Clin Oncol (R Coll Radiol) 2000;12(6):403-8 
<b>Late radiation side-effects in three patients undergoing parotid irradiation for benign disease.</b> Armour A, Ghanna P, O'Rielly B, Habeshaw T, Symonds P. Beatson Oncology Centre, Western Infirmary, Glasgow, UK. 
We report three patients in whom standard radiation therapy was given and serious late radiation damage was seen. The first patient suffered recurrent parotiditis and a parotid fistula. He was treated initially with 20 Gy in ten fractions via a 300 kV field. Further irradiation was required 1 year later and 40 Gy was given in 2 Gy fractions by an oblique anterior and posterior wedged photon pair. Ten years later he developed localized temporal bone necrosis. The second patient, with pleomorphic salivary adenoma, developed localized temporal bone necrosis 6 years after 60 Gy had been given using standard fractionation and technique. The third patient received 55 Gy in 25 fractions for a pleomorphic salivary adenoma and <b>after 3 years developed temporal bone necrosis. Sixteen years later the same patient developed cerebellar and brainstem necrosis. All patients developed chronic persistent infection during or shortly after the radiation therapy, which increased local tissue sensitivity to late radiation damage. As a result, severe bone, cerebellar and brainstem necrosis was observed at doses that are normally considered safe. We therefore strongly recommend that any infection in a proposed irradiated area should be treated aggressively, with surgical debridement if necessary, before radiotherapy is administered, or that infection developing during or after irradiation is treated promptly.</b> 
&&url PMID: 11202094 


Int J Radiat Oncol Biol Phys 2000 Dec 1;48(5):1311-22 
<b>Final report of a randomized trial on altered-fractionated radiotherapy in nasopharyngeal carcinoma prematurely terminated by significant increase in neurologic complications.</b> 
Teo PM, Leung SF, Chan AT, Leung TW, Choi PH, Kwan WH, Lee WY, Chau RM, Yu PK, Johnson PJ. Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China. teoml@ha.org.hk 
PURPOSE: <b>The aim of the present study was to compare the survival, local control and complications of conventional/accelerated-hyperfractionated radiotherapy and conventional radiotherapy in nonmetastatic nasopharyngeal carcinoma (NPC)</b>. ... Accelerated hyperfractionation when used in conjunction with a two-dimensional radiotherapy planning technique, in this case the Ho's technique, <b>resulted in increased radiation damage to the central nervous system without significant improvement in efficacy.</b> 
&&url PMID: 11121628 


Int J Oral Maxillofac Surg 1999 Feb;28(1):50-2 Comment in: Int J Oral Maxillofac Surg. 2000 Apr;29(2):155 
<b>Cerebral radionecrosis following the treatment of parotid tumours: a case report and review of the literature.</b> 
Coghlan KM, Magennis P. Oral and Maxillofacial Unit, The Royal London Hospital, England. 
Radiotherapy is an accepted part of the treatment of malignant tumours of the parotid gland. ... Radiotherapy to the parotid bed is not without morbidity. Complications may arise as a result of radiation damage to neighbouring structures and there is also potential to induce malignant disease. A patient, whose postoperative radiotherapy following resection of a pleomorphic salivary gland adenoma was complicated by cerebral necrosis, is discussed. The literature pertaining to morbidity of radiotherapy for parotid tumours is reviewed.  
&&url PMID: 10065650 


Ups J Med Sci 1998;103(3):203-11 
<b>Proton irradiation of malignant uveal melanoma. A five year follow-up of patients treated in Uppsala, Sweden.</b> 
Naeser P, Blomquist E, Montelius A, Thoumas KA. Department of Ophthalmology, Uppsala University, Sweden. 
&&url PMID: 10052109 


J Nucl Med 1998 Sep;39(9):1551-4 
<b>Intermediate and long-term side effects of high-dose radioiodine therapy for thyroid carcinoma.</b> 
Alexander C, Bader JB, Schaefer A, Finke C, Kirsch CM. Department of Nuclear Medicine, Saarland University Medical Center, Homburg/Saar, Germany. 

