[Post-radiation pelvic disease and ureteral stenosis: physiopathology and evolution in the patient treated for cervical carcinoma. Review of the literature and experience of the Radium Institute].
Ureteral stenosis secondary to radiation-induced fibrosis is a well-known, late complication of radiation treatment in patients with carcinoma of the uterine cervix. This paper focuses on epidemiological data, physiopathology and treatment modalities reviewed from Internet-published literature. Experience from a single institution (Institute of Radiotherapy of Brescia) is reported. Ureteral stenosis has an incidence of 15% in patients treated with standard doses of radiotherapy for carcinoma of the uterine cervix. An asymptomatic low-grade fibrotic ureteral stenosis establishes at doses of 20 Gy in experimental animal models, and both incidence and severity rise with increasing of doses. An emerging role for Transforming Growth Factor beta 1 (TGF-beta 1) is recognized in determining chronic activation of fibroblast/fibrocyte lineage and remodelling extracellular matrix which are known mechanisms in the genesis of any fibrotic disease. Experience of the radiotherapy Institute of Brescia, Italy, is reported. A series of 191 patients with stage IB-IIA cervix carcinoma was treated with radical radiotherapy. About 10% of patients developed late urinary tract complications related to post-actinic fibrosis with only 1% of grade III-IV ureteral fibrosis. These data are consistent with those published by other institutions. In conclusion, late ureteral fibrosis is a common and distressing treatment-related complication in patients treated with radiotherapy for cervix carcinoma. Newer strategies in better defining the target for radiotherapy, conformational radiotherapy and better understanding of biologic factors will contribute to further reducing the frequency of such a complication.
Buglione
Michela
M
Istituto del Radio, Cattedra di Radioterapia dell'Università di Brescia.
Toninelli
Mariasole
M
Pietta
Nicoletta
N
Ambrosi
Enrica
E
Filippini
Marzia
M
De Stefani
Agostina
A
Vitali
Elisabetta
E
De Tomasi
Dolores
D
Bertoni
Filippo
F
Caraffini
Bruno
B
Magrini
Stefano M
SM
D000818:Animals; D001918:Brachytherapy / Q000009:adverse effects; D002277:Carcinoma / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005347:Fibroblasts / Q000528:radiation effects; D005355:Fibrosis; D006801:Humans; D007558:Italy / Q000453:epidemiology; D000292:Pelvic Inflammatory Disease / Q000453:epidemiology / Q000209:etiology*; D011832:Radiation Injuries / Q000209:etiology* / Q000503:physiopathology; D011833:Radiation Injuries, Experimental / Q000209:etiology / Q000473:pathology; D011867:Radioisotope Teletherapy / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016212:Transforming Growth Factor beta / Q000502:physiology; D014513:Ureter / Q000473:pathology / Q000528:radiation effects; D014517:Ureteral Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
D016212:Transforming Growth Factor beta
La malattia pelvica post-attinica e la stenosi ureterale: fisiopatologia ed evoluzione nelle pazienti trattate per carcinoma della cervice. Revisione della letteratura ed esperienza dell'Istituto del Radio.