Aortic Pseudoaneurysm Formation Following Concurrent Chemoradiotherapy And Metallic Stent Insertion in a Patient With Esophageal Cancer

Abstract

Aortic pseudoaneurysm formation subsequent to concurrent chemoradiotherapy (CCRT) for esophageal cancer patient with esophageal metallic stent insertion is a rare condition.A 52-year-old man with esophageal cancer, cT4N1M0, stage IIIC, was treated with concurrent weekly cisplatin (30 mg/m2) and 5-Fluorouracil (500 mg/m2) as well as radiotherapy (50.4 Gy in 28 fractions) for 6 weeks. An esophageal metallic stent was inserted for dysphagia 1 week after initiation of CCRT. During the treatment regimen, the platelet count dropped to less than 200 × 103 /μL. One month after the completion of CCRT, chest CT revealed the presence of an aortic pseudoaneurysm as well as aortoesophageal fistulas. A thoracic aortic endografting was performed and the patient responded well to surgery. However, the patient died 2 months later due to a nosocomial infection.Multimodality treatment for esophageal cancer comprising cisplatin-based CCRT and esophageal metallic stent placement near a great vessel may increase the risk of pseudoaneurysm formation.

Esophageal Metal Stents with Concurrent Chemoradiation Therapy for Locally Advanced Esophageal Cancer: Safe or Not?

“…However, the safety of the combination of SEMS and CCRT or radiotherapy remains controversial. A case report noted the potential risk of lethal aortic pseudoaneurysm and further aortoesophageal fistula following SEMS plus CCRT for esophageal cancer . The reported stent‐related mortality ranged from 0% to 54% in patients treated with CCRT prior to SEMS placement compared with 0%–6% in patients without prior CCRT .…”

Local Irradiation Modulates the Pharmacokinetics of Metabolites in 5-Fluorouracil—Radiotherapy–Pharmacokinetics Phenomenon

“…However, off-target RT may produce unexpected or unwanted biological effects (Shueng et al, 2009;Darby et al, 2013). For example, the increased scattering of low-dose irradiation by esophageal stent during treatment increases the risk of aortic pseudoaneurysm formation and the risk of perforating the esophagus (Hou et al, 2015;Lu et al, 2018). An additional 1 Gy of radiation increases the incidence of major coronary events by 7.4% in breast cancer patients receiving RT FIGURE 4 | (A) Mean bile concentration-time curves of 5-FDHU (•) in rat bile after 5-FU administration (100 mg/kg, iv) alone, 5-FU (100 mg/kg, i.v.)…”

Pseudoaneurysm of the aortic arch

“…In addition, hypertension is a well-known cause of vascular degeneration and atherosclerosis. [ 12 ] Combined with the pulmonary tumor invasion, the prolonged hypertension of this patient might cause the weakening of the aortic wall, and increase the incidence of pseudoaneurysm formation. Thus, this aortic arch pseudoaneurysm lesion under high pressure requires urgent intervention to prevent life-threatening hemoptysis.…”

“…[ 1 ] As a relatively fatal disease, aortic pseudoaneurysm has a high mortality rate as a result of the high tension of the edematous aortic wall, which causes the rupture. [ 2 , 3 ] Therefore, this disease should be treated soon after diagnosis. Currently, there are no reports about spontaneous aortic arch pseudoaneurysm rupture causing hemoptysis in patients with pulmonary cancer.…”