... <b>Severe long-term side effects are rare after high-dose radioiodine treatment. Moderate side effects are common. The side effects are commonly the result of radiation damage to the salivary glands. The frequency of such complaints advocates regular protection of the salivary glands.</b> 
&&url PMID: 9744341 


Neurology 1997 Apr;48(4):1107-9
<b>Post-irradiation neuromyotonia in bilateral facial and trigeminal nerve distribution.</b>
Marti-Fabregas J, Montero J, Lopez-Villegas D, Quer M. 
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Spain. 
We describe a patient with episodic involuntary contraction in the lower facial and masseter muscles, in whom we recorded neuromyotonic discharges. The neuromyotonia was a delayed effect of radiation therapy and responded to carbamazepine therapy. 
&&url PMID: 9109911 


Ear Nose Throat J 1995 Jan;74(1):39-42, 45-8 
<b>Dysphagia in patients with three different etiologies of salivary gland dysfunction.</b> 
Rhodus NL, Moller K, Colby S, Bereuter J. Division of Oral Medicine, Oral Diagnosis & Radiology, School of Dentistry, University of Minnesota, Minneapolis 55455. 
&&url PMID: 7867530 


J Periodontol 1993 Dec;64(12):1253-8 
<b>Severe progressive periodontal destruction due to radiation tissue injury.</b> 
Yusof ZW, Bakri MM. Department of Oral Pathology, Oral Medicine, and Periodontology, Dental Faculty, University of Malaya, Malaysia. 
... Radiation bone injury is a long-term manifestation which could progress to osteoradionecrosis. A case of radiation tissue injury to the periodontium is presented. The possible pathogenesis of these events is described as they relate to the sequential radiographic changes observed over a period of 6 years until the involved teeth were exfoliated. The post-irradiation management of the teeth with advancing periodontal disease in the path of irradiation was by conservative means, including good personal oral hygiene care, scaling and root planing, periodic chlorhexidine irrigation, and topical fluoride application. 
&&url PMID: 8106955

 
Gaoxiong Yi Xue Ke Xue Za Zhi 1993 Jul;9(7):401-9
<b>The effects of radiation therapy on salivary function in patients with head and neck cancer.</b>
Kuo WR, Wu CC, Lian SL, Ching FY, Lee KW, Juan KH. Department of Otolaryngology, Kaohsiung Medical College, Taiwan, Republic of China. 
<b>It is important that the radiation therapist should preserve salivary function whenever possible.</b> 
&&url PMID: 8366544 


Nippon Naibunpi Gakkai Zasshi 1993 Nov 20;69(10):1035-43
<b>[Thyroid and radiation].</b> [Article in Japanese] 
Yamashita S, Namba H, Nagataki S. Department of Cell Physiology, Nagasaki University School of Medicine. 
.... The thyroid is an organ that is usually susceptible to exposure to ionizing radiation, both by virtue of its ability to concentrate radioiodine (internal radiation) and by routine medical examination: Chest X-ray, Dental X-ray, X-irradiation of cervical lymphnodes etc. (external radiation). Iodine-131 is widely used for the therapy of Graves' disease and thyroid cancers, of which the disadvantage is radiation-induced hypothyroidism but not complications of thyroid tumor. The thyroid gland is comparatively radioresistant, however, the data obtained from Hiroshima, Nagasaki and Marshall islands indicates a high incidence of external radiation-induced thyroid tumors as well as hypothyroidism. The different biological effects of internal and external radiation remains to be further clarified. Interestingly, recent reports demonstrate the increased number of thyroid cancer in children around Chernobyl in Belarus. In this review, we would like to introduce the effect of radiation on the thyroid gland at the molecular, cellular and tissue levels. Furthermore the clinical usefulness of iodine-131, including the safety-control for radiation exposure will be discussed. 
&&url PMID: 8282128 


