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Gastric mucosal injury and hemorrhage after definitive chemoradiotherapy for locally advanced esophageal cancer

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Abstract

Background

Definitive chemoradiotherapy is one of the treatment options for locally advanced esophageal cancer with curative intent. Esophagitis and pharyngitis are well-known adverse events that occur during chemoradiotherapy, but gastric mucosal injury has been less frequently reported compared to mucositis. Importantly, gastric mucosal injury is not well known, hard to manage, and sometimes fatal. Hence, we examined the clinical characteristics and the incidence of gastric mucosal injury after CRT for esophageal cancer.

Methods

The medical records of patients who received definitive chemoradiotherapy combined with 5-fluorouracil and cisplatin for stage II/III (nonT4) esophageal squamous cell carcinoma from January 2001 to December 2010 at our institute were reviewed retrospectively.

Results

We investigated 256 patients in whom, data for endoscopic abdomen examinations were both before and after CRT were available. Gastric mucosal damage was observed in 90 patients (35%) (grade 1/2/3 = 69/18/3). One of the possible risk factors identified in this study was the irradiation dose to abdomen. Compared to patients with cervical esophagus–upper thoracic esophagus tumor location, patients with middle thoracic esophagus–abdominal esophagus tumor location were more likely to develop gastric mucosal damage, although there was no statistically significant difference.

Conclusions

It is important to consider gastric mucosal injury in patients who receive CRT, particularly when the irradiation field includes stomach.

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Acknowledgements

This study was supported by the National Cancer Center Research and Development Fund (26-A-4). We thank Dr. Nobukazu Hokamura for collecting the data used in this study.

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Authors and Affiliations

  1. Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Satoko Monma, Ken Kato, Hirokazu Shouji, Natsuko Okita, Atsuo Takashima, Yoshitaka Honma, Satoru Iwasa, Tetsuya Hamaguchi, Yasuhide Yamada, Yasuhiro Shimada & Narikazu Boku

  2. Radiation Oncology Division, National Cancer Center Hospital, Tokyo, Japan

    Yoshinori Ito & Jun Itami

  3. Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan

    Kengo Nagashima

Authors
  1. Satoko Monma
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  2. Ken Kato
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  3. Hirokazu Shouji
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  4. Natsuko Okita
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  5. Atsuo Takashima
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  12. Kengo Nagashima
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  13. Yoshinori Ito
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  14. Jun Itami
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Corresponding author

Correspondence to Ken Kato.

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The authors declare no conflict of interest.

Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Ethics approval was obtained from National Cancer Center Hospital's review board (NCC2012-268).

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Monma, S., Kato, K., Shouji, H. et al. Gastric mucosal injury and hemorrhage after definitive chemoradiotherapy for locally advanced esophageal cancer. Esophagus 16, 402–407 (2019). https://doi.org/10.1007/s10388-019-00680-1

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  • DOI: https://doi.org/10.1007/s10388-019-00680-1

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