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Bentley B, Chanaa F, Clayton S. Complete Esophageal Obstruction: A Rare Complication of Zollinger-Ellison Syndrome. ACG Case Rep J 2023; 10:e01205. [PMID: 38025843 PMCID: PMC10651347 DOI: 10.14309/crj.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Complete esophageal obstruction (CEO) is a rare phenomenon usually observed after receiving head and neck radiation. Zollinger-Ellison syndrome (ZES) is typically associated with minimal esophageal morbidity because of advancements in antisecretory medications. There are currently no documented reports of CEO in patients with ZES. Although surgeries are available for the treatment of CEO, there is no established method for endoscopic lumen restoration, given its rarity. This case documents potential sequala of modern-day patients with ZES.
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Affiliation(s)
- Blake Bentley
- Section on Gastroenterology and Hepatology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Fadi Chanaa
- Section on Gastroenterology and Hepatology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Steven Clayton
- Section on Gastroenterology and Hepatology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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2
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Combined Antegrade-Retrograde Dilation of Radiation-Induced Benign Esophageal Stenosis. ACG Case Rep J 2023; 10:e00947. [PMID: 36713284 PMCID: PMC9876012 DOI: 10.14309/crj.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/28/2022] [Indexed: 01/27/2023] Open
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Kitamura H, Tanigawa T, Kuzumoto T, Nadatani Y, Otani K, Fukunaga S, Hosomi S, Tanaka F, Kamata N, Nagami Y, Taira K, Uematsu S, Watanabe T, Fujiwara Y. Interferon-α exerts proinflammatory properties in experimental radiation-induced esophagitis: Possible involvement of plasmacytoid dendritic cells. Life Sci 2022; 289:120215. [PMID: 34890590 DOI: 10.1016/j.lfs.2021.120215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
AIMS Radiation-induced esophagitis, experienced during radiation therapy for lung cancer and head and neck cancer, is a major dose-limiting side effect of the treatment. This study aimed to elucidate the role of interferon-α (IFN-α) in radiation-induced esophagitis. MAIN METHODS C57BL/6 mice were exposed to 10 and 25Gy of single thoracic irradiation. Esophageal mucosal damage and inflammatory reactions were assessed for 5 days after irradiation. KEY FINDINGS Irradiation induced esophagitis, characterized by reduction in the thickness of epithelial layer, upregulation of proinflammatory cytokines and chemokines, infiltration of inflammatory cells into the esophageal mucosa, and apoptosis of epithelial cells. Irradiation upregulated the level of gene expression for IFN-α in the esophageal tissue, and the neutralizing antibody against IFN-α ameliorated radiation-induced esophageal mucosal damage, while administration of IFN-α receptor agonist (RO8191) had an inverse effect. Depletion of plasmacytoid dendritic cells (pDCs) by anti-CD317 antibody or pharmacological inactivation with bortezomib suppressed radiation-induced mucosal inflammation and damage, accompanied by decrease in IFN-α expression level. SIGNIFICANCE These findings suggest that IFN-α and pDCs exert proinflammatory properties in the pathophysiology of radiation-induced esophagitis.
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Affiliation(s)
- Hiroyuki Kitamura
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Gastroenterology, Osaka City Juso Hospital, Osaka, Japan.
| | - Takuya Kuzumoto
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuji Nadatani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Uematsu
- Department of Immunology and Genomics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan; Department of Premier Preventive Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Spaulding SL, Ansari E, Xing MH, Sandler ML, O'Malley QF, Ho R, Spitzer H, Levy J, Ganz C, Khorsandi AS, Mundi N, Urken ML. Diagnosis and management of pharyngoesophageal stenosis: A comprehensive approach to prophylactic, endoscopic, and reconstructive treatment options. Am J Otolaryngol 2021; 42:103003. [PMID: 33894689 DOI: 10.1016/j.amjoto.2021.103003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pharyngoesophageal stenosis (PES) is a serious complication that substantially impacts functional outcomes and quality of life (QOL) for up to a third of head and neck cancer patients who undergo radiotherapy. Dysphagia is often multifactorial in nature and is a devastating complication of treatment that impacts patients' QOL, general health and overall wellbeing. The authors detail the clinical presentation, risk factors, imaging characteristics, preventive measures, and multimodality treatment options for PES. METHODS The authors present a comprehensive management algorithm for PES, including treatment by dilation, stenting, spray cryotherapy and dilation, and reconstructive treatment options utilizing different pedicled and free flaps. RESULTS The authors advocate for a thorough assessment of the extent and degree of pharyngoesophageal involvement of PES to determine the optimal management strategy. CONCLUSIONS The development of post treatment dysphagia requires appropriate imaging and biopsy, when indicated, to rule out the presence of persistent/recurrent cancer. Multidisciplinary management by a team of physicians well-versed in the range of diagnostic and therapeutic interventions available for PES is critical to its successful management.
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Affiliation(s)
- Sarah L Spaulding
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Edward Ansari
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America.
| | - Mykayla L Sandler
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Quinn F O'Malley
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Rebecca Ho
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Hannah Spitzer
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Juliana Levy
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Cindy Ganz
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary, New York, NY 10003, United States of America
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
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Li Y, Lin J, Xiao J, Li Z, Chen JS, Wei L, Wang X. Therapeutic effects of Co-Venenum Bufonis Oral Liquid on radiation-induced esophagitis in rats. Exp Anim 2020; 69:354-362. [PMID: 32281552 PMCID: PMC7445061 DOI: 10.1538/expanim.19-0142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
To investigate the effects of Co-Venenum Bufonis Oral Liquid (cVBOL) on radiation-induced esophagitis in rats. Irradiation (30 Gy) with X-RAD 225 x-ray was applied to induce esophagitis in 64 Wistar rats and treated by different methods. The body weight of rats either in RT group, cVBOL+RT, or EM+RT group was significantly decreased when compared with that in normal group (P<0.0001). After irradiation, histopathological studies, immunohistochemistry, and MRI scanning on esophagus were performed. Serum TNF-α,IL-6 and IL-10 were also determined by ELISA at 7, 14, 21 and 28 days after radiation treatment. The results demonstrated that radiation caused esophageal injury and thickening of esophageal tissue layers. The esophageal tissues after radiation treatment showed typical pathological changes of esophagitis. Radiation also caused esophagus edema. Treatment of cVBOL reduced the severity of histological esophageal lesion, decreased the expression of bFGF and TGF-β1, and lowered serum levels of inflammatory cytokines including TNF-α, IL-6 and IL-10 over 28 days after radiation treatment. In conclusion, cVBOL treatment is effective to prevent radiation induced esophagitis and reduces radiation induced esophagitis may be mediated through its ant-inflammatory effects.
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Affiliation(s)
- Yang Li
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, Shandong 250017, P.R.China
| | - Jiamao Lin
- Department of internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan 250017, Shandong 250017, P.R.China
| | - Jun Xiao
- Department of internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan 250017, Shandong 250017, P.R.China
| | - Zhenxiang Li
- Department of internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan 250017, Shandong 250017, P.R.China
| | - Jin-Song Chen
- Shanxi C&Y Pharmaceutical Group Co., Ltd, No. 53 Hubin Street, Economic and Technological Development Zone, Datong, Shanxi 037010, P.R.China
| | - Ling Wei
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, Shandong 250017, P.R.China
| | - Xingwu Wang
- Shandong Provincial Key Laboratory of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No. 440 Jiyan Road, Jinan, Shandong 250017, P.R.China
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Petrea OC, Stanciu C, Muzica CM, Sfarti CV, Cojocariu C, Girleanu I, Huiban L, Trifan A. Idiopathic Cervical Esophageal Webs: A Case Report and Literature Review. Int J Gen Med 2020; 13:1123-1127. [PMID: 33235485 PMCID: PMC7679475 DOI: 10.2147/ijgm.s278999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/16/2020] [Indexed: 02/05/2023] Open
Abstract
An esophageal web is a thin and smooth extension of normal esophageal tissue consisting of mucosa and submucosa that can occur anywhere along the length of the esophagus but is typically located in the cervical segment. The webs can be congenital or acquired, commonly associated with Plummer-Vinson syndrome and rarely with celiac disease, dermatological disorders or graft-versus-host disease. A 54-year-old man was referred to our hospital with a history of high non-progressive dysphagia to solid food, meat impaction and weight loss over last ten months. His medical history and family history were unremarkable nor was the physical examination. Complete blood count and basic biochemical tests were normal. Antigliadin and antiendomysial antibodies for celiac disease were negative. Barium swallow esophagography and upper endoscopy detected cervical esophageal webs. The treatment consisted of endoscopic balloon dilation. The patient's dysphagia resolved shortly after dilation, and the endoscope passed easily through the esophagus showing normal esophageal, gastric and duodenal mucosa. This report is consistent with a case of esophageal webs rarely documented in males and that is not related with common causes like Plummer-Vinson syndrome. Thus, the pathogenesis and treatment of esophageal webs are evolving.
