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Graf C, Reden M, Blasberg T, Knabe M, May A, Ell C, Wedi E, Wetzstein N, Michael F, Zeuzem S, Bojunga J, Friedrich-Rust M. Is a higher frequency of esophageal dilations more effective in treating benign esophageal strictures? Retrospective, multicenter study. Endosc Int Open 2024; 12:E78-E89. [PMID: 38205218 PMCID: PMC10781580 DOI: 10.1055/a-2117-8197] [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: 11/29/2022] [Accepted: 03/22/2023] [Indexed: 01/12/2024] Open
Abstract
Background and study aims There is still a lack of evidence-based recommendations concerning endoscopic bougienage in benign esophageal strictures. Our study aimed to assess the relevance of the time interval between endoscopic dilation (ED) sessions with regard to endoscopic and clinical response. Patients and methods We performed a retrospective study including patients treated with endoscopic bougienage for a benign esophageal stricture in two German centers. Primary endpoint was the number of ED until freedom from dysphagia was achieved. Secondary endpoints were analyses on reaching a diameter of 15 mm and on achieving clinical freedom from symptoms. Results Between April 2014 and March 2020, bougienage was used as the primary treatment for benign esophageal strictures in 238 patients (194 patients in Center 1; 44 patients in Center 2). Both centers differed in their endoscopic bougienage regime: Center 1 was characterized by a higher frequency of interventions compared to Center 2 (median: 2 days [range 1-28] vs. 10 days [range 1-41]; P <0.001). Clinical response was achieved significantly earlier using the high-frequency regimen in all patients except for those with post-radiogen strictures, who clinically benefited from a low-frequency ED program. Accordingly, patients receiving higher-frequency ED reached a significantly larger post-dilation diameter and considerably larger diameter differences. Conclusions The results of our study demonstrate that a treatment concept consisting of higher-frequency bougienages seems to be more effective in treating most types of esophageal stricture. Radiogenic strictures were the only types of stenoses that benefited from a lower frequency ED program.
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Affiliation(s)
- Christiana Graf
- Department of Internal Medicine I, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Monika Reden
- Department of Internal Medicine I, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Tobias Blasberg
- Department of Gastroenterology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Mate Knabe
- Department of Internal Medicine I, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andrea May
- Department of Gastroenterology, Asklepios Klinik Wiesbaden, Wiesbaden, Germany
| | - Christian Ell
- Department of Gastroenterology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Edris Wedi
- Department of Gastroenterology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Nils Wetzstein
- Department of Infectious Diseases, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Michael
- Department of Internal Medicine I, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine I, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Internal Medicine I, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine I, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
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Tajiki S, Joya M, Gharekhani V, Richeson D, Gholami S. A systematic review of the normal tissue complication probability models and parameters: Head and neck cancers treated with conformal radiotherapy. Head Neck 2023; 45:3146-3156. [PMID: 37767820 DOI: 10.1002/hed.27469] [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] [Received: 03/24/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 09/29/2023] Open
Abstract
This systematic review study aims to provide comprehensive data on different radiobiological models, parameters, and endpoints used for calculating the normal tissue complication probability (NTCP) based on clinical data from head and neck cancer patients treated with conformal radiotherapy. A systematic literature search was carried out according to the PRISMA guideline for the identification of relevant publications in six electronic databases of Embase, PubMed, Scopus, and Google Scholar to July 2022 using specific keywords in the paper's title and abstract. The initial search resulted in 1368 articles for all organs for the review article about the NTCP parameters. One hundred and seventy-eight articles were accepted for all organs with complete parameters for the mentioned models and finally, 20 head and neck cancer articles were accepted for review. Analysis of the studies shows that the Lyman-Kutcher-Burman (LKB) model properly links the NTCP curve parameters to the postradiotherapy endpoints. In the LKB model for esophagus, the minimum, and maximum corresponding parameters were reported as TD50 = 2.61 Gy with grade ≥3 radiation-induced esophagitis endpoints as the minimum TD50 and TD50 = 68 Gy as the maximum ones. nmin = 0.06, nmax = 1.04, mmin = 0.1, and mmax = 0.65, respectively. Unfortunately, there was not a wide range of published articles on other organs at risk like ear or cauda equina except Burman et al. (Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys Ther. 1991;21:123-135). Findings suggest that the validation of different radiobiological models and their corresponding parameters need to be investigated in vivo and in vitro for developing a more accurate NTCP model to be used for radiotherapy treatment planning optimization.
