Management and prognosis for radiation-induced esophageal cancer

Radiation therapy following mastectomy for breast cancer and mediastinal irradiation for Hodgkins lymphoma increases the risk of second malignancies in the irradiated area. Previous studies demonstrated that the risk of esophageal cancer (EC) is moderately increased starting 5 years after radiation exposure. From 1980 to 2007 we observed 4400 patients with primary EC 32 patients fulfilled the definition criteria for radiation induced carcinoma. We analyzed demographics, surgical treatment, postoperative morbidity, mortality and prognosis. Previous cancers had been: breast cancer in 17 patients, Hodgkin's lymphoma in 9, thymoma in 1, myeloma in 1, lung cancer in 4. Median interval between previous radiotherapy and esophageal cancer was 19 years (5-34). Histology was Squamous Cell Carcinoma in 27 patients, adenocarcinoma in 5. At diagnosis clinical stage was III in 18 patients, stage IV in one. Cytoreductive treatment was performed in 1 Opatients. 15 received palliative therapy without resection. 17 (53 %) patients underwent esophagectomy: 16 had R0 resection and one R2. Postoperative morbidity was 76% (13/17): pulmonary complications were 290, cardiac arrhythmia occurred in 23,5% (in one patients was fatal), sepsis in 17% and chylous leakage in 11,76. Postoperative mortality was 120% (2/17). In our experience of 1900 esophagectomies morbidity was 43% 6 and mortality was 4,5%. Median survival after palliation was 5 months and after curative resection was 18; five patients are still alive. Radiation induced EC is associated with high risk of postoperative mortality and morbidity including major cardiac and pulmonary complications. Neoadjuvant treatment is often not feasible due to previous radiotherapy.