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Affiliation(s)
- Oana Cristina Petrea
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, Iasi, Romania
- Correspondence: Carol Stanciu Institute of Gastroenterology and Hepatology, “St Spiridon” Emergency Hospital, Iași700111, RomaniaTel +40722306020 Email
| | - Cristina Maria Muzica
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Catalin Victor Sfarti
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Camelia Cojocariu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Irina Girleanu
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
| | - Laura Huiban
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Anca Trifan
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Gastroenterology and Hepatology, Iasi, Romania
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Jelvehgaran P, Steinberg JD, Khmelinskii A, Borst G, Song JY, de Wit N, de Bruin DM, van Herk M. Evaluation of acute esophageal radiation-induced damage using magnetic resonance imaging: a feasibility study in mice. Radiat Oncol 2019; 14:188. [PMID: 31666092 PMCID: PMC6822441 DOI: 10.1186/s13014-019-1396-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Thoracic and head and neck cancer radiation therapy (RT) can cause damage to nearby healthy organs such as the esophagus, causing acute radiation-induced esophageal damage (ARIED). A non-invasive method to detect and monitor ARIED can facilitate optimizing RT to avoid ARIED while improving local tumor control. Current clinical guidelines are limited to scoring the esophageal damage based on the symptoms of patients. Magnetic resonance imaging (MRI) is a non-invasive imaging modality that may potentially visualize radiation-induced organ damage. We investigated the feasibility of using T2-weighted MRI to detect and monitor ARIED using a two-phased study in mice. METHODS The first phase aimed to establish the optimal dose level at which ARIED is inducible and to determine the time points where ARIED is detectable. Twenty four mice received a single dose delivery of 20 and 40 Gy at proximal and distal spots of 10.0 mm (in diameter) on the esophagus. Mice underwent MRI and histopathology analysis with esophageal resection at two, three, and 4 weeks post-irradiation, or earlier in case mice had to be euthanized due to humane endpoints. In the second phase, 32 mice received a 40 Gy single dose and were studied at two, three, and 7 days post-irradiation. We detected ARIED as a change in signal intensity of the MRI images. We measured the width of the hyperintense area around the esophagus in all mice that underwent MRI prior to and after irradiation. We conducted a blind qualitative comparison between MRI findings and histopathology as the gold standard. RESULTS/CONCLUSIONS A dose of 40 Gy was needed to induce substantial ARIED. MRI detected ARIED as high signal intensity, visible from 2 days post-irradiation. Quantitative MRI analysis showed that the hyperintense area around the esophagus with severe ARIED was 1.41 mm wider than with no damage and MRI-only mice. The overall sensitivity and specificity were 56 and 43% respectively to detect any form of ARIED. However, in this study MRI correctly detected 100% of severe ARIED cases. Our two-phased preclinical study showed that MRI has the potential to detect ARIED as a change in signal intensity and width of enhancement around the esophagus.
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Affiliation(s)
- Pouya Jelvehgaran
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Physics and Astronomy, Institute for Laser Life and Biophotonics Amsterdam, Amsterdam, the Netherlands
| | - Jeffrey D. Steinberg
- Mouse Clinic for Cancer and Aging (MCCA) Imaging Unit, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Artem Khmelinskii
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Gerben Borst
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Ji-Ying Song
- Department of Experimental Animal Pathology, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Niels de Wit
- Mouse Clinic for Cancer and Aging (MCCA) Imaging Unit, The Netherlands Cancer Institute (NKI), Amsterdam, the Netherlands
| | - Daniel M. de Bruin
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marcel van Herk
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
- Manchester Cancer Research Centre, Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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Jelvehgaran P, de Bruin DM, Khmelinskii A, Borst G, Steinberg JD, Song J, de Vos J, van Leeuwen TG, Alderliesten T, de Boer JF, van Herk M. Optical coherence tomography to detect acute esophageal radiation-induced damage in mice: A validation study. JOURNAL OF BIOPHOTONICS 2019; 12:e201800440. [PMID: 31058437 PMCID: PMC7065648 DOI: 10.1002/jbio.201800440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 05/19/2023]
Abstract
Radiation therapy for patients with non-small-cell lung cancer is hampered by acute radiation-induced toxicity in the esophagus. This study aims to validate that optical coherence tomography (OCT), a minimally invasive imaging technique with high resolution (~10 μm), is able to visualize and monitor acute radiation-induced esophageal damage (ARIED) in mice. We compare our findings with histopathology as the gold standard. Irradiated mice receive a single dose of 40 Gy at proximal and distal spots of the esophagus of 10.0 mm in diameter. We scan mice using OCT at two, three, and seven days post-irradiation. In OCT analysis, we define ARIED as a presence of distorted esophageal layering, change in backscattering signal properties, or change in the esophageal wall thickness. The average esophageal wall thickness is 0.53 mm larger on OCT when ARIED is present based on histopathology. The overall sensitivity and specificity of OCT to detect ARIED compared to histopathology are 94% and 47%, respectively. However, the overall sensitivity of OCT to assess ARIED is 100% seven days post-irradiation. We validate the capability of OCT to detect ARIED induced by high doses in mice. Nevertheless, clinical studies are required to assess the potential role of OCT to visualize ARIED in humans.
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Affiliation(s)
- Pouya Jelvehgaran
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Department of Radiation OncologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Department of Physics and AstronomyInstitute for Laser Life and Biophotonics AmsterdamAmsterdamthe Netherlands
| | - Daniel M. de Bruin
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Department of UrologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Artem Khmelinskii
- Department of Radiation OncologyThe Netherlands Cancer Institute (NKI)Amsterdamthe Netherlands
| | - Gerben Borst
- Department of Radiation OncologyThe Netherlands Cancer Institute (NKI)Amsterdamthe Netherlands
| | - Jeffrey D. Steinberg
- Mouse Clinic for Cancer and Aging (MCCA) Imaging UnitThe Netherlands Cancer InstituteAmsterdamthe Netherlands
| | - Ji‐Ying Song
- Department of Experimental Animal PathologyThe Netherlands Cancer Institute (NKI)Amsterdamthe Netherlands
| | - Judith de Vos
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Ton G. van Leeuwen
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Tanja Alderliesten
- Department of Radiation OncologyAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Johannes F. de Boer
- Department of Physics and AstronomyInstitute for Laser Life and Biophotonics AmsterdamAmsterdamthe Netherlands
| | - Marcel van Herk
- Department of Biomedical Engineering and PhysicsCancer Center Amsterdam, Amsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
- Manchester Cancer Research Centre, Division of Cancer Sciences, Faculty of Biology, Medicine, and HealthUniversity of Manchester, Manchester Academic Health Sciences CentreManchesterUK
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Prevalence and Associated Impacts of Cervical Esophageal Clearance Issues Post Chemoradiotherapy for Nasopharyngeal Carcinoma (NPC). Dysphagia 2019; 35:99-109. [PMID: 30989394 DOI: 10.1007/s00455-019-10007-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/28/2019] [Indexed: 01/27/2023]
Abstract
At present, the nature and extent of upper esophageal stage clearance issues following nonsurgical management of nasopharyngeal cancer (NPC) is not well elucidated. The aim of this study was to conduct an initial retrospective study of the prevalence and severity of upper esophageal clearance impairments in a cohort of patients post-NPC management. A secondary aim was to explore any observed relationship between severity of impairment with both (a) aspiration and (b) temporal oropharyngeal swallowing measures. A cohort of 134 NPC patients who received curative intent (chemo)radiotherapy (C/RT) and completed a videofluoroscopic swallowing study (VFSS) between 2012 and 2015 were reviewed. An Esophageal Clearance parameter, based on the scale used in MBSImP was used to classify the presence and severity of esophageal impairment on thin liquid and semisolids. Data on oral and pharyngeal temporal measures, pharyngeal constriction, and penetration/aspiration were also collected. The prevalence of cervical esophageal clearance impairment was high with ratings > 0 observed among 83% and 97% of patients on thin liquid and semisolids, respectively. With the increasing impairment, significantly (p < 0.05) increased oral transit times were observed for liquid swallows, and increased pharyngeal transit times for semisolids. Significantly higher proportions of patients presented with penetration/aspiration in the group with more severe esophageal clearance impairment. Results confirm that cervical esophageal clearance impairment is highly prevalent post-C/RT treatment for NPC. Causality cannot be determined from this study; however, this initial evidence supports that esophageal impairment may coexist in patients post NPC, presenting with more severe oral/pharyngeal deficits, and the impact of this on swallow function needs to be considered. Further systematic research is required.
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Abstract
PURPOSE OF THE REVIEW The novel concept of third space endoscopy was first applied to humans in 2008 for the management of achalasia through peroral endoscopic myotomy (POEM) procedure. Over the ensuing 10 years, this revolutionary procedure, which started in Japan, has been adopted and mastered by surgeons and gastroenterologists across the globe. In this article, we review the recent innovations and applications of third space endoscopy in the management of esophageal disorders. RECENT FINDINGS With experience and innovation, the application of third-space endoscopy has extended beyond achalasia, and currently, it is used in the management of other esophageal disorders including, spastic esophageal disorders, subepithelial tumors, complete esophageal obstruction, and esophageal diverticula. The recent advances in third space endoscopic procedures have not only permitted endoscopic access to places, previously thought impossible, but also enabled the precision of surgery along with reduced peri-operative morbidity due to its minimally invasive nature. While short- and mid-term outcome studies have shown excellent results, we eagerly await the long-term outcome studies before these procedures could be established as the procedures of choice.
