Death Related to Pleural and Pericardial Effusions Following Chemoradiotherapy in a Patient with Advanced Cancers of the Esophagus and Stomach

Abstract

Abstract. Chemoradiotherapy improves therapeutic outcome in many different types of cancer. However, there is concern about the occurrence of delayed complications, as patients are surviving longer. Because patients with esophageal cancer receive a wide range of irradiation field to the mediastinum and the heart, they may have delayed complications of heart and lung functions as previously reported in Hodgkin's disease. We presented a case of death related to uncontrollable pleural and pericardial effusions in a patient with advanced cancers of the esophagus and stomach who achieved a complete remission following chemoradiotherapy and salvage gastric resection, focusing on detailed pathophysiological conditions related to concurrent chemoradiotherapy. (Keio J Med 56 (4) : 124 -129, December 2007)

Successful corticosteroid treatment for pleural effusion due to radiation-induced pleuritis after chemoradiotherapy in a patient with esophageal cancer

“…Late toxicities after thoracic radiotherapy have been reported in patients with lung, breast, and esophageal cancers, and Hodgkin's lymphoma [6][7][8][9]. In esophageal cancer, late toxicity after CRT including serious, life-threatening complications has been reported [1,2]. It is difficult to exclude the heart and lungs from the field of irradiation when treating the thoracic esophagus.…”

“…For cases of pleural effusion due to radiation therapy, it is difficult to remove the cause of inflammation; therefore, drainage using chest tubes or diuretic therapy was selected as symptomatic therapies [12]. Shigematsu et al reported death related to uncontrollable pleural and pericardial effusion in a patient treated with CRT for esophageal cancer [2]. His autopsy demonstrated infiltration of inflammatory cells to the pleural surface.…”

“…Corticosteroids were also effective for radiation-related pericardial effusion [17]. Pericarditis was characterized pathologically by the infiltration of inflammatory cells including monocytic cells [2,16]. Corticosteroids prevent these inflammatory cells from infiltrating tissue, and 30 mg/day prednisolone has a beneficial effect on radiation-induced pericarditis; 0.2-0.5 mg/kg/day prednisolone is more effective compared with higher doses in reducing recurrences and has fewer side effects [18][19][20].…”

“…Osawa et al reported that 40 mg prednisolone daily improved pleural and pericardial effusions [17]. Shigematsu et al reported radiation-induced pleural effusion treated with diuretic agents and 16 mg dexamethasone for 6 days [2]. The effect of 16 mg dexamethasone is more than twice as strong as that of 30 mg of prednisolone; however, it was insufficient to control the pleural effusion [2].…”

“…While more patients who have complete response (CR) survive for long term, they also have higher rates of delayed complications, particularly of the lungs or heart [1]. A delayed adverse event, such as pleural effusion after CRT for esophageal cancer, is difficult to treat and is associated with mortality [2]; however, appropriate drug therapies for treatment are not yet fully known. Here, we report a case of delayed pleural effusion as an adverse event related to CRT for esophageal cancer, successfully treated with corticosteroids.…”