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Affiliation(s)
- Sareh Tajiki
- Radiotherapy Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Musa Joya
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahideh Gharekhani
- Department of Radiobiology, Faculty of Paramedical, Tehran University of Medical Sciences, Tehran, Iran
| | - Dylan Richeson
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Somayeh Gholami
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Utility of a super-soft hood for esophageal endoscopic submucosal dissection below an esophageal stricture. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2022; 8:53-55. [PMID: 36820251 PMCID: PMC9938290 DOI: 10.1016/j.vgie.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Video 1Use of a super-soft hood (Space Adjuster; TOP, Tokyo, Japan) for esophageal endoscopic submucosal dissection below an esophageal stricture.
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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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Kim IG, Cho H, Shin J, Cho JH, Cho SW, Chung EJ. Regeneration of irradiation-damaged esophagus by local delivery of mesenchymal stem-cell spheroids encapsulated in a hyaluronic-acid-based hydrogel. Biomater Sci 2021; 9:2197-2208. [PMID: 33506817 DOI: 10.1039/d0bm01655a] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Radiation therapy (RT) is a typical treatment for head and neck cancers. Generally, prolonged irradiation of the esophagus causes esophageal fibrosis due to increased reactive oxygen species and proinflammatory cytokines. This study was designed to determine whether catechol-functionalized hyaluronic acid (HA-CA) hydrogel-encapsulated human mesenchymal stem-cell spheroids (MSC-SPs) could ameliorate damage to the esophagus in a mouse model of radiation-induced esophageal fibrosis. MSC-SPs were cultured in concave microwells 600 μm in diameter at a cell density of 1 × 106 cells per mL. Most cells formed spheroids with a 100-300 μm size distribution in concave microwells. MSC-SPs were well maintained in the HA gel, and live-dead staining confirmed that most cells survived. The HA gel containing the MSC-SPs was then injected into the damaged esophageal layer. Inflammatory signs or adverse tissue reactions were not observed after esophageal injection of HA-gel-encapsulated MSC-SPs. Based on Masson's trichrome staining at 4 and 12 weeks postinjection, the inner esophageal layer (IEL) was significantly thinner in the MSC-SP + HA gel group compared to those in the other experimental groups. While the saline and HA gel treatments made the esophageal muscles loose and thick, the MSC-SP + HA gel group showed bundles of tightly packed esophageal muscles, as assayed by desmin immunostaining. qPCR analysis showed that epithelial genes tended to increase over time in the MSC-SP + HA gel group, and the expression of most fibrosis-related genes decreased. This study proposes the potential of using HA-CA-hydrogel-encapsulated MSC-SPs as a promising therapy against radiation-induced esophageal fibrosis.