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Affiliation(s)
- Malav P Parikh
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Niyati M Gupta
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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LaVigne AW, Margalit DN, Rawal B, Puzanov M, Annino DJ, Goguen LA, Sher DJ, Schoenfeld JD, Chau NG, Lorch JH, Rabinowits G, Haddad RI, Tishler RB. IMRT‐based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing. Head Neck 2019; 41:959-966. [DOI: 10.1002/hed.25531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/26/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna W. LaVigne
- Johns Hopkins University School of Medicine Baltimore Maryland
| | - Danielle N. Margalit
- Department of Radiation OncologyDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
| | - Bhupendra Rawal
- Department of Biostatistics and Computational BiologyDana‐Farber Cancer Institute Boston Massachusetts
| | | | - Donald J. Annino
- Division of Otolaryngology, Department of SurgeryDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
| | - Laura A. Goguen
- Division of Otolaryngology, Department of SurgeryDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
| | - David J. Sher
- Department of Radiation OncologyUT Southwestern Medical Center Dallas Texas
| | - Jonathan D. Schoenfeld
- Department of Radiation OncologyDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
| | - Nicole G. Chau
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
| | - Jochen H. Lorch
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
| | | | - Robert I. Haddad
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
| | - Roy B. Tishler
- Department of Radiation OncologyDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
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Jelvehgaran P, de Bruin DM, Salguero FJ, Borst GR, Song JY, van Leeuwen TG, de Boer JF, Alderliesten T, van Herk M. Feasibility of using optical coherence tomography to detect acute radiation-induced esophageal damage in small animal models. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-12. [PMID: 29651825 DOI: 10.1117/1.jbo.23.4.046004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/26/2018] [Indexed: 05/25/2023]
Abstract
Lung cancer survival is poor, and radiation therapy patients often suffer serious treatment side effects. The esophagus is particularly sensitive leading to acute radiation-induced esophageal damage (ARIED). We investigated the feasibility of optical coherence tomography (OCT) for minimally invasive imaging of the esophagus with high resolution (10 μm) to detect ARIED in mice. Thirty mice underwent cone-beam computed tomography imaging for initial setup assessment and dose planning followed by a single-dose delivery of 4.0, 10.0, 16.0, and 20.0 Gy on 5.0-mm spots, spaced 10.0 mm apart in the esophagus. They were repeatedly imaged using OCT up to three months postirradiation. We compared OCT findings with histopathology obtained three months postirradiation qualitatively and quantitatively using the contrast-to-background-noise ratio (CNR). Histopathology mostly showed inflammatory infiltration and edema at higher doses; OCT findings were in agreement with most of the histopathological reports. We were able to identify the ARIED on OCT as a change in tissue scattering and layer thickness. Our statistical analysis showed significant difference between the CNR values of healthy tissue, edema, and inflammatory infiltration. Overall, the average CNR for inflammatory infiltration and edema damages was 1.6-fold higher and 1.6-fold lower than for the healthy esophageal wall, respectively. Our results showed the potential role of OCT to detect and monitor the ARIED in mice, which may translate to humans.
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Affiliation(s)
- Pouya Jelvehgaran
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Academic Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
- Institute for Laser Life and Biophotonics Amsterdam, Department of Physics and Astronomy, Amsterdam, The Netherlands
| | - Daniel Martijn de Bruin
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
- Academic Medical Center, Department of Urology, Amsterdam, The Netherlands
| | - F Javier Salguero
- The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Gerben Roelof Borst
- The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Ji-Ying Song
- The Netherlands Cancer Institute, Department of Experimental Animal Pathology, Amsterdam, The Netherlands
| | - Ton G van Leeuwen
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
| | - Johannes F de Boer
- Institute for Laser Life and Biophotonics Amsterdam, Department of Physics and Astronomy, Amsterdam, The Netherlands
| | - Tanja Alderliesten
- Academic Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Marcel van Herk
- Academic Medical Center, Department of Biomedical Engineering and Physics, Amsterdam, The Netherlands
- University of Manchester, Institute of Cancer Sciences, Manchester, United Kingdom
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Functional Outcomes After De-escalated Chemoradiation Therapy for Human Papillomavirus-Positive Oropharyngeal Cancer: Secondary Analysis of a Phase 2 Trial. Int J Radiat Oncol Biol Phys 2017; 100:647-651. [PMID: 29246721 DOI: 10.1016/j.ijrobp.2017.10.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/12/2017] [Accepted: 10/28/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To analyze functional outcomes for patients treated on a phase 2 trial of de-escalated chemoradiation therapy for human papillomavirus-positive oropharyngeal cancer. METHODS AND MATERIALS Patient eligibility included p16-positive, stage III or IV oropharyngeal squamous cell carcinoma and a Zubrod performance status of 0 to 1. Treatment was induction chemotherapy with paclitaxel, 175 mg/m2, and carboplatin, area under the curve (AUC) of 6 mg/ml/min, for 2 cycles every 21 days, followed by concurrent paclitaxel, 30 mg/m2, every 7 days with dose-reduced radiation therapy of 54 or 60 Gy. Trends in body weight and body mass index (BMI) were analyzed with gastrostomy tube and narcotic use rates. Functional outcomes were assessed using the University of Washington Quality of Life Scale and the Functional Assessment of Cancer Therapy-Head and Neck Scale. RESULTS Forty-five patients were registered, of whom 40 were evaluable. Only 1 patient had a BMI deemed unhealthy at the completion of treatment. For the 15 patients (38%) with a normal BMI (18-25 kg/m2) before treatment, recovery back to baseline occurred at approximately 18 months (average BMI, 23.2 kg/m2 vs 22.3 kg/m2; P=.09). In 2 patients (5%), gastrostomy tubes were placed during treatment. No patient was enteral feeding tube-dependent at 6 months after treatment. Ninety-five percent of patients tolerated a normal regular diet at last follow-up. CONCLUSIONS De-escalated chemoradiation therapy may improve functional outcomes as indicated by the relatively low incidence of gastrostomy tube placement and long-term dysphagia. In patients with a normal BMI prior to chemoradiation therapy, BMI recovered to baseline levels.
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14
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Quantification of Dose-Volume and Dose-Length Parameters for Cervical Esophageal Stricture in Head and Neck Irradiation with the 3DCRT and IMRT Technique. J Med Imaging Radiat Sci 2017; 48:288-293. [PMID: 31047412 DOI: 10.1016/j.jmir.2017.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/21/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To quantify and compare dose-volume and dose-length parameters of cervical esophagus between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT) and to correlate with incidence of cervical strictures in head and neck cancer irradiation with radical intent. MATERIALS AND METHODS Forty consecutive head and neck cancer patients who received radical radiation therapy, either with 3DCRT (n = 20) or IMRT (n = 20), between December 2011 and August 2012 were retrospectively analyzed and followed up for at least 4 years post-treatment completion. RESULTS The volumes of cervical esophagus receiving ≥54 Gy (V54) and ≥60 Gy (V60) and lengths receiving circumferential dose of ≥50 Gy (L50) and ≥54 Gy (L54) were significantly higher in patients treated with IMRT as compared to 3DCRT (P ≤ .05). At the end of minimum 4 years' post-treatment, nine patients had documented symptomatic strictures; three patients were treated with 3DCRT and six patients with IMRT technique. CONCLUSION IMRT technique in entire-neck irradiation is associated with increased spillage dose to the cervical esophagus, and thereby increased risk for late sequelae. The cervical esophagus has to be considered as an organ at risk and constraints need to be given in IMRT planning, particularly for lower-neck irradiation.
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15
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Wagh MS, Draganov PV. Per-oral endoscopic tunneling for restoration of the esophagus: a novel endoscopic submucosal dissection technique for therapy of complete esophageal obstruction. Gastrointest Endosc 2017; 85:722-727. [PMID: 27612924 DOI: 10.1016/j.gie.2016.08.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/28/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Total aphagia from complete esophageal obstruction (CEO) can be seen in patients with head-neck or thoracic malignancies undergoing chemoradiation or surgery. Combined antegrade and retrograde endoscopy (via gastrostomy tube [G-tube] tract) is often performed for esophageal reconstruction but is limited by the length of the obstructed esophagus. We describe per-oral endoscopic tunneling for restoration of the esophagus (POETRE) for patients with longer segments of esophageal obstruction. The aim of this study was to assess the efficacy and safety of POETRE for CEO. METHODS All patients with CEO undergoing endoscopy with POETRE from October 2013 to September 2015 were enrolled in this single-center prospective study. Clinical, endoscopic, and radiologic records were maintained as required for clinical care and for the study. Dysphagia score was recorded before and after POETRE. Adverse events were assessed based on the American Society for Gastrointestinal Endoscopy criteria. RESULTS Four patients (3 men; mean age, 72.3 years) underwent POETRE for CEO ≥3 cm in length. Esophageal reconstruction was technically successful in all patients (100%). Antegrade submucosal tunneling was performed in 2 of 4 patients (50%), and retrograde tunneling was performed in the other 2 patients, all with simultaneous dual endoscope and fluoroscopic guidance. The mean dysphagia score of 4 before the procedure improved to 2.5 after POETRE during follow-up (mean, 27.8 weeks). All patients required subsequent serial endoscopic dilations as needed after POETRE. One adverse event (pneumonia) was seen (25%). CONCLUSIONS We present a novel ESD technique, POETRE, for therapy of complete esophageal obstruction. This approach is specifically useful for lumen restoration in patients with longer segments of esophageal obstruction. (Clinical trial registration number: NCT00968552.).
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Affiliation(s)
- Mihir S Wagh
- Division of Gastroenterology, University of Colorado, Denver, Colorado, USA
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16
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Bak J, Kang HW. Temperature-monitored optical treatment for radial tissue expansion. Lasers Med Sci 2017; 32:993-999. [PMID: 28353121 DOI: 10.1007/s10103-017-2199-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 03/21/2017] [Indexed: 11/27/2022]
Abstract
Esophageal stricture occurs in 7-23% of patients with gastroesophageal reflux disease. However, the current treatments including stent therapy, balloon dilation, and bougienage involve limitations such as stent migration, formation of the new strictures, and snowplow effect. The purpose of the current study was to investigate the feasibility of structural expansion in tubular tissue ex vivo during temperature-monitored photothermal treatment with a diffusing applicator for esophageal stricture. Porcine liver was used as an ex vivo tissue sample for the current study. A glass tube was used to maintain a constant distance between the diffuser and tissue surface and to evaluate any variations in the luminal area after 10-W 1470-nm laser irradiation for potential stricture treatment. The 3D goniometer measurements confirmed roughly isotropic distribution with less than 10% deviation from the average angular intensity over 2π (i.e., 0.86 ± 0.09 in arbitrary unit) from the diffusing applicator. The 30-s irradiation increased the tissue temperature up to 72.5 °C, but due to temperature feedback, the interstitial tissue temperature became saturated at 70 °C (i.e., steady-state error = ±0.4 °C). The irradiation times longer than 5 s presented area expansion index of 1.00 ± 0.04, signifying that irreversible tissue denaturation permanently deformed the lumen in a circular shape and secured the equivalent luminal area to that of the glass tube. Application of a temperature feedback controller for photothermal treatment with the diffusing applicator can regulate the degree of thermal denaturation to feasibly treat esophageal stricture in a tubular tissue.
