DILATION OF ESOPHAGEAL STRICTURES INDUCED BY RADIATION-THERAPY FOR CANCER OF THE ESOPHAGUS

During a 2-year period, 103 consecutive patients undergoing dilation o f esophageal strictures induced by radiation therapy for cancer of the esophagus were prospectively studied. The length of the strictures ra nged from 0.5 to 13.5 cm (median, 5 cm) and the luminal diameter from 1 to 11 mm (median, 6 mm). Patients were referred for dilation from 2 weeks to 5 years (median, 2 months) after completion of radiation ther apy. The guide wire was placed using fluoroscopy in 21 patients, endos copy in 61, and a combination of endoscopy and fluoroscopy in 21. At l east one dilator larger than the stricture could be passed in 101 (98% ) patients. Five strictures were dilated to 16 mm, 29 to 15 mm, 28 to 14 mm, 16 to 12.8 mm, and 23 to 12 mm or less during the initial proce dure. Development of complications and severe resistance were the limi ting factors for optimal dilation. Relief of dysphagia was adequate in 66% of patients. The duration of dysphagia relief was 3 to 84 weeks ( median, 16 weeks). Complications included persistent pain in 7 patient s, unexplained fever in 2, perforation in 2, and delayed tracheo-esoph ageal fistula in 1. Two patients died of treatment-related complicatio ns. Repeated dilation was required in 32 of the 75 patients on long-te rm follow-up. We conclude that adequate palliation of dysphagia can be achieved by dilation in two-thirds of patients with radiation therapy -induced strictures of the esophagus. Dilation of these strictures is relatively simple and safe if performed with care.