Testimonial: How to manage a chronic wound of the face that occurred on an old radiation-induced skin sequelae… and the contribution of conservative solutions!

In 1967, when I was a teenager (15 years old), I was treated for embryonal sarcoma of the face (back of the left cheek) with limited facial surgery, followed by intensive chemotherapy and then brachytherapy. The latter consisted of the insertion of a source of iridium (local radioactive material) in plastic sheaths which passed through my cheek for 8 days, and which caused an immediate burn of the tissues of this area with significant suppuration which interfered with my diet, but also the formation of external thick crusts on the skin. The effects of this burn gradually disappeared with local care, but longer-term effects began to appear despite the satisfaction of the healing obtained!

These progressive side effects were aesthetic in nature, with the appearance of mottling on an increasingly hard and fragile skin and a progressive deformation of the jaw bone below, the growth of which does not was not completed. The effects were also functional, with the appearance of thick flanges stretched inside the cheek hindering the opening of the mouth (and pulling the lip to the side), while the muscles of the cheek melted, transforming gradually into a sort of limp drumhead that prevented me from opening my mouth and practicing perfect dental hygiene.

Thus dental care was made difficult, with a deterioration of the gums in a few years, becoming worrying when the bone was exposed and my teeth started to move. The state of my cheek was not too good either, because in addition to the “smile” modified for several years, I presented an inflammation of the skin followed by a fistulization (communication between the outside and the inside of the cheek through a hole) which was cured at the time by simple successive antibiotic treatments, but which did not bode well.

In 2013, then aged 61 (and 46 years after this radiotherapy), during a conference on the long-term effects of cancer treatments, I met the treasurer of the Association des Aguerris (association dedicated to follow-up of childhood cancers), patient himself carrying sequelae related to childhood radiotherapy. He pointed me to the work of Dr. Delanian who was following him on this subject.

During the consultation, Dr. Delanian was offered a PENTOCLO antifibrosis treatment, which I followed from 2013 to 2017, and which had a spectacular effect on my health: in 3 years, the bone of my upper jaw (maxilla) has become denser, the condition of my gums has improved with less mobile teeth, and the flanges inside my cheek have disappeared.

It was time, because just before this PENTOCLO treatment, I had to pull out two teeth that were moving at the IGR. These dental extractions were completed by mucosal flap cover surgery to prevent oral sinus communication, a potential source of serious infectious complications.

Finally at the beginning of 2020, during a routine examination, my city dermatologist noticed a skin lesion evoking radiation-induced basal cell carcinoma on my left cheek, and asked for a biopsy to find out for sure. Fortunately, this cheek biopsy turned out to be negative (no cancer), but caused a wound with delayed healing on my cheek (fistula that no longer closed).

Professor DELANIAN then consulted on this subject, put me back on PENTOCLO treatment to activate healing. After about a year, after an already clear improvement, she recommended that I complete this result with lipofilling because, even if I had healed, the tissue deficit was very significant. Lipofilling (injection of fat taken from the skin of the belly, therefore of fresh non-irradiated cells, then after centrifugation, reinjected where necessary) was carried out by a maxillofacial surgeon from the IGR in January 2021 A little over a month later, the result was almost perfect. A second injection of lipofilling should consolidate the first because the cells injected after the first injection often blend into the tissues that still lack thickness. The fistulized wound is now completely closed, my cheek seems to have regained a much better local state and I am very satisfied.

Bernard C.


Radio-induced plexopathy and hidden vascular pathology

In 2003, I underwent surgery for right breast cancer, then was treated with chemotherapy and radiotherapy, in particular in the axillary (under the arm) and supraclavicular (above the clavicle) lymph node level and was very happy to get rid of the cancer!

Fourteen years later, in 2017, I started to have tingling in the little and ring fingers of the right hand with the beginning of numbness.  I also suffered on the right side, for a few years (2008), migraines, pain in the right eye and ear pulsatile, and dizziness.  No doctors consulted for this over time could find anything special … The MRI of the brain was normal; to the point of suggesting that, I imagined, cancer concerns.