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Affiliation(s)
- Jinoh Bak
- Department of Biomedical Engineering, Pukyong National University, 45 Yongso-ro Nam-gu, Busan, 48513, Republic of Korea
| | - Hyun Wook Kang
- Department of Biomedical Engineering, Pukyong National University, 45 Yongso-ro Nam-gu, Busan, 48513, Republic of Korea. .,Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong National University, Busan, South Korea.
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Chen AM, Hsu S, Meshman J, Chin R, Beron P, Abemayor E, St John M. Effect of daily fraction size on laryngoesophageal dysfunction after chemoradiation for squamous cell carcinomas of the larynx and hypopharynx. Head Neck 2017; 39:1322-1326. [PMID: 28301066 DOI: 10.1002/hed.24757] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/29/2016] [Accepted: 02/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the effect of fraction size on laryngoesophageal dysfunction among patients treated by chemoradiotherapy for laryngeal and hypopharyngeal cancer. METHODS Forty patients underwent chemoradiotherapy for stage III/IV squamous cell carcinomas of the larynx and hypopharynx. Median radiation dose was 70 Gy (range, 69.3-70.4 Gy) with daily fractionation ranging from 2 Gy to 2.2 Gy. RESULTS When comparing 2 Gy versus >2 Gy daily fractionation, there was no difference in 2-year overall survival (71% vs 72%; p = .68), locoregional control (79% vs 77%; p = .43), or laryngectomy-free survival (60% vs 61%; p = .72). Use of 2 Gy versus >2 Gy fractionation improved laryngoesophageal dysfunction-free survival (2-year estimates, 49% vs 27%; p = .07). Patient-reported voice and swallowing were improved with the former. CONCLUSION As the importance of a functional larynx becomes recognized as an endpoint for patients treated by voice preservation, the results of our study help refine treatment guidelines. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1322-1326, 2017.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Sophia Hsu
- Department of Radiation Oncology, University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Jessica Meshman
- Department of Radiation Oncology, University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Robert Chin
- Department of Radiation Oncology, University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Philip Beron
- Department of Radiation Oncology, University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Elliot Abemayor
- Department of Otolaryngology - Head and Neck Surgery, University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Maie St John
- Department of Otolaryngology - Head and Neck Surgery, University of California - Los Angeles, David Geffen School of Medicine, Los Angeles, California
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18
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Soares PC, Bouayed S, Dulguerov P, Frossard JL. Recurrent Complete Pharyngo-Oesophageal Stricture Treated by Multidisciplinary Anterograde-Retrograde Endoscopic Dilation. Case Rep Gastroenterol 2016; 10:560-567. [PMID: 27920642 PMCID: PMC5121545 DOI: 10.1159/000450678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/07/2016] [Indexed: 12/29/2022] Open
Abstract
Complete pharyngo-oesophageal stricture (PES) after radiotherapy for head and neck cancer is a relatively rare and difficult complication to manage. Historically this condition has been treated surgically, but endoscopic approaches are now available. We present a 61-year-old man with an epidermoid carcinoma of the supraglottic stage and a micro-invasive epidermoid carcinoma of the oropharynx treated surgically and subsequently by adjuvant radiotherapy. Eight months after the end of the radiotherapy, a complete PES was diagnosed and treated with a combined anterograde-retrograde endoscopic dilation (CARD). The procedure was performed using a transoral anterograde progression with a rigid pharyngoscope and a retrograde progression with an extra-slim nasal endoscope using the percutaneous gastrostomy already in place. Using both transillumination and direct visualisation from both sides of the complete stenosis patency was restored between the neopharynx and the oesophagus. Despite the use of an endoprosthesis, the complete PES recurred and the technique had to be performed a second time. Illustrating the complexity of the case different types of endoprosthesis and several dilations had to be performed for our patient to achieve and maintain a normal oral intake. This case report illustrates that even in complicated recurrent radiation-induced complete PES a CARD can be performed safely and successfully using different types of endoprosthesis.
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Affiliation(s)
- Paulo Castro Soares
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Salim Bouayed
- Department of Otolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Pavel Dulguerov
- Department of Otolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Jean-Louis Frossard
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland
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19
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Perbtani Y, Suarez AL, Wagh MS. Emerging techniques and efficacy of endoscopic esophageal reconstruction and lumen restoration for complete esophageal obstruction. Endosc Int Open 2016; 4:E136-42. [PMID: 26878039 PMCID: PMC4751005 DOI: 10.1055/s-0041-107898] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Complete esophageal obstruction (CEO) is a rare occurrence characterized by progressive esophageal stricture, which eventually causes lumen obliteration. With recent advances in flexible endoscopy, various innovative techniques exist for restoring luminal continuity. The primary aim of this study was to assess the efficacy and safety of patients undergoing combined antegrade-retrograde endoscopic dilation for CEO at our institution. The secondary aim was to review and highlight emerging techniques, outcomes, and adverse events after endoscopic treatment of CEO. PATIENTS AND METHODS Our electronic endoscopy database was retrospectively reviewed to identify patients who underwent combined antegrade and retrograde endoscopy for CEO. Patient and procedural data collected included gender, age, technical success, pre- and post-dysphagia scores, and adverse events. RESULTS Six patients (67 % male, mean age 71.6 years [range 63 - 80]) underwent technically successful esophageal reconstruction with combined antegrade-retrograde endoscopy. All patients noted improvement in dysphagia with mean pre-procedure dysphagia score of 4 reduced to 1.33 (range 0 - 3) post-procedure. There were no adverse events and mean follow-up time was 17.3 months (range 3 - 48). CONCLUSIONS Combined antegrade and retrograde endoscopic therapy for CEO is feasible and safe. We present our experience with endoscopic management of complete esophageal obstruction, and highlight emerging techniques, outcomes and adverse events related to this minimally invasive modality.
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Affiliation(s)
- Yaseen Perbtani
- Department of Medicine University of Florida, Gainesville, Florida, United States
| | - Alejandro L. Suarez
- Division of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Mihir S. Wagh
- Division of Gastroenterology, University of Florida, Gainesville, Florida, United States,Corresponding author Mihir S. Wagh, MD, FACG, FASGE. Interventional Endoscopy Division of GastroenterologyUniversity of Colorado1635 Aurora Court, F735Aurora, CO 80045USA1+720-848-27861+720-848-2749
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20
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Lin YC, Hsiao JR, Lee YC. Patch esophagoplasty with a free proximal lateral leg flap for focal stricture of the cervical esophagus: A case report. Microsurgery 2016; 37:426-430. [PMID: 26800296 DOI: 10.1002/micr.30028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 12/16/2015] [Accepted: 12/31/2015] [Indexed: 12/15/2022]
Abstract
Esophageal stricture after surgery or trauma is a major reason for poor oral nutrition, body-weight loss, and general damage to health. Patch esophagoplasty, after repeated failed dilation attempts, is recommended for focal esophageal strictures. In this report, we present a case in which a free proximal lateral leg flap was used for reconstruction of focal stricture of the cervical esophagus. A 62-year-old man developed progressive dysphagia after hypopharyngeal cancer ablation and adjuvant radiotherapy. He was referred for surgical interventions after repeated failed dilation attempts. Preoperative evaluation revealed a 3-cm segment stricture of the cervical esophagus without evidence of an additional distal stricture. Patch esophagoplasty with free tissue transfer was planned. After the stricture site had been explored, the fibrotic tissue was resected. A pathology report confirmed no evidence of malignancy. The resultant defect in an otherwise healthy posterior esophageal wall was reconstructed using a proximal lateral leg flap. Recovery was uneventful and the functional outcome was satisfactory at the 6-month follow-up. For the radiated patients with cervical esophageal focal strictures, we introduced a novel use of the proximal lateral leg flap in patch esophagoplasty because of its unnoticeable donor site morbidity and its thin and pliable nature. © 2016 Wiley Periodicals, Inc. Microsurgery 37:426-430, 2017.
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Affiliation(s)
- You-Cheng Lin
- Division of Plastic and Reconstructive Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jenn-Ren Hsiao
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Chou Lee
- Division of Plastic and Reconstructive Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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21
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Fountain MD, Abernathy LM, Lonardo F, Rothstein SE, Dominello MM, Yunker CK, Chen W, Gadgeel S, Joiner MC, Hillman GG. Radiation-Induced Esophagitis is Mitigated by Soy Isoflavones. Front Oncol 2015; 5:238. [PMID: 26557504 PMCID: PMC4617099 DOI: 10.3389/fonc.2015.00238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/08/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction Lung cancer patients receiving radiotherapy present with acute esophagitis and chronic fibrosis, as a result of radiation injury to esophageal tissues. We have shown that soy isoflavones alleviate pneumonitis and fibrosis caused by radiation toxicity to normal lung. The effect of soy isoflavones on esophagitis histopathological changes induced by radiation was investigated. Methods C57BL/6 mice were treated with 10 Gy or 25 Gy single thoracic irradiation and soy isoflavones for up to 16 weeks. Damage to esophageal tissues was assessed by hematoxylin–eosin, Masson’s Trichrome and Ki-67 staining at 1, 4, 10, and 16 weeks after radiation. The effects on smooth muscle cells and leukocyte infiltration were determined by immunohistochemistry using anti-αSMA and anti-CD45, respectively. Results Radiation caused thickening of esophageal tissue layers that was significantly reduced by soy isoflavones. Major radiation alterations included hypertrophy of basal cells in mucosal epithelium and damage to smooth muscle cells in muscularis mucosae as well as disruption of collagen fibers in lamina propria connective tissue with leukocyte infiltration. These effects were observed as early as 1 week after radiation and were more pronounced with a higher dose of 25 Gy. Soy isoflavones limited the extent of tissue damage induced by radiation both at 10 and 25 Gy. Conclusion Soy isoflavones have a radioprotective effect on the esophagus, mitigating the early and late effects of radiation injury in several esophagus tissue layers. Soy could be administered with radiotherapy to decrease the incidence and severity of esophagitis in lung cancer patients receiving thoracic radiation therapy.
