Il carcinoma esofageo radioindotto: prognosi e trattamento

Alfieri, Rita and Ruol, Alberto and Castoro, Carlo and Sileni, Vanna Chiaron and Boso, C. and Cagol, Matteo and Michieletto, S. and Saibene, T. and Zanchettin, Gianpietro and Tosolini, C. and Ancona, Ermanno (2009) Il carcinoma esofageo radioindotto: prognosi e trattamento. Il giornale di chirurgia, 30 (5 Supp). pp. 83-84. ISSN 1971-145X

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Radiation therapy following mastectomy for breast cancer and mediastinal irradiation for Hodgkin’s lymphoma increases the risk of second malignancies in the irradiated area. Previous studies demonstrated that the risk of esophageal cancer (EC) is moderately increased starting 5 years after radiation exposure. From 1980 to 2007 we observed 4400 patients with primary EC. 32 patients fulfilled the definition criteria for radiation induced carcinoma. We analyzed demographics, surgical treatment, postoperative morbidity, mortality and prognosis. Previous cancers had been: breast cancer in 17 patients, Hodgkin’s lymphoma in 9, thymoma in 1, myeloma in 1, lung cancer in 4. Median interval between previous radiotherapy and esophageal cancer was 19 years (5-34). Histology was Squamous Cell Carcinoma in 27 patients, adenocarcinoma in 5. At diagnosis clinical stage was III in 18 patients, stage IV in one. Cytoreductive treatment was performed in 10 patients. 15 received palliative therapy without resection. 17 (53%) patients underwent esophagectomy: 16 had R0 resection and one R2. Postoperative morbidity was 76% (13/17): pulmonary complications were 29%, cardiac arrhythmia occurred in 23,5% (in one patients was fatal), sepsis in 17% and chylous leakage in 11,7%. Postoperative mortality was 12% (2/17). In our experience of 1900 esophagectomies morbidity was 43% and mortality was 4,5%. Median survival after palliation was 5 months and after curative resection was 18; five patients are still alive. Radiation induced EC is associated with high risk of postoperative mortality and morbidity including major cardiac and pulmonary complications. Neoadjuvant treatment is often not feasible due to previous radiotherapy. .

Item Type: Article
Uncontrolled Keywords: Radiation-induced malignancy, Esophageal cancer, mediastinal irradiation
Subjects: 600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici) > 617 Rami vari della medicina; Chirurgia
Depositing User: Nadia Del Gobbo
Date Deposited: 09 Feb 2016 17:01
Last Modified: 09 Feb 2016 17:01

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