Following the extended custody of my grandson for two weeks, a beautiful 9 month old baby claiming my arms all day long, the condition of my arm worsened by stretching my nerves.  After consultation with a neurologist, the diagnosis was made: latent after-effects of radiotherapy at the level of the plexus and nerves of the right arm.  This doctor informed me that there was nothing to do and that it would get worse at low or high speed, we would see!  A sort of condemnation without appeal.

It was then that I realized that I did not want to stop there, and I started researching the Internet.  I found an article by Pr Sylvie DELANIAN, which answered my questions on plexitis, finally!  I found myself dancing with joy in my living room.  Did I find the rare pearl?

The first dedicated consultation meeting was a revelation.  Finally a doctor who listens and understands with, without a doubt, incredible skills.  I thank Professor Sylvie DELANIAN for existing.  She confirmed the diagnosis of latent radiotherapy after-effects, radio-induced plexopathy of the right brachial plexus, and was surprised by the non-pursuit of investigations.  I benefited straightaway from anti-inflammatory and thinning treatment for a month, the time to finish the explorations, and already the wrist pain was gone.

MRI imaging of the nervous plexus associated with angiographic sequences then made it possible to search for and discover a 95% stenosis (tight narrowing) of the right pre-vertebral subclavian artery in connection with radiotherapy at the base of the neck!  An exploration by arteriography followed by placement of a stent in the almost blocked right subclavian artery was carried out as a matter of urgency.  This gesture saved my life, because there was a very significant threat of a cerebrovascular accident (stroke) and loss of using my arm.  Since then, as if by magic, the problems of the head on the right side disappeared after 10 years of embarrassment: my brain and my arm are well vascularized.

Following that, I was prescribed the anti-fibrosis protocol “PENTOCLO” to treat plexitis.  These drugs tire me a little but that is nothing compared to the benefit and the hope that I put in this treatment.  I have to listen to my arm and not overdo it, such as doing two hours of ironing or intensive cleaning.  I learn to spare my arm and my hand every day, but use them so as not to weaken them.  As soon as pain appears in the hand and as I have less and less grip strength, I find objects that help me, especially in my kitchen: a special hook to effortlessly open cans with a ring,  an automatic jar opener!

I learned that one disease can hide another, complications in the volume of radiotherapy can be multiple, some of immediate threat, others slow and chronic.  I also learned that these consequences are not just a fatality.  Although I am only at the beginning of my treatment, I remain POSITIVE because I have total confidence in Pr Sylvie DELANIAN.

Danielle V.

Radionecrosis of the sternum after radiotherapy treatment for a breast cancer

Testimony of a rebirth and gratitude. (Or a happy story after the assessment of a disabling radionecrosis of the sternum)

I am 70 years old and have been retired for 3 months after a life devoted to pediatrics.  On January 2, 1998, at the age of 49, I underwent surgery for right breast cancer followed by a 3-month radiotherapy treatment.  Just after this radiotherapy at the end of April 1998, I suffered a 2nd degree burn on the thorax (anterior radiodermatitis) at the level of the irradiated zone and still today there is a scar with small-surface red varicose veins called telangiectasias (spider veins).

On December 1, 2001, during a train trip, I was thrown violently against the shelf of a toilet sink after a sudden braking.  Despite the immediate pain in the sternum, the shock seemed minor. On leaving the train, I felt very different, which was accentuated by driving back home without power steering! This was now 4 years after radiotherapy.

By December 2001, the pain seemed under control, bearable, but any movement of the torso provokes it acutely.  I was happy not to have breathing difficulties… I was sedentary and my activities were reduced thanks to the support of my entourage.  Some improvement was felt by the end of the month.

But in mid-January 2002, on the occasion of a hectic trip, the sternal pain came back and would not let go.  It would take five additional months to rediscover arm or body mobilization without pain, without existing treatment other than paracetamol, caution and protection of my chest if necessary.

Then finally, the sternum went SILENT for 16 years, except for its slight deformation that has never changed.

But on April 10, 2018, during a consultation with a hospital rheumatologist who placed me uncomfortably on an examination table, my sternum woke up again when I got down from the table and the pain would not leave me anymore.  It had now been 20 years since my radiotherapy, with no relapse of cancer. I was now 69 years old.

