Radiation-induced esophageal carcinoma 30 years after mediastinal irradiation: Case report and review of the literature

A 54-year-old man who had been irradiated in 1964 for cervical involvement by Hodgkin's disease was admitted in December 1994 to our clinic with stron g complaints of dysphagia. The reason was a moderately differentiated squam ous cell carcinoma of the proximal esophagus in the previously irradiated r egion. The patient had no risk factors (abuse of nicotine or alcohol) for t he developement of esophageal carcinoma. A reirradiation was performed, but the disease progressed locally and two weeks after the beginning of the th erapy the patient developed two tracheoesophagocutaneous fistulae, The radi ation therapy was discontinued and the tumor stenosis was bridged by a tube closing the fistulae, A retrospective dose analysis to evaluate the applie d doses will be performed. Furthermore, an overview of 66 cases of the lite rature with radiation-induced esophageal carcinoma analysed concerning appl ied dose and latent interval will be given, in conclusion the reported case fits the criteria for radiation-induced malignancies (Chudecki Br J Radiol 1972;45:303-4) known from literature: (1) a history of previous irradiatio n, (2) a cancer occurring within the irradiated area, (3) gross tissue dama ge due to an excessive dose of radiation, and (4) a long latent interval be tween irradiation and development of cancer. Esophageal carcinomas belong t o the rare secondary malignancies after the therapeutic use of ionizing rad iation. Nevertheless in patients with dysphagia they should be suspected as a differential diagnosis even many years after mediastinal irradiation. Th e treatment of these tumors is very difficult and is associated with a poor prognosis.