Folinic-acid/Fluorouracil/Oxaliplatin

Abstract

A 55-year-old woman developed benign oesophageal stenosis after treatment with folinic-acid, fluorouracil and oxaliplatin .The woman's medical history was significant for stage IIIa rectal adeno-carcinoma for which she received a modified adjuvant chemotherapy with folinic acid 400 mg/m 2 for 2 days, fluorouracil bolus 400 mg/m 2 , oxaliplatin 85 mg/m 2 and fluorouracil infusion 1200 mg/m 2 /day for 2 days for 2 cycles [routes not stated]. Three weeks after initiation of chemotherapy, she was hospitalised for a new-onset of dysphagia and odynophagia. However, despite discontinuation of chemotherapy her symptoms persisted. Her CT chest and oesophagogram revealed irregular long narrowing in the mid and distal oesophagus. A 11cm long oesophageal stenosis with mucosal erythema and friability starting 25cm from the incisors was noted on an upper endoscopic evaluation.The woman's symptoms improved after an endoscopic dilation therapy. However, she still required repeated endoscopic therapy on a monthly basis including intralesional steroid injections. A fully-covered oesophageal stent was placed twice for a short term improvement. However, she further developed new secondary oesophageal strictures at the proximal and distal ends of the stent. Eventually, the oesophageal stents were removed and the symptoms were controlled with repeat endoscopic dilation of the benign stricture every 4-6 weeks. On repetitive endoscopy with multiple biopsies or cross-sectional imaging for 18 months no evidence was seen of esophageal malignancy.Author comment: "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." Chahla E, et al. A unique case of a patient with rectal cancer who developed benign esophageal stenosis after localized rectal radiation and systemic chemotherapy.