Zimmermann F B, Geinitz H, Feldmann H J
Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar, München.
Strahlenther Onkol. 1998 Nov;174 Suppl 3:78-81.
Radiation-induced esophagitis is a frequent acute side effect in curative and palliative radiotherapy of thoracal and cervical tumors. Late reactions are rare but might be severe.
A research for reports on prophylactic and supportive therapies of radiation-induced esophagitis was performed (Medline, Cancerlit, and others).
Nutrition must be ensured and symptomatic relief of sequelae is important, especially in the case of dysphagia. The latter can be improved by topic or systemic analgetics. If esophageal spasm occurs, calcium antagonists might help. In case of gastro-esophageal reflux proton pump inhibitors should be used. There is no effective prophylactic measure for radiation esophagitis. Late side effects with clinical relevance are rare in conventional radiotherapy. Chronic ulcera, fistula or stenosis may develop. Before any treatment, a tumor infiltration of the esophagus should be excluded by biopsy. This can lead more often to late complications than radiation therapy itself. Nutrition should be ensured by endoscopic dilation, stent-implantation, or endoscopic percutaneous gastrostomy. Local injection of steroids might be used to avoid an early restenosis.
An intensive symptomatic therapy of acute esophagitis is reasonable. Effective prophylaxis do not exist. Late radiation induced sequelae is rare. Therefore, a tumor recurrence should be excluded in cases of dysphagia. Securing nutrition by PEG, stent, or port is well in the fore.
放射性食管炎是胸部和颈部肿瘤根治性及姑息性放疗中常见的急性副作用。晚期反应虽罕见但可能很严重。
对放射性食管炎预防性和支持性治疗的报告进行了检索（医学文献数据库、癌症文献数据库等）。
必须确保营养，缓解后遗症的症状很重要，尤其是在吞咽困难的情况下。后者可通过局部或全身镇痛药改善。如果发生食管痉挛，钙拮抗剂可能有帮助。如果存在胃食管反流，应使用质子泵抑制剂。对于放射性食管炎没有有效的预防措施。在传统放疗中具有临床相关性的晚期副作用很少见。可能会出现慢性溃疡、瘘管或狭窄。在任何治疗前，应通过活检排除食管肿瘤浸润。这比放疗本身更常导致晚期并发症。应通过内镜扩张、支架植入或内镜经皮胃造瘘术确保营养。局部注射类固醇可用于避免早期再狭窄。
对急性食管炎进行强化对症治疗是合理的。不存在有效的预防措施。放射性诱导的晚期后遗症很少见。因此，在吞咽困难的情况下应排除肿瘤复发。通过经皮内镜下胃造瘘术、支架或端口确保营养非常重要。
