The management of treatment-related esophageal complications in children and adolescents with cancer Journal Article


Authors: Lal, D. R.; Foroutan, H. R.; Su, W. T.; Wolden, S. L.; Boulad, F.; La Quaglia, M. P.
Article Title: The management of treatment-related esophageal complications in children and adolescents with cancer
Abstract: Background and Purpose: Serious treatment-induced esophageal strictures and tracheoesophageal fistulae are rare in the pediatric oncology Population. This report details our experience with their management. Methods: We retrospectively reviewed our experience with pediatric oncology patients treated for esophageal complications over a 23-year period. Serious complications were defined as development of structures requiring dilatation or an esophageal fistula. Fifteen patients were identified, 5 of which had been previously reported. Results: Thirteen patients developed esophageal stricture, and 2 progressed to tracheoesophageal fistulae. The remaining 2 patients developed tracheoesophageal fistulae without antecedent Stricture. The median interval from cancer diagnosis until development of esophageal complications was 3.5 years (range, 0.4-11.8 years). Before development of esophageal complication, 14 patients (93%) were treated with mediastinal radiation and 7 (47%) for candidal esophagitis. Strictures were most commonly located in the distal esophagus (5), then midesophagus (3), cervical esophagus (3) and diffusely (2). A median of 5 dilatations (range, 1-50) were necessary before patients were able to resume a normal diet. The origin of tracheoesophageal fistulae was the midesophagus (3) and distal esophagus (1). All 4 patients with fistulae were treated with esophageal division and diversion followed by esophagocoloplasty. Conclusions: Esophageal strictures and fistulae may occur because of cancer therapy in childhood. Prevention includes early treatment of esophagitis especially Candida mucositis. and minimization of radiation dose to the esophagus. Strictures usually respond to dilatation, but Fistulae require esophageal diversion and secondary reconstruction. (c) 2006 Elsevier Inc. All rights reserved.
Keywords: fistula; chemotherapy; radiation; transplantation; oncology; childhood; esophagus; dilatation; stricture; adriamycin
Journal Title: Journal of Pediatric Surgery
Volume: 41
Issue: 3
ISSN: 0022-3468
Publisher: W.B. Saunders Co-Elsevier Inc.  
Date Published: 2006-03-01
Start Page: 495
End Page: 499
Language: English
ACCESSION: WOS:000236325600007
DOI: 10.1016/j.jpedsurg.2005.11.065
PROVIDER: wos
PUBMED: 16516623
Notes: --- - Article - "Source: Wos"
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  1. Wendy Tienhui Su
    11 Su
  2. Dave Lal
    4 Lal
  3. Farid Boulad
    329 Boulad
  4. Suzanne L Wolden
    560 Wolden