The next 5 months would be very difficult, day and night, painful in the movements of the body at the slightest rotation, hindering not only dressing, but also my speech rate and my breathing at the slightest effort.  Life then became very painful. I was looking for solutions…

On September 6, 2018, I met Professor Sylvie DELANIAN and discovered the association ARSER.  She offered me a treatment for osteoradionecrosis, combining three drugs (PENTOCLO) over 6 months, renewed in March 2019. Within one month, the treatment restored my mobility and enabled me to find a quality of life… moving, breathing, getting dressed … living simply became a pleasure in the silence of the body… and it continues.

I thank Professor Sylvie DELANIAN and the ARSER team who contribute to the research and recognition of these rare and unrecognized radionecrosis pathologies.

Beatrice K.

Lymphedema and brachial plexitis

The story of my illness and its evolution is not only medical; it has also nourished the professional and personal aspects of my life for 50 years, with a desire to continue living by rationalizing my medical problems.

It was spring 1971, I was 33 years old and gave birth to 4 children, my days were well filled with my research activity at INSERM (National Institute of Health and Medical Research). I am then diagnosed with a tumor in the left breast which, after mammography and biopsy, turns out to be cancerous. The word cancer at the time was “taboo” and they sometimes refused to shake my hand, the doctors who treated me never said that terrible word, we had at that time, hypocritical conversations that generated “anxiety”.

After three months of preoperative radiotherapy of the breast and adjacent ganglionic areas, and radiotherapy of the ovaries to permanently stop the menstrual cycles, I underwent heavy surgery (removal of the left breast with axillary lymph node dissection) followed by new sessions of postoperative radiotherapy. No medical treatment will be prescribed for me, it was not the time. A delayed mobilization of the arm and massages to control the lymphatic edema will be my only treatments.

Although right handed, a small deficit of the fingers of the left hand at that time was a challenge for me because I played the piano; I felt that the left hand hardly followed the pace… my professional and family activities also contributed to the abandonment of the piano.

The years passed with 2-3 inflammatory episodes and limited lymphatic edema of the arm and forearm controlled with antibiotics. The wearing of long-sleeved clothes (a bit restrictive in summer), avoiding cut-stings by gardening with the left arm, will be my essential precaution. Finished, of course, the beach and the swimsuit, especially because of the comments of summer visitors. I discovered hiking in the mountains in summer, with backpack, no problem for my left arm; these steps at altitude did not pose any difficulty. Professionally, from 1987, I changed direction and for 25 years, I carried out many medical humanitarian missions on the ground with a well-known international association.

In 2008, at the age of 70, thirty-seven years later, I had more difficulties with the left hand when using the computer; I consulted several doctors but no answer, only compassion. I was told that it was an after effect of radiation therapy and that there was nothing to do. After an EMG (electromyogram) evaluating the electrical current of the nerves of each arm, a carpal tunnel operation will be offered to me, the operation on the right side will be a great success but no result on the left.

At the end of 2011, I had a discomfort with loss of consciousness (AIT or Transient Ischemic Accident), aphasia with paralysis of the left side of the tongue for a short period. Transported by firefighters to Bichat hospital, emergency exams will be made: brain MRI – cardiac assessment. If moderate hypertension was found, nothing at the time caught the attention of doctors and therefore no accurate diagnosis. My left arm was losing strength and the pain was managed with paracetamol.

It was then that, quite by chance, I was told about Dr. DELANIAN at the Saint-Louis Hospital, whom I would see for a consultation in June 2012. A randomized “PENTOCLO” therapeutic protocol with a draw had been recently organized by Dr. DELANIAN who suggested that I participate. I gave my agreement quickly because I finally found a doctor who took into account all my neurological symptoms which were accentuated;  a large lymphedema developed despite the daily wearing of an elastic compression sleeve, with intermittent tingling (paresthesia) of fingers. An MRI of the brachial plexus and various examinations confirmed a radially induced brachial plexitis, which is a nerve condition related to the dose of radiotherapy in 1971 in the supraclavicular trough (above the breast), nerve degeneration that has evolved in steps, slowly but gradually.

