Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy

Abstract

BACKGROUNDIt is well recognized that many patients with head and neck carcinoma have problems with food intake and malnutrition. The objective of the current study was to determine the clinical pattern of patients with nonneoplastic stricture of the upper esophagus after radiotherapy for head and neck carcinoma.METHODSA retrospective chart study of 22 patients with stricture of the proximal esophagus diagnosed between 1993 and 1999 at Karolinska Hospital was performed. The dose volume histograms of the first 2 cm and 5 cm, respectively, of the proximal esophagus were calculated.RESULTSFive of the patients (23%) had total obliteration. The first 2 cm of the esophagus received at least 60 grays (Gy) in > 80% of the volume. Radiation injury was not reported to occur at doses < 60 Gy. There was a correlation found between dysphagia during radiotherapy and the development of proximal esophageal stricture. Stricture was diagnosed 1–60 months (median, 6 months) after radiotherapy. In 18 patients, the stricture was treated with single or repeated endoscopic dilation. These treatments allowed a nearly normal diet in 78% of the patients.CONCLUSIONSStricture of the upper esophagus is one deglutition disorder that is reported to occur after radiotherapy for head and neck carcinoma. In the current study, the authors emphasize the importance of knowing the tolerance of the normal esophagus to irradiation as well as early diagnosis of stricture of the proximal esophagus because this condition may lead to physical and emotional distress. Cancer 2003;97:1693–700. © 2003 American Cancer Society.DOI 10.1002/cncr.11236

Determination and Clinical Verification of Dose-Response Parameters for Esophageal Stricture from Head and Neck Radiotherapy

“…At the beginning of this work, 42 patients were analyzed, half of which had radiation-induced esophageal strictures (42). A survey using a questionnaire that was mailed to all surviving patients who received radiotherapy during 1994 at the Department of Oncology, Radiumhemmet, Karolinska Hospital, Stockholm for a head and neck tumor, selected all patients without any swallowing problems.…”

Effects of full-neck volumetric-modulated arc therapyvssplit-field intensity-modulated head and neck radiation therapy on low neck targets and structures

“…17 A lower mean dose to the oesophagus has also been correlated with lower rates of oesophageal stricture. 18 Although we are not aware of studies that examined the effect of maximum dose to the arytenoids on swallowing and voice function, a cited planning objective to avoid swallowing dysfunction in oropharyngeal cancers has been avoidance of dose to the arytenoid cartilage and associated muscles owing to its role in glottic closure, supraglottic adduction and epiglottic inversion. 19 This is the first study of which we are aware where a full-neck plan was overall largely equivalent to and in some ways dosimetrically superior to an SF-IMRT plan, while avoiding matchline uncertainties.…”

Esophageal recanalization by combined antegrade/retrograde esophagoscopy for radiotherapy-induced complete esophageal occlusion

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Esophageal recanalization by combined antegrade/retrograde esophagoscopy for radiotherapy-induced complete esophageal occlusion One side effect of radiochemotherapy of head and neck malignancies is the development of esophageal stenosis [1,2]. Subsequent therapeutic options include endoscopic balloon dilation or bouginage, with the option to perform combined ante-

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