Audebert A, Sauvanet A, Mauvais F, Belghiti J
Service de chirurgie digestive, hôpital Beaujon, 100, Boulevard du Général-Leclerc, 92110 Clichy, France.
Ann Chir. 2002 Apr;127(4):289-96. doi: 10.1016/s0003-3944(02)00762-9.
Radiation-induced oesophageal carcinoma can occur several years after mediastinal irradiation. The aim of this study was to report 11 cases of this rare entity with analysis of its diagnostic, therapeutic and prognostic special features.
From 1983 to 2001, 10 female and one male patients, aged 47 to 76 years, were treated for an oesophageal squamous cell carcinoma which was diagnosed 5 to 25 years after mediastinal irradiation. This irradiation (30 to 78 Gy) was administered in 8 women for breast carcinoma and in other patients for lymphoma. Only one patient had alcoholic consumption and 2 were smokers. An oesophagectomy was performed whenever possible.
All (but one) oesophageal tumors were symptomatic. Ten patients underwent an oesophagectomy, including 2 without thoracotomy. Postoperative course was uneventful in 6 cases, 3 patients developed transient respiratory failure and one patient died postoperatively. At late follow-up, 6 patients developed distant metastases (mainly hepatic and pulmonary). These metastases were associated with mediastinal recurrences in 2 cases. No isolated mediastinal recurrence occurred. Median survival was 13 months.
Clinical presentation and surgical treatment of radiation-induced oesophageal carcinoma are similar to those of other oesophageal squamous cell carcinomas. After oesophagectomy, isolated mediastinal recurrences seem to be rarer than with other cancers. These cancers, which are almost all symptomatic, have a poor prognosis.
放射性食管癌可在纵隔放疗数年之后发生。本研究的目的是报告11例这种罕见疾病，并分析其诊断、治疗及预后的特殊特征。
1983年至2001年期间，10名女性和1名男性患者，年龄在47至76岁之间，因食管鳞状细胞癌接受治疗，该疾病在纵隔放疗5至25年后被诊断出来。8名女性因乳腺癌接受了这种放疗（30至78 Gy），其他患者因淋巴瘤接受放疗。只有1名患者有饮酒习惯，2名患者吸烟。只要有可能，就进行食管切除术。
除1例之外，所有食管肿瘤均有症状。10名患者接受了食管切除术，其中2例未行开胸手术。6例患者术后过程顺利，3例患者出现短暂呼吸衰竭，1例患者术后死亡。在晚期随访中，6例患者发生远处转移（主要是肝转移和肺转移）。其中2例转移与纵隔复发相关。未发生孤立性纵隔复发。中位生存期为13个月。
放射性食管癌的临床表现和外科治疗与其他食管鳞状细胞癌相似。食管切除术后，孤立性纵隔复发似乎比其他癌症少见。这些癌症几乎都有症状，预后较差。
