Chiba Toshimi, Ohashi Yu, Tsunoda Naoko, Onodera Kei, Kawai Tadashi, Miyamoto Ikuya, Yamada Hiroyuki
Division of Internal Medicine, Department of Oral Medicine, Iwate Medical University, Morioka, Japan.
Division of Oral and Maxillofacial Surgery, Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University, Morioka, Japan.
Case Rep Gastroenterol. 2020 Sep 15;14(3):453-457. doi: 10.1159/000508930. eCollection 2020 Sep-Dec.
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.
需要内镜评估的放射性食管炎非常罕见，在接受放射治疗的患者中发生率低于1%。急性放射性食管炎在放射治疗后3周内发生。我们在此描述一例患有口腔癌并伴有多处全身骨转移的患者发生放射性食管炎的病例。给予顺铂、氟尿嘧啶和西妥昔单抗3个周期的治疗。为防止骨转移恶化并缓解疼痛，对胸椎和腰椎进行了30 Gy的放射治疗。化疗还导致了中性粒细胞减少。放射治疗结束后，患者出现胸痛、烧心和吞咽困难。上消化道内镜检查显示为内镜下福井急性放射性食管炎4级的严重放射性食管炎。停止经口进食，并给予静脉质子泵抑制剂。3周后，上消化道内镜检查显示放射性食管炎有所改善，出现了瘢痕。胸痛、烧心和吞咽困难的症状也消失了。这是首例报告的患有骨转移的口腔癌患者发生急性放射性食管炎且内镜检查结果显著改善的病例。中性粒细胞减少似乎与更严重的急性放射性食管炎有关。
