TREATMENT AND LONG-TERM OUTCOME OF CHRONIC RADIATION ESOPHAGITIS AFTER RADIATION-THERAPY FOR HEAD AND NECK TUMORS - A REPORT OF 13 CASES

The natural history of chronic radiation esophagitis occurring in prev iously normal esophagus is still unknown. We describe here the long-te rm outcome of chronic esophagitis arising after neck irradiation for o ropharynx and larynx carcinomas in 13 consecutive adult patients. The first clinical signs of radiation esophagitis were dysphagia or imposs ibility of oral intake, which appeared within 26 months (range 2-120 m onths) after the end of radiation for pyriform fossae carcinoma (N = 5 ), tonsil carcinoma (N = 2), larynx carcinoma (N = 2), pharynx carcino ma (N = 2), base of the tongue (N = 1), and thyroid carcinomas (N = 1) . During upper endoscopy, an esophageal stenosis was found in 11 cases and was associated with ulceration in three cases. An isolated esopha geal ulceration was present in only two cases. Chronic radiation esoph agitis diagnosis was confirmed by histology and surgery in seven cases . In the last six cases, diagnosis was supported by the absence of fir st cancer relapses within a median follow-up of two years (16 months t o nine years) and by endoscopic findings. Seven patients received pare nteral or enteral nutrition. Ten patients were treated by peroral dila tations. These treatments allowed nearly normal oral diet in 11/13 pat ients. Only one patient was lost of follow-up after 20 months. Four pa tients died from chronic radiation esophagitis. One of these patients died from massive hemorrhage after peroral dilatation. Four patients d ied of a second carcinoma with no first cancer recurrence. Four patien ts were alive after six months to nine years of follow-up. Moderate dy sphagia was still present, allowing nearly normal oral feeding. In con clusion, chronic radiation esophagitis is a severe disease with an und erestimated frequency. In our study, peroral dilatations appeared to b e necessary and were not associated with an increased morbidity.