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Surgical treatment of esophageal perforation after stereotactic body radiotherapy: A report of two cases
INTRODUCTION AND IMPORTANCE: Esophageal perforation due to stereotactic body radiotherapy (SBRT) is rare, and there is no consensus on the treatment strategy. Here, we report two cases of esophageal perforation caused by CyberKnife irradiation managed with distinct surgical approaches. CASE PRESENTA...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9758521/ https://www.ncbi.nlm.nih.gov/pubmed/36502658 http://dx.doi.org/10.1016/j.ijscr.2022.107805 |
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author | Kato, Takeharu Kazama, Yoshihiro Matsuura, Sho Nagaoka, Sakae |
author_facet | Kato, Takeharu Kazama, Yoshihiro Matsuura, Sho Nagaoka, Sakae |
author_sort | Kato, Takeharu |
collection | PubMed |
description | INTRODUCTION AND IMPORTANCE: Esophageal perforation due to stereotactic body radiotherapy (SBRT) is rare, and there is no consensus on the treatment strategy. Here, we report two cases of esophageal perforation caused by CyberKnife irradiation managed with distinct surgical approaches. CASE PRESENTATION: Case 1 was a 54-year-old woman who was administered chemotherapy including bevacizumab and underwent CyberKnife SBRT for postoperative ovarian cancer (pStage IIIc) with metastasis in the eighth thoracic vertebra. Thirteen months after irradiation, she suddenly developed right back and anterior thoracic pain and was diagnosed with esophageal perforation. Despite open chest drainage and intercostal muscle (ICM) flap coverage, the fistula could not be closed, leading to pyogenic spondylitis and epidural abscess. Case 2 was of a 58-year-old woman with mediastinal lymph node metastasis 5 years after uterine cancer surgery (pStage Ia) who underwent CyberKnife SBRT. Six months after irradiation, she experienced back pain and was diagnosed with esophageal perforation. After curative esophagectomy, the patient was discharged on postoperative day 22 without any adverse effects. CLINICAL DISCUSSION: Esophageal perforation by SBRT with vascular endothelial growth factor inhibitors (VEGFI) such as bevacizumab has rarely been reported. Considering the impaired wound healing system and blood perfusion caused by radiation therapy and VEGFI, difficulty closing the perforation covered with an ICM flap was hypothesized. CONCLUSION: Late esophageal toxicity from irradiation may cause impaired blood flow and wound healing; therefore, curative esophagectomy, including at the perforation site, is effective. |
format | Online Article Text |
id | pubmed-9758521 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-97585212022-12-18 Surgical treatment of esophageal perforation after stereotactic body radiotherapy: A report of two cases Kato, Takeharu Kazama, Yoshihiro Matsuura, Sho Nagaoka, Sakae Int J Surg Case Rep Case Report INTRODUCTION AND IMPORTANCE: Esophageal perforation due to stereotactic body radiotherapy (SBRT) is rare, and there is no consensus on the treatment strategy. Here, we report two cases of esophageal perforation caused by CyberKnife irradiation managed with distinct surgical approaches. CASE PRESENTATION: Case 1 was a 54-year-old woman who was administered chemotherapy including bevacizumab and underwent CyberKnife SBRT for postoperative ovarian cancer (pStage IIIc) with metastasis in the eighth thoracic vertebra. Thirteen months after irradiation, she suddenly developed right back and anterior thoracic pain and was diagnosed with esophageal perforation. Despite open chest drainage and intercostal muscle (ICM) flap coverage, the fistula could not be closed, leading to pyogenic spondylitis and epidural abscess. Case 2 was of a 58-year-old woman with mediastinal lymph node metastasis 5 years after uterine cancer surgery (pStage Ia) who underwent CyberKnife SBRT. Six months after irradiation, she experienced back pain and was diagnosed with esophageal perforation. After curative esophagectomy, the patient was discharged on postoperative day 22 without any adverse effects. CLINICAL DISCUSSION: Esophageal perforation by SBRT with vascular endothelial growth factor inhibitors (VEGFI) such as bevacizumab has rarely been reported. Considering the impaired wound healing system and blood perfusion caused by radiation therapy and VEGFI, difficulty closing the perforation covered with an ICM flap was hypothesized. CONCLUSION: Late esophageal toxicity from irradiation may cause impaired blood flow and wound healing; therefore, curative esophagectomy, including at the perforation site, is effective. Elsevier 2022-11-30 /pmc/articles/PMC9758521/ /pubmed/36502658 http://dx.doi.org/10.1016/j.ijscr.2022.107805 Text en © 2022 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Case Report Kato, Takeharu Kazama, Yoshihiro Matsuura, Sho Nagaoka, Sakae Surgical treatment of esophageal perforation after stereotactic body radiotherapy: A report of two cases |
title | Surgical treatment of esophageal perforation after stereotactic body radiotherapy: A report of two cases |
title_full | Surgical treatment of esophageal perforation after stereotactic body radiotherapy: A report of two cases |
title_fullStr | Surgical treatment of esophageal perforation after stereotactic body radiotherapy: A report of two cases |
title_full_unstemmed | Surgical treatment of esophageal perforation after stereotactic body radiotherapy: A report of two cases |
title_short | Surgical treatment of esophageal perforation after stereotactic body radiotherapy: A report of two cases |
title_sort | surgical treatment of esophageal perforation after stereotactic body radiotherapy: a report of two cases |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9758521/ https://www.ncbi.nlm.nih.gov/pubmed/36502658 http://dx.doi.org/10.1016/j.ijscr.2022.107805 |
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