A Audebert1, A Sauvanet, F Mauvais, J Belghiti. 1. Service de chirurgie digestive, hôpital Beaujon, 100, Boulevard du Général-Leclerc, 92110 Clichy, France.
Abstract
STUDY AIM: Radiation-induced oesophageal carcinoma can occur several years after mediastinal irradiation. The aim of this study was to report 11 cases of this rare entity with analysis of its diagnostic, therapeutic and prognostic special features. PATIENTS AND METHODS: From 1983 to 2001, 10 female and one male patients, aged 47 to 76 years, were treated for an oesophageal squamous cell carcinoma which was diagnosed 5 to 25 years after mediastinal irradiation. This irradiation (30 to 78 Gy) was administered in 8 women for breast carcinoma and in other patients for lymphoma. Only one patient had alcoholic consumption and 2 were smokers. An oesophagectomy was performed whenever possible. RESULTS: All (but one) oesophageal tumors were symptomatic. Ten patients underwent an oesophagectomy, including 2 without thoracotomy. Postoperative course was uneventful in 6 cases, 3 patients developed transient respiratory failure and one patient died postoperatively. At late follow-up, 6 patients developed distant metastases (mainly hepatic and pulmonary). These metastases were associated with mediastinal recurrences in 2 cases. No isolated mediastinal recurrence occurred. Median survival was 13 months. CONCLUSION: Clinical presentation and surgical treatment of radiation-induced oesophageal carcinoma are similar to those of other oesophageal squamous cell carcinomas. After oesophagectomy, isolated mediastinal recurrences seem to be rarer than with other cancers. These cancers, which are almost all symptomatic, have a poor prognosis.
STUDY AIM: Radiation-induced oesophageal carcinoma can occur several years after mediastinal irradiation. The aim of this study was to report 11 cases of this rare entity with analysis of its diagnostic, therapeutic and prognostic special features. PATIENTS AND METHODS: From 1983 to 2001, 10 female and one male patients, aged 47 to 76 years, were treated for an oesophageal squamous cell carcinoma which was diagnosed 5 to 25 years after mediastinal irradiation. This irradiation (30 to 78 Gy) was administered in 8 women for breast carcinoma and in other patients for lymphoma. Only one patient had alcoholic consumption and 2 were smokers. An oesophagectomy was performed whenever possible. RESULTS: All (but one) oesophageal tumors were symptomatic. Ten patients underwent an oesophagectomy, including 2 without thoracotomy. Postoperative course was uneventful in 6 cases, 3 patients developed transient respiratory failure and one patient died postoperatively. At late follow-up, 6 patients developed distant metastases (mainly hepatic and pulmonary). These metastases were associated with mediastinal recurrences in 2 cases. No isolated mediastinal recurrence occurred. Median survival was 13 months. CONCLUSION: Clinical presentation and surgical treatment of radiation-induced oesophageal carcinoma are similar to those of other oesophageal squamous cell carcinomas. After oesophagectomy, isolated mediastinal recurrences seem to be rarer than with other cancers. These cancers, which are almost all symptomatic, have a poor prognosis.
Authors: Jeroen Hagendoorn; Marguerite E I Schipper; Arjan Cloïn; Faiz Z Ramjankhan; Peter D Siersema; Richard van Hillegersberg Journal: Nat Rev Gastroenterol Hepatol Date: 2010-11-09 Impact factor: 46.802