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Affiliation(s)
- Matthew D Fountain
- Department of Immunology and Microbiology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA ; Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
| | - Lisa M Abernathy
- Department of Immunology and Microbiology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA ; Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
| | - Fulvio Lonardo
- Department of Pathology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
| | - Shoshana E Rothstein
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
| | - Michael M Dominello
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
| | - Christopher K Yunker
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
| | - Wei Chen
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
| | - Shirish Gadgeel
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
| | - Michael C Joiner
- Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
| | - Gilda G Hillman
- Department of Immunology and Microbiology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA ; Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine , Detroit, MI , USA
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Gavriel H, Chowdhury AT, Duong C, Spillane J, Sizeland A. Poor functional performance following bidirectional dilatation of severe post radiation oesophageal stricture. Acta Otolaryngol 2015; 135:629-34. [PMID: 25812431 DOI: 10.3109/00016489.2015.1006794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Bidirectional oesophageal dilatation for severe chemoradiation-induced oesophageal strictures is efficacious in improving luminal patency but ineffective in relieving functional dysphagia. OBJECTIVE To assess the efficacy of bidirectional oesophageal dilatation in the severely strictured oesophagus induced by radiation therapy following the treatment of head and neck malignancies. METHODS The study design was a case series in the setting of a tertiary cancer centre. We carried out a retrospective analysis of patients who underwent bidirectional oesophageal dilatation for oesophageal stricture secondary to radiation therapy for head and neck malignancies over a 5-year period. The parameters of the primary tumour, evaluation of preoperative and postoperative oesophageal dysfunction and complications of the procedure were evaluated. RESULTS There were nine episodes of bidirectional oesophageal dilatation among five patients with complete or severe oesophageal obstruction. Mean age was 63 years. The procedure was uneventful in all but one patient who was found to have postoperative mediastinitis, and healed completely. Four patients had persistent dysphagic symptoms despite post dilatation video fluoroscopy failing to reveal any significant narrowing of the oesophageal lumen.
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Affiliation(s)
- Haim Gavriel
- Department of Surgical Oncology, Peter MacCallum Cancer Centre , Melbourne , Australia
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MacNeil S, Liu K, Shariff S, Thind A, Winquist E, Yoo J, Nichols A, Fung K, Hall S, Garg A. Secular trends in the survival of patients with laryngeal carcinoma, 1995-2007. Curr Oncol 2015; 22:e85-99. [PMID: 25908925 PMCID: PMC4399628 DOI: 10.3747/co.22.2361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Recent reports suggest a decline over time in the survival of patients newly diagnosed with laryngeal cancer in spite of developments in treatment practices. Our study set out to determine whether the survival of patients with laryngeal cancer in Ontario has changed over time. METHODS This population-based cohort study of patients diagnosed with laryngeal cancer in the province of Ontario between 1995 and 2007 used data extracted from linked provincial administrative and registry databases. Its main outcomes were overall survival, laryngectomy-free survival, and survival ratio relative to an age- and sex-matched general population. RESULTS The 4298 patients newly diagnosed with laryngeal cancer during the period of interest were predominantly men (n = 3615, 84.1%) with glottic cancer (n = 2787, 64.8%); mean age in the group was 66 years (interquartile range: 59-74 years). Patient demographics did not significantly change over time. Overall, 5-year survival was 57.4%; laryngectomy-free survival was 45.4%. Comparing patients from three eras (1995-1998, 1999-2003, 2004-2007) and adjusting for age, sex, and comorbidity status, we observed no differences in overall survival or laryngectomy-free survival over time. The 5-year relative survival ratio for patients with laryngeal cancer compared with an age- and sex-matched group from the general population was 81.1% for glottic cancer and 44.5% for supraglottic cancer. CONCLUSIONS In patients with a new diagnosis of laryngeal cancer, overall and laryngectomy-free survival have remained unchanged since the mid-1990s. New methods to improve survival and the rate of laryngeal preservation in this patient population are needed.
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Affiliation(s)
- S.D. MacNeil
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, ON
- Institute for Clinical and Evaluative Sciences, Toronto, ON
- Department of Oncology, Western University, London, ON
| | - K. Liu
- Institute for Clinical and Evaluative Sciences, Toronto, ON
| | - S.Z. Shariff
- Institute for Clinical and Evaluative Sciences, Toronto, ON
| | - A. Thind
- Institute for Clinical and Evaluative Sciences, Toronto, ON
- Department of Epidemiology and Biostatistics, Western University, London, ON
- Department of Family Medicine, Western University, London, ON
| | - E. Winquist
- Department of Oncology, Western University, London, ON
| | - J. Yoo
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, ON
- Department of Oncology, Western University, London, ON
| | - A. Nichols
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, ON
- Department of Oncology, Western University, London, ON
| | - K. Fung
- Department of Otolaryngology–Head and Neck Surgery, Western University, London, ON
- Department of Oncology, Western University, London, ON
| | - S. Hall
- Institute for Clinical and Evaluative Sciences, Toronto, ON
- Department of Otolaryngology–Head and Neck Surgery, Cancer Care and Epidemiology, Queen’s University, Kingston, ON
| | - A.X. Garg
- Institute for Clinical and Evaluative Sciences, Toronto, ON
- Department of Epidemiology and Biostatistics, Western University, London, ON
- Division of Nephrology, Department of Medicine, Western University, London, ON
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Chahla E, Cheesman A, Hammami M, Taylor JR, Poddar N, Garrett RW, Alkaade S. A unique case of a patient with rectal cancer who developed benign esophageal stenosis after localized rectal radiation and systemic chemotherapy. Case Rep Gastroenterol 2015; 9:44-8. [PMID: 25802497 PMCID: PMC4357684 DOI: 10.1159/000376608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Acute esophagitis and esophageal strictures typically occur after local radiation therapy to the thoracic field. Toxicity is usually limited to the field of radiation and potentially augmented by concomitant use of chemotherapy, however esophageal stricturing due to chemotherapy alone is exceedingly rare. Gastrointestinal toxicity has been previously reported in the setting of 5-fluorouracil (5-FU)-based chemotherapy with abnormal thymidylate synthase or dihydropyrimidine dehydrogenase activities. We present a unique case of isolated chemotherapy-induced esophageal stricture in the setting of stage IIIa rectal adenocarcinoma which presented shortly after initiation of treatment with 5-FU-based chemotherapy in a patient with normal thymidylate synthase and dihydropyrimidine dehydrogenase assays. These findings prompt further investigation of pathways and potential risk factors leading to esophageal toxicity in patients treated with 5-FU-based chemotherapy.
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Affiliation(s)
- Elie Chahla
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Antonio Cheesman
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Muhammad Hammami
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Jason R Taylor
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Nishant Poddar
- Division of Hematology and Oncology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Robert W Garrett
- Department of Radiology, Saint Louis University School of Medicine, St. Louis, Mo., USA
| | - Samer Alkaade
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Mo., USA
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Francis DO, Hall E, Dang JH, Vlacich GR, Netterville JL, Vaezi MF. Outcomes of serial dilation for high-grade radiation-related esophageal strictures in head and neck cancer patients. Laryngoscope 2014; 125:856-62. [PMID: 25345779 DOI: 10.1002/lary.24987] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 09/18/2014] [Accepted: 09/29/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Dysphagia and esophageal stricture are frequent consequences of treatment for head and neck cancer. This study examines the effectiveness of the anterograde-retrograde rendezvous procedure and serial dilations in reestablishing esophageal patency to allow return to oral diet and gastrostomy tube removal in a cohort of patients with complete or near-complete esophageal stricture following nonsurgical cancer treatment. STUDY DESIGN Retrospective review of patients treated with radiation therapy with or without concurrent chemotherapy presented with complete or near-complete esophageal stricture. Patients underwent serial dilations using combined anterograde-retrograde dilation (rendezvous) techniques. METHODS Medical records of patients having undergone treatment between 2006 and 2012 were reviewed, and semistructured interviews were also conducted to determine current swallowing function and actual patient experience. The primary outcome was swallowing improvement that allowed for return to oral diet and/or gastrostomy tube removal. Outcomes were compared between patients with complete and near-complete (<5 mm in diameter) strictures and univariate analysis performed to identify associations between patient, cancer, and treatment characteristics on odds of gastrostomy tube removal. RESULTS Twenty-four patients (median age 59.5 years, 63% male, 91% Caucasian) underwent treatment. Fifty percent of patients had complete occlusion of the esophageal lumen. The majority of patients (92%) underwent either anterograde (54%) or combined antero-retrograde (38%) approach. Following a median (interquartile range) of 9 (6-20) dilation sessions, 42% of patients were able to return to an oral diet and/or had their gastrostomy tube removed. This outcome was independent of whether the stricture was complete or near complete (P = .67). Of patients who had their gastrostomy tubes removed, only 33.3% had ever smoked, compared to 92.3% of those whose tubes were not discharged (P = .007). CONCLUSIONS Recannulation is possible even in cases of complete or near-complete stricture. Several factors appear to impact the likelihood of successful outcome, but in this study, only patients with a history of smoking had a significantly lower likelihood of return to full oral diet.
