Radiation Esophagitis in a Patient with Oral Carcinoma and Bone Metastasis

Abstract

Radiation esophagitis requiring endoscopic evaluation occurs quite rarely, affecting <1% of patients undergoing radiation treatment. Acute radiation esophagitis develops within 3 weeks of radiation therapy. We describe herein a case of radiation esophagitis in a patient with oral carcinoma with multiple general bone metastases. Cisplatin, fluorouracil, and cetuximab were given for 3 cycles. Radiation therapy (30 Gy) to the thoracic vertebrae and lumbar vertebrae was prescribed to prevent worsening of bone metastases and relieve pain. Neutropenia was also observed due to chemotherapy. After the end of radiation therapy, the patient experienced chest pain, heartburn, and dysphagia. Upper gastrointestinal endoscopy revealed severe radiation esophagitis of endoscopic Fukui Acute Radiation Esophagitis grade 4. Oral food was discontinued and an intravenous proton-pump inhibitor was administered. After 3 weeks, upper gastrointestinal endoscopy showed improvement of radiation esophagitis, with scars. The symptoms of chest pain, heartburn, and dysphagia had also disappeared. This is the first case to be reported of acute radiation esophagitis in a patient with oral carcinoma with bone metastasis who experienced dramatic improvement of endoscopic findings. Neutropenia appears to be associated with more severe acute radiation esophagitis.

Safety and Tolerability of Metastasis-Directed Radiation Therapy in the Era of Evolving Systemic, Immune, and Targeted Therapies

“… 37 , 38 , 39 , 40 In the palliative setting, only 1 case has reported a grade 3 esophagitis when fluorouracil/cisplatin and cetuximab were combined with 30 Gy in 10 fr spine RT. 41 A retrospective study reported no CTCAE grade 3 or higher toxicity 42 when hypofractionated RT was used in 3 patients with metastatic head and neck cancer. 42 Other studies reporting head and neck SBRT delivered concomitantly with cetuximab were in recurrent settings.…”

Radiation injuries of organs and tissues: mechanisms of occurrence, methods of prevention and treatment: A review

“…Профилактику развития ЛЭ обеспечивают коррекция диеты пациента (механически и химически щадящая диета), прием ингибиторов протонной помпы. Для лечения острого ЛЭ используют препараты для восстановления слизистой, анальгетики [16].…”