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Affiliation(s)
- In Gul Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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Mesbahi A, Alizade-Harakiyan M, Jangjoo A, Jafari-Koshki T, Fatemi A. Radiobiological modeling of acute esophagitis after radiation therapy of head, neck, and thorax tumors: The influence of chemo-radiation. J Cancer Res Ther 2021; 18:1706-1715. [DOI: 10.4103/jcrt.jcrt_271_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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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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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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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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Sami SS, Haboubi HN, Ang Y, Boger P, Bhandari P, de Caestecker J, Griffiths H, Haidry R, Laasch HU, Patel P, Paterson S, Ragunath K, Watson P, Siersema PD, Attwood SE. UK guidelines on oesophageal dilatation in clinical practice. Gut 2018; 67:1000-1023. [PMID: 29478034 PMCID: PMC5969363 DOI: 10.1136/gutjnl-2017-315414] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/03/2018] [Accepted: 01/14/2018] [Indexed: 01/10/2023]
Abstract
These are updated guidelines which supersede the original version published in 2004. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone extensive revision by the 16 members of the Guideline Development Group with representation from individuals across all relevant disciplines, including the Heartburn Cancer UK charity, a nursing representative and a patient representative. The methodological rigour and transparency of the guideline development processes were appraised using the revised Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.Dilatation of the oesophagus is a relatively high-risk intervention, and is required by an increasing range of disease states. Moreover, there is scarcity of evidence in the literature to guide clinicians on how to safely perform this procedure. These guidelines deal specifically with the dilatation procedure using balloon or bougie devices as a primary treatment strategy for non-malignant narrowing of the oesophagus. The use of stents is outside the remit of this paper; however, for cases of dilatation failure, alternative techniques-including stents-will be listed. The guideline is divided into the following subheadings: (1) patient preparation; (2) the dilatation procedure; (3) aftercare and (4) disease-specific considerations. A systematic literature search was performed. The Grading of Recommendations Assessment, Develop-ment and Evaluation (GRADE) tool was used to evaluate the quality of evidence and decide on the strength of recommendations made.
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Affiliation(s)
- Sarmed S Sami
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hasan N Haboubi
- Cancer Biomarker Group, Swansea Medical School, Swansea University, Swansea, UK
| | - Yeng Ang
- Department of GI Sciences, University of Manchester, Manchester, UK,Salford Royal NHS Foundation Trust, Salford, UK
| | - Philip Boger
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - John de Caestecker
- Digestive Diseases Centre, University Hospitals of Leicester, Leicester, UK
| | - Helen Griffiths
- Department of Gastroenterology, Wye Valley NHS Trust, Wye Valley, UK
| | - Rehan Haidry
- Department of Gastroenterology, University College Hospital, London, UK
| | - Hans-Ulrich Laasch
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Praful Patel
- Department of Gastroenterology, Southampton University Hospital, Southampton, UK
| | - Stuart Paterson
- Department of Gastroenterology, NHS Forth Valley, Stirling, UK
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Belfast, UK
| | - Peter Watson
- Faculty of Medicine Health and Life Sciences, Queen’s University Belfast, Belfast, UK
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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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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Howell RJ, Schopper MA, Giliberto JP, Collar RM, Khosla SM. Office-based esophageal dilation in head and neck cancer: Safety, feasibility, and cost analysis. Laryngoscope 2018; 128:2261-2267. [DOI: 10.1002/lary.27121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/24/2017] [Accepted: 01/10/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Rebecca J. Howell
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Melissa A. Schopper
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - John Paul Giliberto
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Ryan M. Collar
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - Sid M. Khosla
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
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Moss WJ, Pang J, Orosco RK, Weissbrod PA, Brumund KT, Weisman RA, Brigger MT, Coffey CS. Esophageal dilation in head and neck cancer patients: A systematic review and meta-analysis. Laryngoscope 2017; 128:111-117. [DOI: 10.1002/lary.26618] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 12/24/2022]
Affiliation(s)
- William J. Moss
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, University of California; San Diego California U.S.A
| | - John Pang
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, University of California; San Diego California U.S.A
| | - Ryan K. Orosco
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, University of California; San Diego California U.S.A
| | - Philip A. Weissbrod
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, University of California; San Diego California U.S.A
| | - Kevin T. Brumund
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, University of California; San Diego California U.S.A
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, VA San Diego Healthcare; La Jolla California U.S.A
| | - Robert A. Weisman