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Affiliation(s)
- David O Francis
- Department of Otolaryngology, Nashville, Tennessee; Bill Wilkerson Center, Center for Surgical Quality & Outcomes Research, Nashville, Tennessee
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26
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Hassan WA, Darwish K, Shalan IM, Elbaki LA, Elmohsen EA, Sayed WH. Aetiologic mechanisms of dysphagia in lung cancer: A case series. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2013.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Silver N, Gal TJ. Endoscopic CO2 laser management of chemoradiation-related cricopharyngeal stenosis. Ann Otol Rhinol Laryngol 2014; 123:252-6. [PMID: 24595625 DOI: 10.1177/0003489414525019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Treatment of head and neck cancer with chemoradiation (CRT) can result in strictures of the cervical esophagus, often at the level of the cricopharyngeus. The objective of this study is to assess the feasibility of endoscopic CO2 laser cricopharyngeal myotomy for stricture ablation in the setting of prior CRT. METHODS A retrospective review of patients who underwent endoscopic CO2 laser cricopharyngeal myotomy for dysphagia after radiation for squamous cell carcinoma of the head and neck (SCCHN). Pre- and postoperative barium swallow and swallowing assessment were performed before and after surgery. Outcomes and complication rates were examined. RESULTS Endoscopic CO2 laser cricopharyngeal myotomy was performed in 10 patients with dysphagia secondary to cricopharyngeal stenosis/stricture, which developed following treatment for SCCHN with chemoradiation. All patients demonstrated radiographic improvement in stricture, with complete resolution of stricture in 9 of 10 patients. All patients noted improvement in dysphagia with 9 of 10 patients demonstrating significant advancement of diet by modified barium swallow. No complications were observed. CONCLUSION Endoscopic CO2 cricopharyngeal myotomy can be performed safely in the setting of prior CRT, with significant improvement in swallowing in select patients. Indications and technical considerations will be discussed.
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Affiliation(s)
- Natalie Silver
- Department of Otolaryngology, University of Kentucky, Lexington, Kentucky, USA
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Jørgensen AYS, Maraldo MV, Brodin NP, Aznar MC, Vogelius IR, Rosenschöld PMA, Petersen PM, Specht L. The effect on esophagus after different radiotherapy techniques for early stage Hodgkin's lymphoma. Acta Oncol 2013; 52:1559-65. [PMID: 24047340 DOI: 10.3109/0284186x.2013.813636] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The cure rate of early stage Hodgkin's lymphoma (HL) is excellent; investigating the late effects of treatment is thus important. Esophageal toxicity is a known side effect in patients receiving radiotherapy (RT) to the mediastinum, although little is known of this in HL survivors. This study investigates the dose to the esophagus in the treatment of early stage HL using different RT techniques. Estimated risks of early esophagitis, esophageal stricture and cancer are compared between treatments. MATERIAL AND METHODS We included 46 patients ≥ 15 years with supradiaphragmatic, clinical stage I-II HL, who received chemotherapy followed by involved node RT (INRT) to 30.6 Gy at our institution. INRT was planned with three-dimensional conformal RT (3DCRT). For each patient a volumetric modulated arc therapy (VMAT), proton therapy (PT) and mantle field (MF) treatment plan was simulated. Mean, maximum and minimum dose to the esophagus were extracted from the treatment plans. Risk estimates were based on dose-response models from clinical series with long-term follow-up. Statistical analyses were performed with repeated measures ANOVA using Bonferroni corrections. RESULTS Mean dose to the esophagus was 16.4, 16.4, 14.7 and 34.2 Gy (p < 0.001) with 3DCRT, VMAT, PT and MF treatment, respectively. No differences were seen in the estimated risk of developing esophagitis, stricture or cancer with 3DCRT compared to VMAT (p = 1.000, p = 1.000, p = 0.356). PT performed significantly better with the lowest risk estimates on all parameters compared to the photon treatments, except compared to 3DCRT for stricture (p = 0.066). On all parameters the modern techniques were superior to MF treatment (p < 0.001). CONCLUSIONS The estimated dose to the esophagus and the corresponding estimated risks of esophageal complications are decreased significantly with highly conformal RT compared to MF treatment. The number of patients presenting with late esophageal side effects will, thus, likely be minimal in the future.
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Affiliation(s)
- Anni Y S Jørgensen
- Department of Radiation Oncology, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
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Abstract
Pharyngo-oesophageal stricture (PES) is a serious complication that occurs in up to a third of patients treated with external beam radiotherapy or combined chemoradiotherapy for head and neck cancer. This entity is under-reported and as a result, our understanding of the pathophysiology and prevention of this complication is restricted. This Review presents the knowledge so far on radiation-related and non-radiation-related risk factors for PES, including tumour stage and subsite, patient age, and comorbidities. The interventions to decrease this toxicity are discussed, including early detection of PES, initiation of an oral diet, and protection of swallowing structures from high-dose radiation. We discuss various treatment options, including swallowing exercises and manoeuvres, endoscopic dilatations, and for advanced cases, oesophageal reconstruction. Study of the subset of patients who develop this toxicity and early recognition and intervention of this pathological change in future trials will help to optimise treatment of these patients.
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Chapuy CI, Annino DJ, Tishler RB, Haddad RI, Snavely A, Goguen LA. Success of endoscopic pharyngoesophageal dilation after head and neck cancer treatment. Laryngoscope 2013; 123:3066-73. [PMID: 23775806 DOI: 10.1002/lary.24268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/02/2013] [Accepted: 05/30/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess clinical success and safety of endoscopic pharyngoesophageal dilation after chemoradiation or radiation for head and neck cancer and to identify variables associated with dilation failure. STUDY DESIGN Case series with chart review. METHODS Between 2000 and 2008, a total of 111 patients treated with chemoradiation or radiation for head and neck cancer with subsequent pharyngoesophageal stenosis requiring endoscopic dilation were identified. Patients were evaluated for endoscopic dilation technique, severity of stenosis, technical and clinical success, and intra- and postoperative complications. The Diet/GT score (range, 1-5) was utilized to measure swallow success. Variables associated with dilation failure were analyzed by univariate and multivariate logistic regression. RESULTS There were 271 dilations analyzed, with 42 combined antegrade retrograde dilations, 208 dilations over a guidewire, and 21 dilations without guidewire. Intraoperative patency and successful dilation of the stenotic segment was achieved in 95% of patients. A Diet/GT score of 5 (gastrostomy tube removed and soft/regular diet) was attained in 84 of 111 (76%) patients. Safety analysis showed complications occurred in 9% of all dilations. Perforations were noted in 4% of all procedures, with only two esophageal perforations requiring significant intervention. Multiple dilations were associated with an increased risk for perforations. Further logistic regression analyses revealed that the number of dilations was indicating a poor outcome and low Diet/GT score. CONCLUSIONS Pharyngoesophageal stenosis, occurring after chemoradiation and radiation treatment, can be successfully and safely treated with endoscopic dilation techniques. Patients with restenosis, requiring multiple dilations, have a higher risk of persistent dysphagia.
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Affiliation(s)
- Claudia I Chapuy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Paleri V, Roe JWG, Strojan P, Corry J, Grégoire V, Hamoir M, Eisbruch A, Mendenhall WM, Silver CE, Rinaldo A, Takes RP, Ferlito A. Strategies to reduce long-term postchemoradiation dysphagia in patients with head and neck cancer: An evidence-based review. Head Neck 2013; 36:431-43. [DOI: 10.1002/hed.23251] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 12/22/2022] Open
Affiliation(s)
- Vinidh Paleri
- Department of Otolaryngology-Head and Neck Surgery; Newcastle upon Tyne Hospitals; Newcastle upon Tyne United Kingdom
| | - Justin W. G. Roe
- Head and Neck Unit; The Royal Marsden Hospital NHS Foundation Trust; Fulham Road London UK
| | - Primož Strojan
- Department of Radiation Oncology; Institute of Oncology; Ljubljana Slovenia
| | - June Corry
- Division of Radiation Oncology; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Vincent Grégoire
- Department of Radiation Oncology; Université Catholique de Louvain, St Luc University Hospital and Cancer Center; Brussels Belgium
| | - Marc Hamoir
- Department of Head and Neck Surgery; Université Catholique de Louvain, St Luc University Hospital and Cancer Center; Brussels Belgium
| | - Avraham Eisbruch
- Department of Radiation Oncology; University of Michigan; Ann Arbor Michigan
| | | | - Carl E. Silver
- Departments of Surgery and Otolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine, Montefiore Medical Center; Bronx New York
| | | | - Robert P. Takes
- Department of Otolaryngology-Head and Neck Surgery; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
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Li Y, Gobin AM, Dryden GW, Kang X, Xiao D, Li SP, Zhang G, Martin RCG. Infrared light-absorbing gold/gold sulfide nanoparticles induce cell death in esophageal adenocarcinoma. Int J Nanomedicine 2013; 8:2153-61. [PMID: 23818775 PMCID: PMC3693818 DOI: 10.2147/ijn.s37140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Gold nanoparticles and near infrared-absorbing light are each innocuous to tissue but when combined can destroy malignant tissue while leaving healthy tissue unharmed. This study investigated the feasibility of photothermal ablation therapy for esophageal adenocarcinoma using chitosan-coated gold/gold sulfide (CS-GGS) nanoparticles. A rat esophagoduodenal anastomosis model was used for the in vivo ablation study, and three human esophageal cell lines were used to study the response of cancer cells and benign cells to near infrared light after treatment with CS-GGS. The results indicate that both cancerous tissue and cancer cells took up more gold nanoparticles and were completely ablated after exposure to near infrared light. The benign tissue and noncancerous cells showed less uptake of these nanoparticles, and remained viable after exposure to near infrared light. CS-GGS nanoparticles could provide an optimal endoluminal therapeutic option for near infrared light ablation of esophageal cancer.
