EFFECTS OF MEDIASTINAL IRRADIATION ON ESOPHAGEAL FUNCTION

Although it is well recognised that oesophageal symptoms are common du ring therapeutic mediastinal irradiation of intrathoracic malignant di seases, the effects of mediastinal irradiation on oesophageal function are poorly defined. To clarify the pathogenesis of these sequelae a p rospective study was performed to document comprehensively the effects of mediastinal irradiation on oesophageal function. Oesophageal sympt oms, barium swallow, endoscopy, and combined radionuclide scintigraphy and oesophageal manometry were evaluated in eight patients with poten tially curable intrathoracic malignant disease before treatment, durin g the last week of mediastinal irradiation, and six to eight weeks aft er its completion. Before irradiation, structural abnormalities were e xcluded by barium swallow and endoscopy. All but one patient experienc ed odynophagia or dysphagia, or both, during mediastinal irradiation ( p<0.001) but endoscopic abnormalities were observed in only three pati ents and there was no correlation between oesophageal symptoms and end oscopic changes. Irradiation, however, had no significant effect on oe sophageal motility or transit. It is concluded that oesophageal sympto ms which develop during mediastinal irradiation are not a result of al tered oesophageal motility or transit and may reflect increased mucosa l sensitivity.