Management of radiation wounds

 

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ABSTRACT

Radiotherapy forms an integral part in cancer treatment today. It is used alone or in combination with surgery and chemotherapy. Although radiotherapy is useful to effect tumour death, it also exerts a deleterious effect on surrounding normal tissues. These effects are either acute or can manifest months or years after the treatment. The chronic wounds are a result of impaired wound healing. This impairment results in fibrosis, nonhealing ulcers, lymphoedema and radionecrosis amongst others. This article will discuss the pathophysiology in brief, along with the manifestations of radiation-induced injury and the treatment available currently

• 1 Dormand EL, Banwell PE, Goodacre TE. Radiotherapy and wound healing. Int Wound J 2005;2:112-27.
• 2 Gieringer M, Gosepath J, Naim R. Radiotherapy and wound healing: Principles, management and prospects. Oncol Rep 2011;26:299-307.
• 3 O′Sullivan B, Rumble RB, Warde P; Members of the IMRT Indications Expert Panel. Intensity-modulated Radiotherapy in the Treatment of Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2012;24:474-87.
• 4 Sciubba JJ, Goldenberg D. Oral complications of radiotherapy. Lancet Oncol 2006;7:175-83. Review.
• 5 Basu T, Laskar SG, Gupta T, Budrukkar A, Murthy V, Agarwal JP. Toxicity with radiotherapy for oral cancers and its management: A practical approach. J Cancer Res Ther 2012;8(Suppl 1):S72-84.
• 6 Reinke JM, Sorg H. Wound Repair and Regeneration. Eur Surg Res 2012;49:35-43.
• 7 Tibbs MK. Wound healing following radiation therapy: A review. Radiother Oncol 1997;42:99-106.
• 8 Lyons A, Ghazali N. Osteoradionecrosis of the jaws: Current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 2008;46:653-60.
• 9 Wang J, Boerma M, Fu Q, Hauer-Jensen M. Radiation responses in skin and connective tissues: Effect on wound healing and surgical outcome. Hernia 2006;10:502-6.
• 10 Sullivan MC, Roman SA, Sosa JA. Emergency surgery in patients who have undergone recent radiotherapy is associated with increased complications and mortality: Review of 536 patients. World J Surg 2012; 36:31-8.
• 11 Kunisada T, Ngan SY, Powell G, Choong PF. Wound complications following pre-operative radiotherapy for soft tissue sarcoma . Eur J Surg Oncol 2002;28:75-9.
• 12 Javaid M, Song F, Leinster S, Dickson MG, James NK. Radiation effects on the cosmetic outcomes of immediate and delayed autologous breast reconstruction: An argument about timing. J Plast Reconstr Aesthet Surg 2006;59:16-26.
• 13 Emerick KS, Tomycz L, Bradford CR, Lyden TH, Chepeha DB, Wolf GT, et al. Primary versus secondary tracheoesophageal puncture in salvage total laryngectomy following chemoradiation. Otolaryngol Head Neck Surg 2009;140:386-90.
• 14 Ganly I, Patel S, Matsuo J, Singh B, Kraus D, Boyle J, et al. Postoperative complications of salvage total laryngectomy. Cancer 2005;103:2073-81.
• 15 Redaelli de Zinis LO, Ferrari L, Tomenzoli D, Premoli G, Parrinello G, Nicolai P. Postlaryngectomy pharyngocutaneous fistula: Incidence, predisposing factors, and therapy. Head Neck 1999;21:131-8.
• 16 Magdy EA. Surgical closure of postlaryngectomy pharyngocutaneous fistula: A defect based approach. Eur Arch Otorhinolaryngol 2008;265:97-104.
• 17 Delanian S, Porcher R, Balla-Mekias S, Lefaix JL. Randomized, placebo-controlled trial of combined pentoxifylline and tocopherol for regression of superficial radiation-induced fibrosis. J Clin Oncol 2003;21:2545-50.
• 18 Hutcheson KA, Lewin JS. Functional outcomes after chemoradiotherapy of laryngeal and pharyngeal cancers. Curr Oncol Rep 2012;14:158-65.
• 19 Aygenc E, Celikkanat S, Kaymakci M, Aksaray F, Ozdem C. Prophylactic effect of pentoxifylline on radiotherapy complications: A clinical study. Otolaryngol Head Neck Surg 2004;130:351-6.
• 20 Støre G, Boysen M. Mandibular osteoradionecrosis: Clinical behaviour and diagnostic aspects. Clin Otolaryngol Allied Sci 2000;25:378-84.
• 21 Beumer J, Harrison R, Sanders B, Kurrasch M. Osteoradionecrosis: Predisposing factors and outcomes of therapy. Head Neck Surg 1984;6:819-27.
• 22 Epstein JB, Rea G, Wong FL, Spinelli J, Stevenson-Moore P. Osteonecrosis: Study of the relationship of dental extractions in patients receiving radiotherapy. Head Neck Surg 1987;10:48-54.
• 23 Delanian S, Depondt J, Lefaix JL. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: A phase II trial. Head Neck 2005;27:114-23.
• 24 Chang EI, Leon P, Hoffman WY, Schmidt BL. Quality of life for patients requiring surgical resection and reconstruction for mandibular osteoradionecrosis: 10-year experience at the University of California San Francisco. Head Neck 2012;34:207-12.
