A Unique Case of a Patient with Rectal Cancer Who Developed Benign Esophageal Stenosis after Localized Rectal Radiation and Systemic Chemotherapy

Abstract

Acute esophagitis and esophageal strictures typically occur after local radiation therapy to the thoracic field. Toxicity is usually limited to the field of radiation and potentially augmented by concomitant use of chemotherapy, however esophageal stricturing due to chemotherapy alone is exceedingly rare. Gastrointestinal toxicity has been previously reported in the setting of 5-fluorouracil (5-FU)-based chemotherapy with abnormal thymidylate synthase or dihydropyrimidine dehydrogenase activities. We present a unique case of isolated chemotherapy-induced esophageal stricture in the setting of stage IIIa rectal adenocarcinoma which presented shortly after initiation of treatment with 5-FU-based chemotherapy in a patient with normal thymidylate synthase and dihydropyrimidine dehydrogenase assays. These findings prompt further investigation of pathways and potential risk factors leading to esophageal toxicity in patients treated with 5-FU-based chemotherapy.

Esophageal Stricture Resulting from Systemic Chemotherapy for Solid Malignancy

“… 4 , 5 In the adult population, only 2 patients have been previously identified who developed stricture during treatment with systemic chemotherapy. 2 , 3 In both of these cases, symptoms began within 3 weeks of initiation of systemic chemotherapy, as in our case. However, the previously reported causative chemotherapeutic agents were different from our case.…”

“…Her symptoms initially improved following endoscopic dilation therapy, but she required monthly endoscopy secondary to the development of new strictures at the proximal and distal ends of the stents. 3 She had no evidence of esophageal malignancy on repetitive endoscopy with multiple biopsies, and cross-imaging confirmed the benign process. The second patient received idrarubucin and cytarabine chemotherapy for acute myelogenous leukemia.…”

“…To our knowledge, only 2 other cases are described in adult patients. 2 , 3 In pediatric patients, it has been identified as a rare complication following induction therapy for acute leukemia. 4 …”