I followed the randomized protocol “PENTOCLO” for 18 months (from June 2012 to December 2013) with regular monitoring, with no side effects. The double-blind therapeutic protocol included Pentoxifylline, Tocopherol, and Clodronate as a daily dose, and I later learned that I had received the “real” treatment, without measuring the benefit. I was stable, but had no way of comparing whether the inevitable progression of plexitis was slower with treatment, each patient being unique in their reactions to the disease and treatment.

In 2014, despite maintaining a lighter treatment, the loss of sensitivity and motor skills of the hand was accentuated, and I had to put my arm in a sling to relieve the weight during walking.  In 2015, lymphedema had become so important with a sore and very heavy arm that I contacted Cognacq-Jay Hospital, a reference center for lymphedema. I was offered a 15-day hospitalization to mechanically reduce lymphedema with night-time self-bandaging and wearing a Mobiderm sleeve. The result will be useful therefore satisfactory at least some time.

At the end of 2015-2016, Dr. Delanian suggested a more advanced vascular exploration (Doppler – angioscanner – angio-MRI) which shows the existence of evolutionary arterial and venous vascular disorders post-radic with a stenosis (narrowing) at axillary-sub-clavicle, which increased the edema of the arm while the hand became cold. Phlebography and angioplasty followed by the placement of a venous stent were proposed and then performed in good conditions.

However, the following night, I suffered a brief cardiorespiratory stop, necessitating a transfer to intensive care … the heart also had received a lot of rays… The stent will be effective 1 month but will definitely stop.

In 2017, I again have a heart attack, am transported to the emergency room of the hospital Saint-Louis, I am released in the evening without anything abnormal outside a very low transient blood pressure. The subsequent cardiological assessment will finally show something… in echocardiography, a small pedicled left intra-ventricular mass (like a bell stick in the cardiac ventricle) evoking a myxoma (benign tumor); and I am on anticoagulation. Cardiac MRI at Saint-Joseph Hospital will confirm left intraventricular myxoma with emboligenic risk, new sequelae of so-called exceptional radiotherapy…

Thus, in 2019, I am aware that almost 50 years after the discovery of breast cancer, I am there, “lucky”, despite the loss of the use of my hand and my left wrist, compensated by a right arm ensuring double work!  In addition with a specific support that allowed me to limit many pitfalls.

If I remain medically realistic, my mind is always alert to the world. With my 81 years, I keep a satisfactory autonomy and I have confidence in the progress of clinical research as in basic research to understand the mechanisms of the disease.  Budgets could allow continuation of the research work initiated by Dr. Delanian and her team, whom I thank for the work done and the knowledge put at the service of patients.

The purpose of my testimony is to help people who, like me, have been operated on for breast cancer, to make the right decisions, and to be proactive about the care that is offered to them, always with hope and confidence in medicine that is constantly progressing.

March 2019 Marie-Claire G.

Lumbosacral plexopathy

Treated for 3 years by doctor Sylvie DELANIAN, I wish to attest to the improvement of my health.

First my story:
In August 1997, at the age of 47, discovery of colorectal cancer.
Radiotherapy treatment (25 pre-operative sessions) and chemotherapy. Colo-anal resection with colostomy followed by chemotherapy. Continued in March 1998.

Very quickly in 1998, heaviness in the left foot then more intense pain when getting up and going to bed.  I learned to live for ten years with these daily pains, which were intensified by running or walking. Then, I noticed an amyotrophy of the left calf and a progressive claudication appeared.

At the end of 2013, after prolonged physical work, I suffered from very painful cramps in both legs with fasciculations in the calves.  Walking had become almost impossible.

In March 2014, appearance of daily urinary disorders and following a 1st EMG (Electromyography) in Saumur, ALS (motor neuron disease) is diagnosed and a treatment is prescribed (RILUTEK and TOCO).

Six months later, after a 2nd EMG, the diagnosis of ALS was questioned because the symptomatology had improved.

In March 2015, 3rd EMG in Tours evoked a radiculopathy (pinched nerve) in the lower limbs.

I was then directed in Paris to Dr PRADAT who diagnosed a lumbosacral radio-induced Plexopathy and who sent me to consult Dr Sylvie DELANIAN.

