Radiation-induced esophageal strictures in children with cancer

Abstract

The purpose of this study was to determine the long-term esophageal side effects of irradiation and (doxorubicin) chemotherapy given to children with cancer. Barium esophagograms and medical records of 18 patients with esophagitis who received between 1200 and 5580 cGy to the chest and chemotherapy were reviewed. The age range was 3-14 years. Esophageal strictures occurring 1-10 years after therapy were found in 5 patients with lymphoma; 3 of the five received doses of 4000 cGy or greater. Three children with esophagitis who received doses of 4000 cGy did not have stricture formation. However, their follow-up time was only 1-3 years. Of the 5 patients with esophageal stricture, 4 were treated with multiple dilatations, and a fifth required colonic interposition. Combined mediastinal irradiation and chemotherapy can result in esophageal stricture 1-10 years after therapy.

The management of treatment-related esophageal complications in children and adolescents with cancer

“…Vinblastine, dactinomycin, doxorubicin, 5-fluorouracil, and methotrexate have all been reported to cause esophageal ulcerations, fibrosis, and stricture formation [4,8,9]. In addition, doxorubicin and dactinomycin act as radiosensitizers and synergistically induce severe esophagitis and stricture formation when combined with radiotherapy [3,[10][11][12]. Hirota et al [13] found a 30% incidence of esophageal ulceration in patients receiving combined chemotherapy and radiotherapy.…”

“…This can lead to thrombosis of the submucosal small blood vessels and complete necrosis of the mucosa [6]. Late changes are seen anywhere from 6 months to 10 years after treatment and result in severe fibrosis, mucosal atrophy, and deep ischemic ulcerations [3,6,7].…”

“…Before the development of fistulae, 2 patients [1,2] underwent multiple dilations for esophageal strictures, and 3 [1,3,4] were treated for severe Candida esophagitis.…”

“…Although rare, esophageal fistula and stricture formation have been reported in pediatric patients treated for cancer [1,2]. Esophagitis from radiotherapy, chemotherapy, candidiasis, graft-versus- host disease (GVHD), and reflux are likely instigators in the development of esophageal strictures and fistulae [1,[3][4][5].…”

Risk-based health monitoring of childhood cancer survivors: A report from the children’s oncology group

“…Radiation and specific chemotherapeutic agents produce gastrointestinal and hepatic toxicity that is usually acute and self limited. Esophageal strictures have been described in survivors of mediastinal lymphoma who have undergone radiotherapy, but this complication is rare with contemporary low-dose therapy [35]. In survivors of abdominal sarcomas treated with combined modalities, including radiation (doses > 30 Gy) of the gastrointestinal tract, fibrosis and inflammation may cause partial or complete bowel obstruction, ulcers, fistulae, chronic enterocolitis, or incontinence [36].…”