Esophageal Stricture Following Radiotherapy for Head & Neck Carcinoma

 

Patients received high dose radiation therapy with delivery involving the proximal esophagus. The authors found delivery of a mean dose of 65 Gy to the proximal 2 cm and a mean dose of 60 Gy to the proximal 5 cm of the esophagus.

 

Onset is usually several months after radiation therapy, but ranges from a few weeks to several years.

 

Symptoms:

(1) impaired swallowing, which is persistent or progressive after onset

(2) progressive weight loss

 

Diagnosis:

(1) X-rays while swallowing barium contrast material

(2) endoscopic examination

 

Appearance	Grade of Stricture
moderate stricture with a fibrous membranous ring or moderate fibrosis	1
severe stricture with severe fibrosis	2
complete obliteration of the lumen	3

 

Differential diagnosis:

(1) tumor progression with neoplastic stricture

(2) neurologic impairment

(3) depression and/or anorexia related to cancer

 

Therapy:

(1) Mild to moderate strictures may respond to repeated dilation using Savary dilators.

(2) Severe stricture may require placement of a nasogastric or PEG tube.