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Affiliation(s)
- Yan Li
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
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Ghazali N, Shaw RJ, Rogers SN, Risk JM. Genomic determinants of normal tissue toxicity after radiotherapy for head and neck malignancy: a systematic review. Oral Oncol 2012; 48:1090-100. [PMID: 22939215 DOI: 10.1016/j.oraloncology.2012.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 07/31/2012] [Accepted: 08/01/2012] [Indexed: 01/06/2023]
Abstract
Interindividual variations in radiotoxicity responses exist despite uniform treatment protocols. It is speculated that normal genetic variants, particularly single nucleotide polymorphisms (SNPs) may influence normal head and neck (HN) tissue radiotoxicity. This first-ever systematic review was undertaken to evaluate the association of SNPs with normal HN tissues radiotoxicity. Multiple databases (1950-February 2012) were reviewed using a combination of related keywords and MeSH terms. All published HN radiotoxicity studies with sufficient relevant data for extraction were included. The outcomes evaluated were acute and late radiotoxicity endpoints. Methodological quality assessment based on the STrengthening the REporting of Genetic Association (STREGA) statement was performed. Seven articles from 692 articles searched fulfilled the eligibility criteria. Recruited sample sizes were small (range, 32-140). There were 5/7 case-control studies. All studies used multimodality treatment with heterogeneous radiation parameters. Candidate gene approach was used in all studies. Fourteen SNPs from 9 genes were evaluated from the following pathways: DNA damage response, radiation fibrogenesis and oxidative/xenobiotic metabolism. Acute radiotoxicity events were associated with SNPs of DNA repair genes (OR, 3.01-4.08). SNPs of TGFβ1 were associated with osteoradionecrosis (OR, 4.2) and subcutaneous fibrosis. Genetic association studies in HN radiotoxicity currently provide hypothesis-generating findings that require validation in larger studies. Future studies must incorporate critical methodological issues and technological improvements, including using a genome-wide approach. Headway is possible through case-pooling of existing clinical trial data which could create a larger sample size of well-characterized treatment and endpoints. Also, on-going HN cancer clinical trials should consider extending their toxicity evaluation to include genetic association studies.
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Affiliation(s)
- Naseem Ghazali
- Regional Maxillofacial Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK.
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Mullen TD, Sharma AK, Varma AK. Cervical osteomyelitis after placement of a self-expanding plastic stent for palliation of dysphagia associated with chemoradiation-induced esophageal strictures. Head Neck 2012; 35:E197-201. [PMID: 22367919 DOI: 10.1002/hed.22975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Esophageal strictures are a common sequela of chemoradiation and/or surgery to the head and neck cancers and can lead to stenosis and significant dysphagia. Endoscopic dilation endoscopic and placement of self-expanding stents are often to used relieve dysphagia symptoms. However, these stents are not without risks and complications. METHODS We present a case of a 58-year-old man who had the rare complication of cervical osteomyelitis as a result of plastic esophageal stent placement for palliation of chemoradiation-induced strictures. RESULTS The patient was successfully managed with immobilization of the cervical spine in a halo vest and appropriate antibiotics. CONCLUSION To the best of our knowledge, this is the first reported case of cervical spine osteomyelitis after self-expanding plastic stent (SEPS) placement for esophageal stricture. It was successfully treated with immobilization and antibiotic therapy. The treating physician should be aware of this rare complication to make an early diagnosis. Literature on esophageal stent-induced cervical osteomyelitis is reviewed.
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Affiliation(s)
- Thomas D Mullen
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
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36
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Chapuy CI, Annino DJ, Snavely A, Li Y, Tishler RB, Norris CM, Haddad RI, Goguen LA. Swallowing function following postchemoradiotherapy neck dissection: review of findings and analysis of contributing factors. Otolaryngol Head Neck Surg 2011; 145:428-34. [PMID: 21493276 DOI: 10.1177/0194599811403075] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assesses swallowing function following chemoradiotherapy and neck dissection in head and neck cancer patients and investigates clinical, treatment, and neck dissection factors associated with dysphagia. STUDY DESIGN Case series with chart review. SETTING Tertiary care center. SUBJECTS AND METHODS Eighty-eight patients undergoing neck dissection after chemoradiotherapy for advanced head and neck cancer were reviewed. Dysphagia outcome measures included weight loss, diet, gastrostomy tube (GT) dependency,and video swallow findings of aspiration or stenosis. In addition,the researchers created a Diet/GT Scale, with scores ranging from 1 to 5. Univariate and multivariate analysis of clinical, treatment, or neck dissection factors potentially associated with dysphagia outcome measures was undertaken. RESULTS Peak mean weight loss was 17% at 6 months after chemoradiotherapy. At 12 months, a soft/regular diet was taken by 78 of 88 patients (89%), and only 1 of 88 patients (1%)was nil per os. Gastrostomy tube dependence at 6, 12, and 24 months was 53%, 25%, and 10%, respectively. The Diet/GT score was 5 (gastrostomy tube removed and soft/regular diet)for 47% at 6 months, 74% at 12 months, and 89% at 24 months.Multivariate analyses revealed that higher tumor stage was associated with a lower Diet/GT score at 12 months (P = .02)and gastrostomy dependence at 12 months (P = .01) and 24 months (P = .04). CONCLUSION Despite the addition of neck dissection to chemoradiotherapy,nearly all patients took a soft or regular diet and reached a Diet/GT score of 5, and only 1% remained nil per os. A higher tumor stage is associated with a lower Diet/GT score and gastrostomy tube dependency beyond 12 months.
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Affiliation(s)
- Claudia I Chapuy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Wang JJ, Goldsmith TA, Holman AS, Cianchetti M, Chan AW. Pharyngoesophageal stricture after treatment for head and neck cancer. Head Neck 2011; 34:967-73. [PMID: 21953721 DOI: 10.1002/hed.21842] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 03/17/2011] [Accepted: 05/12/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to report the risk of pharyngoesophageal stricture after treatment for head and neck cancer. METHODS Human studies on radiation therapy with or without chemotherapy for head and neck cancer published in peer-reviewed journals with assessment of pharyngoesophageal stricture with barium swallow or endoscopy were included. RESULTS A total of 4727 patients from 26 studies treated between 1989 and 2008 were eligible for analysis. The reported overall risk of stricture was 7.2%. The risks of pharyngoesophageal stricture in both conventional and intensity-modulated radiation therapy (IMRT) studies were 5.7% and 16.7%, respectively (p < .001). Use of concurrent (p < .001) and taxane (p = .01) chemotherapy was associated with the IMRT technique. Prospective studies reported a 3.3-fold increased risk of stricture compared with that of retrospective studies (odds ratio: 3.3; 95% confidence interval: 2.3-4.8; p < .001). CONCLUSIONS Pharyngoesophageal stricture after IMRT and chemotherapy treatment for head and neck cancer is not uncommon. Videofluoroscopic swallow study should be performed prospectively to evaluate swallowing function.
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Affiliation(s)
- Jing Jing Wang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Anterograde-retrograde rendezvous approach for radiation-induced complete upper oesophageal sphincter stenosis: case report and literature review. The Journal of Laryngology & Otology 2011; 125:761-4. [PMID: 21693080 DOI: 10.1017/s0022215111001058] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Strictures of the hypopharynx and oesophagus are frequently observed following (chemo)radiation. Anterograde dilatation of a complete stenosis carries a high risk of perforation. An alternative is described: a combined anterograde-retrograde approach. CASE REPORT A 75-year-old man developed complete stenosis of the oesophageal inlet after primary radiotherapy for laryngeal carcinoma and full percutaneous endoscopic gastrostomy feeding. To prevent creation of a false route into the mediastinum, a dilatation wire was introduced in a retrograde fashion into the oesophagus, through the gastrostomy opening. The wire was endoscopically identified from the proximal side and then passed through a perforation created by CO2 laser. Anterograde dilatation was safely performed, and the patient returned to a normal diet. There is consensus in the literature that blind anterograde dilatation carries a high risk of perforation; therefore, an anterograde-retrograde rendezvous technique is advisable. CONCLUSION In cases of complete obstruction of the oesophageal inlet, anterograde-retrograde dilatation represents a safe technique with which to restore enteric continuity.
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Moon SH, Jung YS, Ryu JS, Choi SW, Park JY, Yun T, Lee SH, Cho KH. Outcomes of Postoperative Simultaneous Modulated Accelerated Radiotherapy for Head-and-Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2011; 81:140-9. [DOI: 10.1016/j.ijrobp.2010.04.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 04/20/2010] [Accepted: 04/23/2010] [Indexed: 10/19/2022]
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Fowlkes J, Zald PB, Andersen P. Management of complete esophageal stricture after treatment of head and neck cancer using combined anterograde retrograde esophageal dilation. Head Neck 2011; 34:821-5. [PMID: 22127917 DOI: 10.1002/hed.21826] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 03/29/2011] [Accepted: 04/05/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Complete esophageal stricture is a difficult problem to manage. There is limited literature to support clinical decision-making. To evaluate outcomes and efficacy, we performed a retrospective medical chart review of patients who received combined anterograde retrograde esophageal dilation (CARD) between 2002 and 2009 at our institution. METHODS Fifteen patients were identified who developed a stricture requiring CARD after treatment for head and neck cancers. Outcomes were pretreatment and posttreatment diet, gastrostomy tube status, and operative complications. RESULTS Six of 15 patients were gastrostomy tube-free at last follow-up and 11 of 15 patients were taking oral nutrition. There were 4 complications. One patient died. Two gastrostomy tube site complications occurred. One patient sustained a dental injury. CONCLUSION CARD offers benefit to most patients. Despite risks associated with the procedure, CARD should be considered by the clinician and patient in management of complete esophageal stricture.