• 25 Baumann DP, Yu P, Hanasono MM, Skoracki RJ. Free flap reconstruction of osteoradionecrosis of the mandible: A 10-year review and defect classification. Head Neck 2011;33:800-7.
• 26 McGuirt WF. Laryngeal radionecrosis versus recurrent cancer. Otolaryngol Clin North Am 1997;30:243-50.
• 27 Skoracki RJ, Chang DW. Reconstruction of the chest wall and thorax. J Surg Oncol 2006;94:455-65.
• 28 Schierle C, Winograd JM. Radiation-induced brachial plexopathy: Review. Complication without a cure. J Reconstr Microsurg 2004;20:149-52.
• 29 Gosk J, Rutowski R, Reichert P, Rabczyñski J. Radiation-induced brachial plexus neuropathy - aetiopathogenesis, risk factors, differential diagnostics, symptoms and treatment. Folia Neuropathol 2007;45:26-30.
• 30 Bajrovic A, Rades D, Fehlauer F, Tribius S, Hoeller U, Rudat V, et al. Is there a life-long risk of brachial plexopathy after radiotherapy of supraclavicular lymph nodes in breast cancer patients? Radiother Oncol 2004;71:297-301.
• 31 Ga³ecki J, Hicer-Grzenkowicz J, Grudzieñ-Kowalska M, Michalska T, Za³ucki W. Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer--a review. Acta Oncol 2006;45:280-4.
• 32 Pritchard J, Anand P, Broome J, Davis C, Gothard L, Hall E, et al. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiother Oncol 2001;58:279-86.
• 33 Delanian S, Lefaix JL, Maisonobe T, Salachas F, Pradat PF. Significant clinical improvement in radiation-induced lumbosacral polyradiculopathy by a treatment combining pentoxifylline, tocopherol, and clodronate (Pentoclo). J Neurol Sci 2008;275:164-6.
• 34 Wong M, Tang AL, Umapathi T. Partial ulnar nerve transfer to the nerve to the biceps for the treatment of brachial plexopathy in metastatic breast carcinoma: Case report. J Hand Surg Am 2009;34:79-82.
• 35 Tung TH, Liu DZ, Mackinnon SE. Nerve transfer for elbow flexion in radiation-induced brachial plexopathy: A case report. Hand (N Y) 2009;4:123-8.
• 36 Avraham T, Yan A, Zampell JC, Daluvoy SV, Haimovitz-Friedman A, Cordeiro AP, et al. Radiation therapy causes loss of dermal lymphatic vessels and interferes with lymphatic function by TGF-beta1-mediated tissue fibrosis. Am J Physiol Cell Physiol 2010;299:C589-605.
• 37 Avraham T, Daluvoy S, Zampell J, Yan A, Haviv YS, Rockson SG, et al. Blockade of transforming growth factor-beta1 accelerates lymphatic regeneration during wound repair. Am J Pathol 2010;177:3202-14.
• 38 Anscher MS. Targeting the TGF-beta1 pathway to prevent normal tissue injury after cancer therapy. Oncologist 2010;15:350-9.
• 39 Bruns F, Micke O, Bremer M Current status of selenium and other treatments for secondary lymphedema. J Support Oncol 2003;1:121-30.
• 40 Dennert G, Horneber M. Selenium for alleviating the side effects of chemotherapy, radiotherapy and surgery in cancer patients. Cochrane Database Syst Rev 2006;19;:CD005037.
• 41 Gothard L, Stanton A, MacLaren J, Lawrence D, Hall E, Mortimer P, et al. Non-randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema and tissue fibrosis after radiotherapy for early breast cancer. Radiother Oncol 2004;70:217-24.
• 42 Gothard L, Haviland J, Bryson P, Laden G, Glover M, Harrison S, et al. Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema after radiotherapy for cancer. Radiother Oncol 2010;97:101-7.
• 43 Bengtson BP, Schusterman MA, Baldwin BJ, Miller MJ, Reece GP, Kroll SS, et al. Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction. Am J Surg 1993;166:326-30.
• 44 Choi S, Schwartz DL, Farwell DG, Austin-Seymour M, Futran N. Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer. Arch Otolaryngol Head Neck Surg 2004;130:1308-12.
• 45 Thankappan K. Microvascular free tissue transfer after prior radiotherapy in head and neck reconstruction - a review. Surg Oncol 2010;19:227-34.
• 46 Mücke T, Rau A, Weitz J, Ljubic A, Rohleder N, Wolff KD, et al. Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions. Oral Oncol 2012;48:367-71.
• 47 Jacobson AS, Eloy JA, Park E, Roman B, Genden EM. Vessel-depleted neck: Techniques for achieving microvascular reconstruction. Head Neck 2008;30:201-7.
• 48 Hanasono MM, Barnea Y, Skoracki RJ. Microvascular surgery in the previously operated and irradiated neck. Microsurgery 2009;29:1-7.
• 49 Halle M, Bodin I, Tornvall P, Wickman M, Farnebo F, Arnander C. Timing of radiotherapy in head and neck free flap reconstruction--a study of postoperative complications J Plast Reconstr Aesthet Surg 2009;62:889-95.
• 50 Patel UA, Keni SP. Pectoralis myofascial flap during salvage laryngectomy prevents pharyngocutaneous fistula. Otolaryngol Head Neck Surg 2009;141:190-5.
• 51 Withrow KP, Rosenthal EL, Gourin CG, Peters GE, Magnuson JS, Terris DJ, et al. Free tissue transfer to manage salvage laryngectomy defects after organ preservation failure. Laryngoscope 2007;117:781-4.