For 3 years Dr DELANIAN, who prescribed a treatment that she had developed, treated me.  I noticed a rapid improvement, the pain becoming bearable and the walking easier.

Suspecting stenosis of the arteries following persistent pain in the left calf Dr. DELANIAN used an angio-scanner to highlight a tight stenosis of 70% of the left iliac artery.  The insertion of a stent for 1 year contributed greatly to improving walking and largely eliminated pain.

I am now able to walk 4 to 5 km without difficulty.

In conclusion, I am very grateful to Dr Sylvie DELANIAN who enabled me to benefit from her treatment.

Her expertise and the knowledge she has accumulated provide great hope for the relief of patients suffering from the after-effects of radiotherapy.

Robert P.


First and foremost, I want to publicly acknowledge my thanks to Dr. Sylvie Delanian.  Through her extreme competence, her ability to listen, and her humanity, she is a role model and I can really say that she saved me.

Born in 1957, I presented a pure seminoma in 1996, at the age of 39, which was treated and cured by local surgery followed by “intense” radiotherapy on the abdomen and then the thorax.  In 2012, 16 years later, I suffered a sudden and rapid loss of strength in my legs.  In retrospect, I had a tendency for 2-3 years to twist my ankle, etc.

After many examinations and hypotheses spread out over long months, the diagnosis was finally made and confirmed by Dr. Delanian (for the record I’m a researcher and I found her scientific articles on the subject).  I was convinced to take a PENTOCLO antifibrosant treatment that started in 2012 and is still in progress in 2019. This treatment allowed me to stop the process of degeneration (nerves and fibrosis) of my lumbar plexus (radiculopathy) by  a slight improvement of the neurological situation then a stabilization … Since then, I am autonomous, I can move with feet almost normally, but with a persistent weakness in the legs especially when lifting the feet (beware of the carpets!).  Finished tennis, etc., but I live almost normally.

It must be said that this situation was not easy to accept and there followed a slight depression (this was new to me) at the end of 2012 because of anxiety about the rest (I already saw myself in a wheelchair, and with professional and family consequences).  I met a Buddhist psychiatrist (Zen) and these circumstances caused deep soul searching and gradually led to a clarification of many things.  I continue to practice Zen meditation since then with my wife; I did not need antidepressants.

For the record, the psychiatrist I consulted during my depressive reaction had prescribed an antidepressant.  Which I did not take, because of my resistance to the idea, and the meditation helped me to get through it.  I spoke to Dr. Delanian who offered me a drug from the IRS family Venlafaxine 37.5 every morning.  This is the smallest dose to limit the energy losses of the class of anti-depressants but at a dose 10 times lower … which convinced me.  The goal is to better recycle serotonin (by inhibiting its recapture) and so help (analog of a small crutch, according to Dr. Delanian) one of the neurotransmitters control (my legs in this case) … allowing W to avoid exhaustion.  As for this medicine, in the end I think we should not hesitate, because it allowed me to get through a tough situation and break out of a vicious circle.

Finally, I also practiced (and practice still irregularly) meditation, the idea is not a miracle drug that makes the pain disappear, but a help to give perspective by looking at the situation with a soothing effect (calm mind and body).  There are many related practices (sophrology, mindfulness, etc.) depending on the objective (meditation paradoxically not having an objective, it is precisely the way not to focus on a desired result!).

Courage, sharing, hope and compassion.



Dear Members of ARSER,

I testified during the French TV program “Allo Docteurs” on Monday May 23, 2016 on France 5, as a patient with latent after-effects of ENT (Ear Nose Throat) radiotherapy.

The office of our Association considered it useful that I set out, in an editorial, my journey that led me to a healing and an acceptable life.  Therefore, 48 years old, I had ENT cancer in 1994. Unusual mouth odors had appeared: I consulted my usual dentist who, after examination, confirmed to me that the cause was not dental.  A discomfort with swallowing was also present; my ear doctor noted an anomaly at the base of the tongue.  After a biopsy, he told me that I had a cancerous tumor (an invasive undifferentiated ulcerating carcinoma).

