THERAPY AND PROPHYLAXIS OF ACUTE AND LATE RADIATION-INDUCED SEQUELAE OF THE ESOPHAGUS

Background: Radiation-induced esophagitis is a frequent acute side eff ect in curative and palliative radiotherapy of thoracal and cervical t umors. Late reactions are rare but might be severe. Methods: A researc h for reports on prophylactic and supportive therapies of radiation-in duced esophagitis was performed (Medline. Cancerlit. and others). Resu lts: Nutrition must be ensured and symptomatic relief of sequelae is i mportant, especially in the case of dysphagia. The latter can be impro ved by topic or systemic analgetics. If esophageal spasm occurs, calci um antagonists might help. In case of gastro-esophageal reflux proton pump inhibitors should be used. There is no effective prophylactic mea sure for radiation esophagitis. Late side effects with clinical releva nce are rare in conventional radiotherapy. Chronic ulcera, fistula or stenosis may develop. Before any treatment, a tumor infiltration of th e esophagus should be excluded by biopsy. This can lead more often to late complications than radiation therapy itself. Nutrition should be ensured by endoscopic dilation, stent-implantation, or endoscopic perc utaneous gastrostomy. Local injection of steroids might be used to avo id an early restenosis. Conclusions: An intensive symptomatic therapy of acute esophagitis is reasonable. Effective prophylaxis do not exist . Late radiation induced sequelae is rare. Therefore, a tumor recurren ce should be excluded in cases of dysphagia. Securing nutrition by PEG , stent, or port is well in the fore.