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Affiliation(s)
- Jonathan Fowlkes
- Department of Otolaryngology, Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Silander E, Nyman J, Bove M, Johansson L, Larsson S, Hammerlid E. Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer - a randomized study. Head Neck 2011; 34:1-9. [DOI: 10.1002/hed.21700] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 09/14/2010] [Accepted: 10/22/2010] [Indexed: 01/22/2023] Open
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Efficacy and toxicity of chemoradiotherapy using intensity-modulated radiotherapy for unknown primary of head and neck. Int J Radiat Oncol Biol Phys 2010; 80:1405-11. [PMID: 21177045 DOI: 10.1016/j.ijrobp.2010.04.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Revised: 04/05/2010] [Accepted: 04/06/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary (HNCUP). Bilateral neck radiotherapy with mucosal axis irradiation is widely used, with or without chemotherapy and/or surgical resection. Intensity-modulated radiotherapy (IMRT) is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for HNCUP. PATIENTS AND MATERIALS A retrospective study of all patients treated at the Dana-Farber Cancer Institute for HNCUP with IMRT between August 2004 and January 2009. The primary endpoint was overall survival; the secondary endpoints were locoregional and distant control, and acute and chronic toxicity. RESULTS A total of 24 patients with HNCUP were included. Of these patients, 22 had Stage N2 disease or greater. All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. Of the 24 patients, 22 received concurrent chemotherapy, and 7 (29%) also underwent induction chemotherapy. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy. With a median follow-up of 2.1 years, the 2-year actuarial overall survival and locoregional control rate was 92% and 100%, respectively. Only 25% of the patients had Grade 2 xerostomia, although 11 patients (46%) required esophageal dilation for stricture. CONCLUSION In a single-institution series, IMRT-based chemoradiotherapy for HNCUP was associated with superb overall survival and locoregional control. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis.
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Farwell DG, Rees CJ, Mouadeb DA, Allen J, Chen AM, Enepekides DJ, Belafsky PC. Esophageal pathology in patients after treatment for head and neck cancer. Otolaryngol Head Neck Surg 2010; 143:375-8. [DOI: 10.1016/j.otohns.2010.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 04/20/2010] [Accepted: 05/06/2010] [Indexed: 01/31/2023]
Abstract
OBJECTIVE: To determine the prevalence of esophageal pathology following treatment for primary head and neck cancer (HNCA). STUDY DESIGN: Case series with planned data collection. SETTING: Academic medical practice. SUBJECTS AND METHODS: Subjects comprised HNCA survivors. Esophagoscopy was prospectively performed on 100 patients at least three months after treatment for HNCA. Patient demographics including cancer stage, cancer treatment, use of reflux medications, symptoms surveys, and esophageal findings were prospectively determined. RESULTS: The mean age of the cohort was 64 (± 10) years; 75 percent were male. The mean time between the end of treatment and endoscopy was 40 (± 51) months. Eighty-one percent of HNCA was advanced stage (3 or 4). The distribution of site of the primary HNCA was as follows: oropharynx (38%), larynx (33%), oral cavity (17%), unknown primary (10%), hypopharynx (1%), and nasopharynx (1%). Treatment modalities included surgery alone (15%), surgery with radiation (34%), radiation alone (6%), chemoradiation alone (24%), and chemoradiation with surgery (20%). The findings on esophagoscopy included peptic esophagitis (63%), stricture (23%), candidiasis (9%), Barrett metaplasia (8%), gastritis (4%), and carcinoma (4%). Only 13 percent had a normal esophagoscopy. CONCLUSION: Esophageal pathology is extremely common in patients treated for HNCA. These findings support routine esophageal screening after HNCA treatment. © 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.
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Affiliation(s)
- D. Gregory Farwell
- From the Department of Otolaryngology-Head and Neck Surgery, University of California Davis School of Medicine Sacramento, CA
| | - Catherine J. Rees
- Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Debbie A. Mouadeb
- From the Department of Otolaryngology-Head and Neck Surgery, University of California Davis School of Medicine Sacramento, CA
| | - Jacqueline Allen
- From the Department of Otolaryngology-Head and Neck Surgery, University of California Davis School of Medicine Sacramento, CA
| | - Allen M. Chen
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Danny J. Enepekides
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Medical Center, Toronto, Ontario, Canada
| | - Peter C. Belafsky
- From the Department of Otolaryngology-Head and Neck Surgery, University of California Davis School of Medicine Sacramento, CA
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Ahlberg A, al-Abany M, Alevronta E, Friesland S, Hellborg H, Mavroidis P, Lind BK, Laurell G. Esophageal stricture after radiotherapy in patients with head and neck cancer: experience of a single institution over 2 treatment periods. Head Neck 2010; 32:452-61. [PMID: 19672963 DOI: 10.1002/hed.21201] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Risk factors for development of a stricture of the upper esophagus after radiotherapy for head and neck cancer are poorly defined. METHODS This was a retrospective case-control study of patients diagnosed and treated for esophageal stricture after radiotherapy for head and neck cancer. RESULTS The incidence of esophageal stricture after external beam radiation therapy (EBRT) was 3.3%. Seventy patients with stricture and 66 patients without stricture were identified. A multivariate analysis showed that there was increased risk of stricture in receiving enteral feeding during EBRT or in receiving a mean dose of >45 Gy to the upper esophagus. CONCLUSIONS Enteral feeding during EBRT is strongly associated with the development of stricture of the esophagus, as is a mean dose of >45 Gy to the upper esophagus. Treatment of the stricture with Savary-Gilliard bougienage or through scope balloon dilatation is safe and successful but often has to be repeated.
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Affiliation(s)
- Alexander Ahlberg
- Department of Otolaryngology, Karolinska University Hospital, Stockholm, Sweden.
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Chen AM, Li BQ, Jennelle RLS, Lau DH, Yang CC, Courquin J, Vijayakumar S, Purdy JA. Late esophageal toxicity after radiation therapy for head and neck cancer. Head Neck 2010; 32:178-83. [PMID: 19536858 DOI: 10.1002/hed.21164] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the incidence of esophageal toxicity after radiation therapy for head and neck cancer. METHODS The records of 211 patients treated by radiation therapy for head and neck cancer were reviewed to identify those with dysphagia lasting more than 90 days after therapy. Late toxicity criteria established by the Radiation Therapy Oncology Group were used to score the symptoms. RESULTS The incidence of grade 3+ esophageal toxicity at 3 and 6 months was 30% and 19%, respectively. The rate of gastrotomy-tube dependence at 3 and 6 months was 20% and 11%, respectively. Hypopharyngeal and unknown primary site (p = .01, for both), T4 disease (p = .01), and the use of concurrent chemotherapy (p = .001) were associated with grade 3+ esophageal toxicity and stricture formation. CONCLUSION A significant proportion of patients exhibit symptoms of esophageal toxicity after radiation therapy for head and neck cancer. Therefore, preventive strategies need further investigation.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California 95817, USA.
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Goguen LA, Norris CM, Jaklitsch MT, Sullivan CA, Posner MR, Haddad RI, Tishler RB, Burke E, Annino DJ. Combined antegrade and retrograde esophageal dilation for head and neck cancer-related complete esophageal stenosis. Laryngoscope 2010; 120:261-6. [PMID: 19998421 DOI: 10.1002/lary.20727] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Assess the safety and efficacy of combined antegrade and retrograde esophageal dilation (CARD) for complete esophageal stenosis following head and neck cancer (HNC) treatment. Review HNC dysphagia management. STUDY DESIGN Retrospective review of all patients undergoing CARD following HNC treatment between May 2001 and September 2008. METHODS Forty-five patients were identified for review. Parameters assessed included: ability to obtain intraoperative esophageal patency, complications, number of dilations required, diet, and gastric tube (GT) status. Factors associated with dilation failure were analyzed. RESULTS Intraoperative esophageal patency was obtained in 91% of patients. Median number of all dilations per patient was three. Median number of CARDs per patient was one. Resumption of oral intake occurred in 36/45 (80%). Diet results included: regular or soft diet 32/45 (71%), GT removal 27/45 (60%), and GT dependence with nothing by mouth 9/45 (20%). Laryngeal and pharyngeal stenosis, radionecrosis, tracheotomy dependence, and elongated stenosis were associated with dilation failure. Complications occurred in 18/63 (29%) CARD procedures: eight pneumomediastinum, seven GT site problems, two esophageal perforations, and one pharyngeal infection. All complications resolved spontaneously or with minimal interventions. CONCLUSIONS CARD was safe and effective. Intraoperative patency was achieved in 91% of patients. Eighty percent resumed oral intake. The majority of patients had their GTs removed and resumed a soft or regular diet. Dilation failure was associated with laryngeal, pharyngeal, and excessively long esophageal stenosis, often resulting from radionecrosis. Complications were minor. CARD should be considered before relegating patients with complete esophageal stenosis to chronic GT dependence or subjecting them to laryngopharyngo esophagectomy.
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Affiliation(s)
- Laura A Goguen
- Department of Surgery/Division of Otolaryngology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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Chemotherapy-induced oesophageal stricture in a child with osteosarcoma: a case report. CHEMOTHERAPY RESEARCH AND PRACTICE 2010; 2010:240763. [PMID: 22482050 PMCID: PMC3265240 DOI: 10.1155/2010/240763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 06/08/2010] [Indexed: 11/25/2022]
Abstract
Treatment with a combination of chemotherapy and radiotherapy is known to be associated with oesophageal stricture in both children and adults with malignancies. However, oesophageal stricture resulting from chemotherapy alone is a rare complication, with few reports on it. We experienced a rare paediatric case of oesophageal stricture caused by chemotherapy for osteosarcoma of the left distal femur. After completion of the chemotherapy course, the patient showed dysphagia caused by the oesophageal stricture and underwent balloon dilatation for the oesophageal stricture. After balloon dilatation, he was able to ingest solid foods, and the oesophagus was normal without any strictures at the last follow-up (20 months after ballooning). Therefore, oesophageal stricture should be considered as a complication of treatment with chemotherapy alone in children with malignancies.
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Dysphagia After Chemoradiotherapy for Head-and-Neck Squamous Cell Carcinoma: Dose–Effect Relationships for the Swallowing Structures. Int J Radiat Oncol Biol Phys 2009; 75:385-92. [DOI: 10.1016/j.ijrobp.2008.11.041] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 10/24/2008] [Accepted: 11/05/2008] [Indexed: 11/17/2022]
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Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol 2009; 266:1333-52. [PMID: 19597837 DOI: 10.1007/s00405-009-1028-2] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 06/18/2009] [Indexed: 11/24/2022]
Affiliation(s)
- Carl E Silver
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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