Assessment of pituitary function in patients with nasopharyngeal carcinoma: the effect of radiotherapy

Radiotherapy (RT) plays a very important role in nasopharyngeal carcinoma (NPC). the pituitary gland can be affected by radiation due to its proximity to the nasopha-ryngeal cavity. Our aim is to demonstrate the effect of radiotherapy given for NPC on anterior pituitary function with basal pituitary hormones and provocative tests. Patients with NPC that were treated with definitive chemoradioherapy were reviewed retrospectively. Serum ACTH, GH, PRL, FSH, LH, TSH and cortisol, DHEAS, IGF-1, E2, testosterone, fT3, fT4 levels were recorded to evaluate pituitary function. Insulin tolerance test was performed to investigate hypothalamic-pituitary-adrenal axis and GH -IGF-1 axis. Comparison between early tumor stage and advanced tumor stage for pituitary dysfunction was done. the median time interval between the RT and endocrinologic evaluation was 4.0 (1-13) years. ACTH deficiency was found to be most common hormonal problem with a frequency of 73.7%. of these 71.4% were mild adrenal deficiencies. GH deficiency was seen in 60% of patients. fT3, TSH, GH and IGF-1 levels were significantly lower in patients with advanced tumor stage compared with early tumor stage (p = 0.033, p = 0.022, p = 0.043, p = 0.022, respectively). Growth hormone deficiency was found in all of advanced and in 43% of early tumor stage patients (p = 0.017). We found higher rates of ACTH and GH deficiencies followed by gonadotropin, corticotropin and thyrotropin deficiency. Basal pituitary hormones will not be sufficient to evaluate anterior pituitary failure. Annual and systematic dynamic tests together with basal anterior pituitary hormones would be neede

Radiation-Associated Chronic Dysphagia Assessment by Flexible Endoscopic Evaluation of Swallowing (FEES) in Head and Neck Cancer Patients: Swallowing-Related Structures and Radiation Dose-Volume Effect

###EgeUn###Purpose We aimed to restore dose-volume parameters of swallowing-related structures (SRSs) by evaluating long-term swallowing dysfunctions after radiotherapy (RT) in head and neck cancer patients (HNCPs). Materials and Methods Head and neck cancer patients whose pharyngeal region was involved in RT portal and treated with definitive RT/chemoradiotherapy (CRT) were included in the analyses. Patients underwent objective swallowing assessment by flexible endoscopic evaluation of swallowing (FEES). Volumes of SRSs that received 55 Gy (V-55) (mean dose [D-mean]) were evaluated according to the dose-volume histograms of each patient. For every SRS, optimal dose-volume cut-off values were determined by receiver operating characteristic curve analysis. Results Fifty-five patients at a median 20 months (range, 12-26 months) after their treatments were evaluated. There was a strong negative correlation between FEES scores and dose-volume parameters of SRS (r 57 Gy, base of tongue (BOT) D-mean > 50 Gy, supraglottic larynx (SGL) and glottic larynx (GL) D-mean > 55 Gy, and cervical esophagus (CE) D-mean > 45 Gy. MPC V-55 > 70%, IPC V-55 > 50%, BOT V-55 > 65%, CE V-55 > 40%, and SGL and GL V-55 > 50% were significant predictors for dysphagia. Conclusion It was found that dysphagia correlates strongly with dose-volume parameters of SRSs. IPC, SGL, and CE were found to be structures significantly associated with dysphagia

Radiation-Induced Ocular Surface Disorders and Retinopathy: Ocular Structures and Radiation Dose-Volume Effect

Purpose This study aimed to evaluate the radiation-induced adverse effects on ocular structures in head and neck cancer patients and investigate the radiation dose-volume effects on the cornea, lacrimal gland, retina, optic nerve and chiasm. Materials and Methods A total of 38 eyes of 19 patients were included in this prospective, cohort study. All patients underwent complete ophthalmological examination in addition to contrast sensitivity, visual field and visual evoked potentials (VEP) tests. Ophthalmological examinations and psychophysical tests were performed in 6th, 12th, 18th, 24th months and in the last visit. The relationship between the ophthalmologic findings, and the radiation doses below and above the cut-off values was evaluated. Results Contrast sensitivity decrease and visual field deterioration were observed in 42% of the patients in the last visit (median 26 months) whereas a prolonged latency and decreased amplitude of P100 wave in VEP was observed in 58% and 33% of the eyes, respectively at 24th month. Totally 16 patients (84.2%) developed dry eye disease and eight of them received radiotherapy below tolerance doses and had mild to moderate dry eye findings. Radiation-induced retinopathy was observed in three of the eyes in eight patients who received radiation above tolerance dose. Conclusion Head and neck cancers treated with radiotherapy, resulted in various ophthalmic complications. All patients who are treating with radiotherapy should be evaluated by an ophthalmologist in terms of anterior and posterior segment damage, even if the radiation dose is below the tolerance limit

Local Recurrence Outcomes After Breast Conserving Surgery and Adjuvant Radiotherapy in Ductal Carcinoma in Situ of the Breast and a Comparison with Ecog E5194 Study

Scopu