Esophageal carcinoma following irradiation for breast cancer.

A patient previously irradiated for inner-quadrant breast cancer developed a midesophageal stricture that on repeated biopsies showed pathologic changes consistent with acute and chronic radiation injury. Eventually a focus of well-differentiated esophageal carcinoma was found in the stricture. The patient was the second in a series of 20 patients treated at Georgetown University Hospital, Medical Oncology Division, 1973-1978, for esophageal cancer, who gave a history of previous irradiation for breast carcinoma. This finding led to the review of related case reports, follow-up studies on irradiated spondylitic patients, and data from the Connecticut Tumor Registry on esophageal cancer following breast carcinoma. These data suggest that the modest increase in risk for esophageal cancer reported in studies of atomic bomb survivors is of clinical significance to patients receiving therapeutic radiation, and, that specifically, women irradiated for inner-quadrant breast cancer, in which the dose of radiation to the esophagus can be large, may be at risk for subsequent esophageal carcinoma.