Int J Radiat Oncol Biol Phys 1992;24(2):359-67
<b>A survey of prevention and treatment regimens for oral sequelae resulting from head and neck radiotherapy used in Dutch radiotherapy institutes.</b> 
Jansma J, Vissink A, Bouma J, Vermey A, Panders AK, Gravenmade EJ. Department of Oral and Maxillofacial Surgery, University Hospital Groningen, The Netherlands. 
Radiation treatment plays an important role in the management of head and neck cancer. Unfortunately several radiation-induced side effects may occur including mucositis, hyposalivation, radiation caries, trismus and osteoradionecrosis. <b>It is generally accepted that most side effects can be prevented or reduced in severity.</b> ... and the observation that a rather large number of patients were not referred, or not timely referred to the dental team. There seems to be a need for the development of a general protocol for the prevention of oral complications applicable in all centers. 
&&url PMID: 1526875 


J Am Optom Assoc 1989 Sep;60(9):664-7 
<b>Retinopathy secondary to radiation therapy for squamous cell carcinoma.</b> 
Groomer AE, Gutwein DE. Eye Clinic, VA Medical Center, Huntington, WV 25704. 
This report discusses a case of radiotherapy-induced retinopathy following treatment of squamous cell carcinoma. Treatment of the carcinoma with external beam radiotherapy to the supraorbital region and base of the skull was followed by the onset of retinopathy. The sensory retina, as well as other central nervous system tissues, is highly resistant to radiation damage; however, the retinal vasculature is extremely sensitive to radiation damage, producing a retinopathy that is characteristic of other vascular occlusive diseases. Management is discussed. 
&&url PMID: 2794336 


Med Radiol (Mosk) 1988 Oct;33(10):30-5 
<b>[Local radiation reactions and injuries in neutron and combined therapy of tumors using the U-120 cyclotron].</b> [Article in Russian] 
Musabaeva LI, Lavrenkov KA, Demochko VB, Podoplekin MV, Novikov VA. 
Early local radiation reactions and radiation damage during fast neutron therapy of head and neck tumors were studied. The frequency of moist epidermitis in a radical course of neutron therapy was 33%, that in combined neutron and photon irradiation was 21%. Mucosal reactions were observed in 30-35% of the patients with tumors of the oral mucosa. The most frequent radiation damage in a long-term period were fibrotic changes of the skin and subcutaneous connective tissue. 
&&url PMID: 3185187 


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. 
&&url PMID: 3448028 


Retina 1987 Fall;7(3):142-7 
<b>Retinopathy following radiation therapy of paranasal sinus and nasopharyngeal carcinoma.</b> 
Midena E, Segato T, Piermarocchi S, Corti L, Zorat PL, Moro F.Institute of Ophthalmology, University of Padova, Italy. 
Radiation retinopathy is a complication of the therapeutic irradiation of orbital and periorbital structures. ... This study demonstrates that radiation retinopathy occurs in a significant number of cases when the eye is not totally involved in the irradiation field and shows at least two different clinical aspects in relation to the radiation treatment. It also suggests that portal design and choroidal circulation damage may represent important factors in the development of radiation retinopathy. 
&&url PMID: 3423429 


Clin Endocrinol (Oxf) 1986 Jun;24(6):643-51 
<b>Hypothalamic hypopituitarism following cranial irradiation for nasopharyngeal carcinoma.</b>
Lam KS, Wang C, Yeung RT, Ma JT, Ho JH, Tse VK, Ling N. 
... These data suggest that post-irradiation hypopituitarism in these patients results from radiation damage to the hypothalamus leading to varying degrees of deficiency of the hypothalamic releasing or inhibitory factors. 
&&url PMID: 3098456


Int J Radiat Oncol Biol Phys 1986 Mar;12(3):401-5 
<b>Oral side effects of head and neck irradiation: correlation between clinical manifestations and laboratory data.</b> 
Kuten A, Ben-Aryeh H, Berdicevsky I, Ore L, Szargel R, Gutman D, Robinson E. 
... We found that most of the parotids have to be outside of the treated volume, when the rest of the major salivary glands are irradiated, to prevent severe dryness phenomena. 
&&url PMID: 3957738 