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, University of California; San Diego California U.S.A
| | - Matthew T. Brigger
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, University of California; San Diego California U.S.A
- Department of Otolaryngology-Head & Neck Surgery; Naval Medical Center San Diego; San Diego California U.S.A
| | - Charles S. Coffey
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, University of California; San Diego California U.S.A
- Department of Surgery; division of Otolaryngology-Head & Neck Surgery, VA San Diego Healthcare; La Jolla California U.S.A
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Lapeyre M, Biau J, Racadot S, Moreira J, Berger L, Peiffert D. Radiothérapie des cancers de la cavité buccale. Cancer Radiother 2016; 20 Suppl:S116-25. [DOI: 10.1016/j.canrad.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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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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16
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Toltz A, Shin N, Mitrou E, Laude C, Freeman CR, Seuntjens J, Parker W, Roberge D. Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential. J Appl Clin Med Phys 2015; 16:167–178. [PMID: 26699298 PMCID: PMC5690189 DOI: 10.1120/jacmp.v16i5.5386] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 05/20/2015] [Accepted: 05/03/2015] [Indexed: 12/22/2022] Open
Abstract
In 2010, all young patients treated for intrathoracic Hodgkin lymphoma (HL) at one of 10 radiotherapy centers in the province of Quebec received 3D conformal photon therapy. These patients may now be at risk for late effects of their treatment, notably secondary malignancies and cardiac toxicity. We hypothesized that more complex radiotherapy, including intensity‐modulated proton therapy (IMPT) and possibly IMRT (in the form of helical tomotherapy (HT)), could benefit these patients. With institutional review board approval at 10 institutions, all treatment plans for patients under the age of 30 treated for HL during a six‐month consecutive period of 2010 were retrieved. Twenty‐six patients were identified, and after excluding patients with extrathoracic radiation or treatment of recurrence, 20 patients were replanned for HT and IMPT. Neutron dose for IMPT plans was estimated from published measurements. The relative seriality model was used to predict excess risk of cardiac mortality. A modified linear quadratic model was used to predict the excess absolute risk for induction of lung cancer and, in female patients, breast cancer. Model parameters were derived from published data. Predicted risk for cardiac mortality was similar among the three treatment techniques (absolute excess risk of cardiac mortality was not reduced for HT or IMPT (p>0.05,p>0.05) as compared to 3D CRT). Predicted risks were increased for HT and reduced for IMPT for secondary lung cancer (p<0.001,p<0.001) and breast cancers (p<0.001,p<0.001) as compared to 3D CRT. PACS numbers: 87.55.dh, 87.55.dk
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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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18
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Interactive Decision-Support Tool for Risk-Based Radiation Therapy Plan Comparison for Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2014; 88:433-45. [DOI: 10.1016/j.ijrobp.2013.10.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/09/2013] [Accepted: 10/23/2013] [Indexed: 12/25/2022]
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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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Délinéation des cancers de la cavité buccale et de l’oropharynx. Cancer Radiother 2013; 17:493-7. [DOI: 10.1016/j.canrad.2013.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 05/25/2013] [Indexed: 12/25/2022]
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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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Overgaard J. Advancing radiation oncology through scientific publication – 100 volumes of Radiotherapy and Oncology. Radiother Oncol 2011; 100:1-6. [DOI: 10.1016/j.radonc.2011.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Christianen MEMC, Langendijk JA, Westerlaan HE, van de Water TA, Bijl HP. Delineation of organs at risk involved in swallowing for radiotherapy treatment planning. Radiother Oncol 2011; 101:394-402. [PMID: 21664711 DOI: 10.1016/j.radonc.2011.05.015] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 04/18/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy, alone or combined with chemotherapy, is a treatment modality used frequently in head and neck cancer. In order to report, compare and interpret the sequelae of radiation treatment adequately, it is important to delineate organs at risk (OARs) according to well-defined and uniform guidelines. The aim of this paper was to present our institutional Computed Tomography (CT)-based delineation guidelines for organs in the head and neck at risk for radiation-induced swallowing dysfunction (SWOARs). MATERIAL AND METHODS After analyses of the human anatomy of the head and neck area and literature review, CT-based guidelines for delineation of the most relevant SWOARs were described by a panel of experts. RESULTS AND CONCLUSIONS This paper described institutional guidelines for the delineation of potential SWOARs, accompanied by CT-based illustrations presenting examples of the delineated structures and their corresponding anatomic borders. This paper is essential to ensure adequate interpretation of future reports on the relationship between dose distribution in these SWOARs and different aspects of post-treatment swallowing dysfunction.
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Affiliation(s)
- Miranda E M C Christianen
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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