Morphology and pathology of radiation-induced esophagitis

Abstract

Radiation-induced esophagitis can cause substantial morbidity. Experiments in lab animals have shown that pretreatment with indomethacin protects the esophagus from radiation damage. We conducted a prospective, double-blind, randomized trial of naproxen vs placebo in patients undergoing thoracic radiation therapy for lung cancer. Twenty-eight patients were enrolled, of which 26 completed the study. Sixteen patients were given a short course of radiation (30 Gy/10 fractions/2 weeks), and 10 patients were given a longer course and a larger dose (40-50 Gy/25 fractions/5 weeks). Half of the irradiated patients were treated with naproxen, 375 mg, taken orally twice a day, and half were given an identical placebo. All patients were given ranitidine 300 mg, taken orally once a day. Study drugs were taken throughout the course of radiation. Endoscopy with esophageal biopsies and brushings was performed before and on the last day of treatment. Patients kept a daily diary for symptom scoring. Symptoms such as chest pain, dysphagia, odynophagia, and/or heartburn were reported in 15 patients from both subgroups, resulting in diet restriction to liquids only in eight patients and requiring temporary discontinuation of radiation therapy in one of them. Approximately half the patients in each subgroup developed esophagitis, usually mild and usually limited to the proximal esophagus. Severity of symptoms was not proportional to the severity of esophagitis. Candidiasis was documented in eight patients, but only four had symptoms that were severe in one. We conclude that acute radiation injury to the esophagus is observed in approximately half the patients receiving radiation therapy and can result in substantial morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

Amphotericin B Lozengers: Prophylaxis for Esophagitis in Thoracic Radiotherapy

“…A placebo-controlled trial, however, did not show a beneficial effect [13]. For nonsteroidal anti-inflammatory drugs like indomethacin or naproxen a prophylactic effect is not proven either [15,20]. Likewise, several randomized phase II and III studies of amifostine have demonstrated mixed results regarding its ability to reduce esophagitis [4,9].…”

“…In 16% of the patients a Candida infection was found with a comparable incidence in both groups. Soffer et al performed endoscopy with esophageal biopsies and brushings before and at the last day of thoracic radiotherapy with 30-50 Gy in 26 patients [20]. 17 patients showed significant deterioration of their histological lesions regarding esophagitis.…”

Rational Design of Nanomaterials for Various Radiation‐Induced Diseases Prevention and Treatment

“… 1)Radiation‐induced esophageal diseases are usually induced by thoracic neoplasm radiotherapy, particularly radiation treatment for lung cancer. [ 130–133 ] It can result in dysphagia, odynophagia, heartburn, and chest pain, which may even require temporary interruption of treatment under severe circumstances. [ 132 ] The mainstream route for the nanomaterial design of radiation‐induced esophagus disease treatment is nanocarrier‐associated gene therapy.…”

“…[ 130–133 ] It can result in dysphagia, odynophagia, heartburn, and chest pain, which may even require temporary interruption of treatment under severe circumstances. [ 132 ] The mainstream route for the nanomaterial design of radiation‐induced esophagus disease treatment is nanocarrier‐associated gene therapy. MnSOD‐plasmid/liposome complex is a typical representative, which uses plasmid/liposome to transfer MnSOD into the esophagus.…”

Efficacy of a Propolis-Based Syrup (FARINGEL) in Preventing Radiation-Induced Esophagitis in Locally Advanced Lung Cancer

“…Currently, there are no evidence-based guidelines to prevent esophagitis. Some reports attest that sucralfate might be useful to reduce radiation-induced esophagitis [8, 9], but a placebo-controlled trial did not confirm its effectiveness [10], and no prophylactic effect has been proven for nonsteroidal anti-inflammatory drugs [11, 12]. Moreover, several randomized phase II and III studies of amifostine have shown conflicting results in reducing esophagitis [13, 14].…”