Nghiên cứu đặc điểm lâm sàng, giải phẫu bệnh và phẫu thuật điều trị tổn thương da do xạ trị tt tiếng anh

MINISTRY OF EDUCATION AND THE MINISTRY OF TRAINING DEFENSE Military Medical University - HOANG THANH TUAN CLINICAL, PATHOANATOMICAL CHARACTERISTICS, AND SURGICAL TREATMENT FOR SKIN LESION CAUSED BY RADIOTHERAPY Major: Surgery Code: 9720104 SUMMARY OF MEDICAL DOCTORAL THESIS Hanoi - 2020 THIS RESEARCH WORKS IS ACCOMPLISHED AT: Science instructor: Assoc Prof Dr Vu Quang Vinh Assoc Prof Dr Trinh Tuan Dung Reviewer 1: Assco Prof Dr Le Van Doan Reviewer 2: Prof Dr Le Trung Hai Reviewer 3: Assco Prof Dr Ta Van To The dissertation will be defended before School-level Thesis Council at the Military Medical University At hour , day month year 2020 The thesis can be found at: The National Library of VietNam Library of Military Medical University INTRODUCTION Radiotherapy is the method of using ionizing radiation to kill cancer cells, which is one of the important modalities in the treatment of malignant tumors However, Apart from affecting the tumor, radiotherapy also affects the surrounding healthy tissue, including the skin and subcutaneous structures - at the irradiated location Chronic manifestations of radiotherapy-induced lesions include derma atrophy form mild extent to the severe extent with skin ulcers and local infection Radiation ulcers often cannot heal on their own, due to ischemia and poor granular tissue regeneration Around the world, surgical treatment for radiation-induced ulcers has achieved remarkable results, however there are still many disagreements in the treatment of this type of lesion In Vietnam, there were a number of reports on surgical treatment of chronic radiation-induced skin lesions, but most of them were retrospective There are unadequate studies on clinical, microorganism, histopathological, immunohistochemical characteristics, as well as the selection of appropriate plastic surgery methods for this lesion Therefore, we conduct the thesis: " Clinical, pathoanatomiical characteristics and surgical treatment for skin injury caused by radiotherapy ", with two objectives: Investigation of clinical, histopathological and immunohistochemistry characteristics for chronic skin lesion due to radiotherapy Evaluation of surgical results of flap transfer in treatment for Radiotherapy-induced ulcers STRUCTURE OF THE THESIS The thesis consists of 129 pages excluding references and appendices, with 38 tables, charts, diagram, 12 images and 15 pictures The introduction includes pages; 30 pages for overview; 27 pages for subjects and research methods; 26 pages for research results; 42 pages for discussion; pages for conclusion and page for recommendation.There are 104 references, including Vietnamese documents and 96 English ones Chapter OVERVIEW 1.1 Overview of radiotherapy 1.1.1 Radiotherapy concept Radiotherapy is a method using high-energy ionizing radiation to deprive cancer cells 1.1.2 Action mechanism of ionizing radiation - Radiation affects the body through two mechanisms: (1) Directly break DNA chains; (2) Indirectly form free radicals Besides the effect on the tumor, radiation also causes side effects on tissues and organs at radiation site 1.1.3 Indications for radiotherapy - For cancer treatment: Radiotherapy alone for may be small size tumors, inoperable cancers, symptomatic relief or in combination with other treatments, such as surgery, chemotherapy - For treatment of hemangiomas: Applied from the early 20th century According to Lindberg S., in a study on 11.807 under-12 month children with hemangiomas recieving radiotherapy, author found that there were 248 cases of cancer after treatment Radiotherapy is used only for patients with life - or function – threatening hemangiomas - For keloid scars 1.1.4 Systemic and local effects after radiotherapy Side effects of radiotherapy mainly depend on the radiation dose, the larger the dose and the more undesirable effects Systemic effects include fatigue, anemia, body aches, depression The local effect can be seen as edema skin, congestion; dry mouth, dry eyes; esophagitis 1.2 Overview of skin lesion induced by radiotherapy 1.2.1 Normal skin histology The skin composes layers: epidermis, dermis and hypodermis The appendages of the skin include sebaceous gland, sweat gland, and hair follicles 1.2.2 Mechanism of radiotherapy-induced skin lesion Radiation affect the young cells and rapidly divided cells, causing damage to the germ cells of the skin and appendages, affecting vascular endothelial cells resulting in post radiation skin lesion In the early stages, edema, hyperemia and congestion occur In the late stages, sclerosis, loss of appendages, skin ulcers is observed 1.2.3 Diagnosis of radiotherapy-induced skin lesion - Acute skin lesion: Occurs anytime, during and immediately after radiation, which can last until 90 days post-radiotherapy Symptoms include: erythema, dry skin, edema, hyperpigmentation, dry or moist desquamation, folliculitis - Chronic skin damage: Clinical manifestations include: skin atrophy, vasodilation, sclerosis, pigmentation changes (increase or decrease), hair loss, skin ulcers Diagnostic subclinical measures such as: Ultrasound, thermal imaging, microscopic capillary examination, magnetic resonance imaging, bone radiography 1.2.4 Histopathological and immunohistochemical characteristics of chronic post-radiotherapy skin lesions - Histopathology characteristics: Skin atrophy, capillary vasodilation, fibrosis, pigmentation changes, reduction or loss of skin appendages, vascular lesions, radiation fibroblasts - Immunohistochemistry: Assessment of vascular lesions through the expression of CD31 and CD34 Quarmby S (1999) and Gaugler M.H (2004) showed that CD31 plays an important role in adhering platelet to vascular endothelial cells and involves the endothelial cell proliferation Allan (2009) showed that the increased CD34 led to repeated inflammatory reactions causing tissular edema, forming foam cells leading to the endoluminal protrusion of endothelial cells 1.2.5 Staging and extent of lesion - Dasgeb B (2008) divided radiotherapy-induced damage into stages: acute dermatitis, chronic dermatitis, necrosis and fibrosis - Matthews M (2009) graded them into stages: acute (first months), subacute (second months) and chronic (over year) - Saunder (2003) grouped them into grades: Grade 1: Skin atrophy, sclerosis, darkening, hair loss Grade 2: Small long-lasting ulcer (