Int J Radiat Oncol Biol Phys 1985 Jul;11(7):1339-47 
<b>Precision, high dose radiotherapy. II. Helium ion treatment of tumors adjacent to critical central nervous system structures.</b> 
Saunders WM, Chen GT, Austin-Seymour M, Castro JR, Collier JM, Gauger G, Gutin P, Phillips TL, Pitluck S, Walton RE, et al. 
In this paper we present a technique for treating relatively small, low grade tumors located very close to critical, radiation sensitive central nervous system structures such as the spinal cord and the brain stem. A beam of helium ions is used to irradiate the tumor. The nearby normal tissues are protected by exploiting the superb dose localization properties of this beam, particularly its well defined and controllable range in tissue, the increased dose deposited near the end of this range (i.e., the Bragg peak), the sharp decrease in dose beyond the Bragg peak, and the sharp penumbra of the beam. To execute this type of treatment, extreme care must be taken in localization of the tumor and normal tissues, as well as in treatment planning and dosimetry, patient immobilization, and verification of treatment delivery. To illustrate the technique, we present a group of 19 patients treated for chordomas, meningiomas and low grade chondrosarcomas in the base of the skull or spinal column. We have been able to deliver high, uniform doses to the target volumes (doses equivalent to 60 to 80 Gy of cobalt-60) while keeping the doses to the nearby critical tissues below the threshold for radiation damage. Follow-up on this group of patients is short, averaging 22 months (2 to 75 months). Currently, 15 patients have local control of their tumor. Two major complications, a spinal cord transection and optic tract damage, are discussed in detail. Our treatment policies have been modified to minimize the risk of these complications in the future, and we are continuing to use this method to treat such patients. We are enthusiastic about this technique, since we believe there is no other potentially curative treatment for these patients. 
&&url PMID: 4008290 


Cancer 1985 Mar 15;55(6):1190-4 
<b>Thyroid dysfunction and neoplasia in children receiving neck irradiation for cancer.</b> 
Fleming ID, Black TL, Thompson EI, Pratt C, Rao B, Hustu O. 
The reported relationship of radiation exposure and thyroid carcinoma stimulated this retrospective study of 298 patients treated at St. Jude Children's Hospital with radiation therapy to the neck for childhood cancer to identify patients who developed subsequent thyroid abnormalities. ... Inclusion in the study required 5 years of disease-free survival following therapy for their original tumor, which included thyroid irradiation. Follow-up has been 100%. Most patients also received chemotherapy. Seventeen patients were found to have decreased thyroid reserve with normal levels of free triiodothyroxine (T3) or free thyroxin, (T4) and an elevated level of thyroid-stimulating hormone (TSH). In nine patients hypothyroidism developed, with decreased T3 or T4 levels and an elevated level of TSH. One hyperthyroid patient was identified. Two patients had thyroiditis, and seven had thyroid neoplasms: (carcinoma in two, adenoma in two, colloid nodule in one, and undiagnosed nodules in two). This survey has demonstrated an increased incidence of thyroid dysfunction and thyroid neoplasia when compared to the general population. <b>The importance of long-term follow-up for thyroid disease is emphasized in patients who have received thyroid irradiation. The possible role of subclinical hypothyroidism with TSH elevation coupled with radiation damage to the thyroid gland as a model for the development of neoplastic disease is discussed.</b> 
&&url PMID: 3855682 


Br J Oral Maxillofac Surg 1984 Apr;22(2):77-86 
<b>A pilot study of the clinical effects of irradiation on the oral tissues.</b> 
Al-Tikriti U, Martin MV, Bramley PA. 
&&url PMID: 6585226 


Ophthalmology 1982 Dec;89(12):1494-501 
<b>Radiation retinopathy.</b> 
Brown GC, Shields JA, Sanborn G, Augsburger JJ, Savino PJ, Schatz NJ. 
The wide spectrum of radiation retinopathic manifestations from local or external beam irradiation is described in 36 eyes. The most commonly encountered ophthalmoscopic signs of retinopathy include retinal hard exudates, hemorrhages, microaneurysms, cotton-wool spots, and telangiectases. The fluorescein angiographic hallmark of radiation-induced retinopathy is retinal capillary nonperfusion, supporting the concept that vascular decompensation is the primary mechanism in the production of radiation damage to the posterior segment. 
&&url PMID: 7162794