So I was directed to a specialist ENT unit at Bichat Hospital (Dr Joël Depondt).  At the end of this consultation, a surgical operation on the tongue seemed obvious despite the inevitable aesthetic consequences and the subsequent difficulties for speech and food.  Needless to say, I was SHOCKED.

During another appointment with Dr Depondt, he informed me that at a meeting between doctors, including Dr Sylvie Delanian Oncologist Radiotherapist, he was offered treatment with EXCLUSIVE RADIOTHERAPY with Cobalt (at the dose of 45Gy) associated with CHEMOTHERAPY (Carboplatin) followed by CURITHERAPY with Iridium at a dose of 30 Gy (Dr Delanian Hôpital St-Louis).

Six weeks after this conservative treatment, the tumor had completely disappeared.

I HAVE ALWAYS BEEN UPBEAT, knowing that I am in the hands of a competent and attentive team.  During my radiotherapy and chemotherapy treatment, I NEVER STOPPED WORKING, in order to live a normal life like everyone else.  I was only forced to stop for three weeks after brachytherapy, due to significant weight loss and fatigue.

I experienced reactions during radiotherapy: the oral mucus membranes were red and tender.  Then immediate transitory reactions (in the weeks that followed) just after treatment:
– Dry mouth (hyposalivation) requiring me to drink often
– Total loss of taste associated with a black tongue (yeast infection), preventing me from distinguishing between foods, followed by significant weight loss
– Dry cheek skin
– A double chin with swelling (“jabot” sub-chin)
– Tongue pains linked to an ulceration in the brachytherapy area.
Then these first reactions went away, and I only suffered from neck and ear pain from time to time.  I still lost my job … So I decided to start my own business, the disease had hardened me …

When I finally thought all was well, 8 years later, I suffered from severe dental pain for which my dentist extracted the right wisdom tooth.  But I did not heal; there was local pain and then pain in the dental nerve, despite having the dental extractions before radiotherapy treatment and the fluorinated aligners afterwards.

A mandibular OSTEORADIONECROSIS (hole in the bone) then developed with severe mandibular pain associated with anesthesia of the chin and tingling on the path of the lower dental nerve, causing me to bite my tongue.  This severe pain was treated with morphine for many months while I was visiting the Pain Center at Bichât Hospital.  Antibiotic treatments followed one another but only brought partial relief for a few weeks.

After 6 months of evolution, Dr Delanian offered me the possibility of benefiting from a treatment that she had developed for this (it did not yet have a name, but since then he has been called “PENTOCLO”).  I took this treatment for 3 years, controlled by regular dental checkups.  Little by little the pain diminished, the hole in the jawbone closed and infections became more rare… healing on the surface first in the mouth, (a bone sequestration or piece of “rotten” bone)  1 cm came out on its own just before;  then healing in depth, allowing reduction and stopping of tingling in the chin in 3 years.  I admit to having resumed smoking in certain difficult moments, which did not help the situation… But I was happy to note that I could definitively stop morphine after a few months, then that the level of bone went up on the radios and the mandibular scanner.  We then stopped everything in 2007!

This was without counting on a new event … I indeed suffered then from my arteries of the neck, the left carotid.  I was abruptly afflicted with a brief neurological case of vision disturbance, dizziness and speech impairment from an ischemic stroke.  The assessment showed that I had a tight stenosis of the carotid artery at 90%, which we could also link to radiotherapy without attributing all the fault to it since the tobacco had passed there …

Carotid arterial stenosis was treated via an ENDARTERECTOMY and BRIDGE.  During this intervention, the surgeon had many difficulties (which he overcame) partly due to the cervical fibrosis of the radiotherapy.  I was again able to benefit from the “PENTOCLO” 6 months post-operatively to help neurological recovery and speech returned to 95% fluency.

Thus, my medical journey over 22 years was complicated and painful, but it resulted in a satisfactory cure, not only of cancer but of the after-effects associated with the treatment of cancer.  I would like to thank the doctors who have treated and supported me for these long years, and who still accompany me, in particular Dr Joël Depondt and Dr Sylvie Delanian.

Jean-Michel R. – November 2016