol (Paris) 1983 Nov;32(7):465-72 
<b>[Cardiac complications of radiotherapy].</b> [Article in French] 
Vacheron A, Heulin A, Metzger JP, Baubion N, Le Pailleur C, Delage F, Gilles R, Laugier A, Schlienger M, Delaby F. 
...
 radiotherapy also carries a risk of severe cardiac complications. ... Ionizing radiation can damage the three layers of the heart and the coronary arteries. Pericardial involvement is the most frequent, occurring in 10 to 12 per cent of cases. It generally occurs 6 to 18 months after the radiotherapy and may present either acutely (35 per cent of cases) or chronically (65 per cent of cases). It is often latent, only detected on X-rays or on ultrasound. Constrictive forms can occur, which require pericardiectomy. Myocardial fibrosis, which is anatomically common, may present as disturbances of repolarization, arrhythmia or disturbances of conduction, or even cardiac failure. Rarely, radiation damage of the coronary arteries can cause angina or myocardial infarction. These cases can benefit from coronary artery by-pass grafts. All of these lesions have a common anatomical denominator: fibrosis, which develops progressively following the radiotherapy. It has now been demonstrated that the incidence of cardiac radiation lesions can be reduced by homogeneous distribution of the dose of radiation administered to the mediastinum, by treating each side alternately, by fractionating the radiation and staggering the sessions and by reducing the cardiac mass which is irradiated. 
&&url PMID: 6660823


Radiology 1983 Jul;148(1):257-8 
<b>Pacemaker failure resulting from radiation damage.</b> 
Quertermous T, Megahy MS, Das Gupta DS, Griem ML. 
The authors present a case of radiation-induced pacemaker failure. After 2,000 rad (20 Gy) of photon irradiation for metastatic bronchogenic carcinoma, the pulse generator circuitry failed, producing a "runaway" rhythm. This suggests that present pacemaker circuitry may be more susceptible to irradiation than previously believed, and that even modest radiation doses can induce life-threatening arrhythmias. 
&&url PMID: 6856846 


Klin Monatsbl Augenheilkd 1983 Jun;182(6):560-4 
Cancer Treat Rep 1983 Dec;67(12):1099-103
<b>Heart size and function after radiation therapy to the mediastinum in patients with Hodgkin's disease.</b> 
Gomez GA, Park JJ, Panahon AM, Parthasarathy KL, Pearce J, Reese P, Bakshi S, Henderson ES. 

... A significantly higher proportion of patients who had received RT to the mediastinum had a decrease in transverse heart diameter and cardiothoracic ratio. ...t our findings indicate a subclinical cardiomyopathy in more than one-half of the patients who received RT to the mediastinum, suggesting that the incidence of heart damage after mediastinal RT might be higher than expected. Prospective studies are necessary to elucidate the incidence and implications of this potentially serious complication. 
&&url PMID: 6652627 


Invest Radiol 1977 May-Jun;12(3):224-37
<b>Regional and total lung function in patients following pulmonary irradiation.</b> 
Prato FS, Kurdyak R, Saibil EA, Rider WD, Aspin N. 
Regional and total lung function measurements and chest radiographs were obtained from 18 patients with cancer of the breast from 3 months to 6.7 years after the start of treatment. A control group of 20 patients was studied before radiotherapy but after mastectomy. <b>The functional parameter most affected by radiation was blood flow. In some cases in which the radiographic changes were mild the functional measurements indicated severe vascular damage. The radiation appears to reduce the number and efficiency of functioning lung units within the irradiated region.</b> 
&&url PMID: 863626 


Med Klin 1975 Feb 28;70(9):385-91
<b>[Radiation late damage of the thoracic marrow after irradiation in the thoracic region (author's transl)].</b> [Article in German] 
Busse O, Wieland C, Egge M. 
A report is given about radiation late damage on the thoracic marrow, basing on the case histories of 100 patients irradiated in the mediastinal region with telegamma from a 60 Cobalt or 137 Caesium source between 1959, January 1st and 1972, december 31st. 77 patients were followed up during 18 months after the radiotherapy was ended; in 3 of them (equal to 4 p.c.) a radiation-induced myelopathy was found. These 3 cases were suffering from Hodgkin's disease, whereas in none of the patients with bronchial carcinoma--in spite of markedly higher radiation doses--any late damage was observed. Therefore, in irradiation of the mediastinal region, the exposure of the spinal marrow should be reduced, although the dose alone is not decisive for the development of a radiation myelopathy. 
&&url PMID: 1124051