Radiation-induced injury of the esophagus.

Lepke, Ronald A.; Libshitz, HI

doi:10.1148/radiology.148.2.6867327

Cited by 108 publications

(36 citation statements)

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“…The median time to the development of dysphagia after radiation has been reported to be 6-8 months [13,20,21] . Our study confirms this and found that the median time to the development of esophageal stenosis or dysphagia was 6-8.5 months after the completion of either radiation or TL (whichever one was later).…”

Section: Discussionmentioning

confidence: 99%

Proximal Esophageal Stenosis in Head and Neck Cancer Patients after Total Laryngectomy and Radiation

Vu¹,

Day²,

Gillespie³

et al. 2008

ORL

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Background: There has been an increasing focus on late functional effects of head and neck cancer (HNC) treatment. This study was undertaken to evaluate the incidence of late proximal esophageal stricture in patients undergoing total laryngectomy (TL) and radiation therapy (RT). Material and Methods: An institutional retrospective review of HNC patients treated between 1995 and 2003 with TL and RT was undertaken. Thirty-three patients with stage II–IV disease were included; 25 patients had TL and postoperative RT (group 1), while 8 patients had definitive RT with salvage laryngectomy (group 2). Results: The median follow-up was 28 months. At the last follow-up, 25 patients (76%) were alive and disease free. Four had died and 3 developed distant metastasis. Dysphagia or stenosis developed in 40% in group 1 and 75% in group 2 patients. The median time to dysphagia was 5.5 months for all patients. Conclusions: The incidence of esophageal stenosis was 33% for all patients. Contributing factors for esophageal stenosis after TL and RT include continued alcohol and tobacco use, the dose-volume relationship of the RT and normal tissue damage from the tumor and the treatment.

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Section: Discussionmentioning

confidence: 99%

Proximal Esophageal Stenosis in Head and Neck Cancer Patients after Total Laryngectomy and Radiation

Vu¹,

Day²,

Gillespie³

et al. 2008

ORL

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“…Most changes that occur later than 3 mo or more after irradiation are mortal disturbances possibly due to damage to nerves and smooth muscle, stricture may eventually develop [2] . It was reported that abnormalities include abnormal mortality with or without mucosal edema, stricture, ulceration, pseudodiverticulum and fistula, abnormal death occurs 4-12 wk following RT alone and as early as 1 wk after therapy when concurrent chemotherapy is given, strictures often develop 4-8 mo following completion of RT [3] . Radiation-induced esophageal injury occurs more frequently when RT and chemotherapy are combined.…”

Section: Discussionmentioning

confidence: 99%

Clinical and dosimetric factors of radiation-induced esophageal injury: Radiation-induced esophageal toxicity

Qiao

Zhao²,

Zhao³

et al. 2005

WJG

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AIM:To analyze the clinical and dosimetric predictive factors for radiation-induced esophageal injury in patients with non-small-cell lung cancer (NSCLC) during threedimensional conformal radiotherapy (3D-CRT). METHODS:We retrospectively analyzed 208 consecutive patients (146 men and 62 women) with NSCLC treated with 3D-CRT. The median age of the patients was 64 years (range 35-87 years). The clinical and treatment parameters including gender, age, performance status, sequential chemotherapy, concurrent chemotherapy, presence of carinal or subcarinal lymph nodes, pretreatment weight loss, mean dose to the entire esophagus, maximal point dose to the esophagus, and percentage of volume of esophagus receiving >55 Gy were studied. Clinical and dosimetric factors for radiation-induced acute and late grade 3-5 esophageal injury were analyzed according to Radiation Therapy Oncology Group (RTOG) criteria. RESULTS:Twenty-five (12%) of the two hundred and eight patients developed acute or late grade 3-5 esophageal injury. Among them, nine patients had both acute and late grade 3-5 esophageal injury, two died of late esophageal perforation. Concurrent chemotherapy and maximal point dose to the esophagus ≥60 Gy were significantly associated with the risk of grade 3-5 esophageal injury. Fifty-four (26%) of the two hundred and eight patients received concurrent chemotherapy. Among them, 25 (46%) developed grade 3-5 esophageal injury (P = 0.0001<0.01). However, no grade 3-5 esophageal injury occurred in patients who received a maximal point dose to the esophagus <60 Gy (P = 0.0001<0.01). CONCLUSION:Concurrent chemotherapy and the maximal esophageal point dose ≥60 Gy are significantly associated with the risk of grade 3-5 esophageal injury in patients with NSCLC treated with 3D-CRT. INTRODUCTIONRadiotherapy (RT) can achieve good results in the treatment of non-small-cell lung cancer (NSCLC). The key is how to monitor the dose to critical normal tissues such as the heart, normal lung, and esophagus. Several factors can minimize the dose of RT to the esophagus, including proximity of the esophagus to midline tumors or mediastinal adenopathy, proximity of the esophagus to higher priority organs such as spinal cord and heart and relative paucity of information on the clinical and dosimetric predictors of radiation-induced esophageal injury.Clinicians familiar with RT planning are often forced to evaluate multiple plans that produce equivalent coverage of the target with variable sparing of critical structures. By our experience, the esophageal dose is not critically considered because the clinical and dosimetric variables predicting esophageal injury are not well characterized. The purpose of this investigation was to analyze the incidence of acute and late grade 3-5 esophageal injury in patients with NSCLC during three-dimensional conformal radiotherapy (3D-CRT) combined with or without chemotherapy (sequential or concurrent).

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“…Total doses of 30 Gy or more can lead to severe esophagitis with irreversible damage and stricture formation [10]. The strictures develop 6-8 months after radiotherapy, although longer delays have been reported [12]. The overall frequency of stricture formation has ranged from 17 to 42 % of patients undergoing mediastinal radiation [10,12,13].…”

Section: Discussionmentioning

confidence: 99%

Radiation-induced esophageal strictures in children with cancer

Mahboubi

Silber

1997

Eur Radiol

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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.

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Radiation-induced injury of the esophagus.

Cited by 108 publications

References 0 publications

Proximal Esophageal Stenosis in Head and Neck Cancer Patients after Total Laryngectomy and Radiation

Proximal Esophageal Stenosis in Head and Neck Cancer Patients after Total Laryngectomy and Radiation

Clinical and dosimetric factors of radiation-induced esophageal injury: Radiation-induced esophageal toxicity

Radiation-induced esophageal strictures in children with cancer

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