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Ann Thorac Surg 2001;72:669
© 2001 The Society of Thoracic Surgeons

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Correspondence

Radiation-induced secondary malignancy of the esophagus

^a Schiffler Cancer Center, Wheeling, WV 26003, USA

To the Editor

I read with interest the Case Report recently describing a radiotherapy-induced gastrointestinal stromal sarcoma (GIST) of the esophagus [1]. As a radiation oncologist, there are several comments made by the authors that are of concern to me. There is little question that radiation-induced secondary malignancies are something we acknowledge, yet the overall incidence is quite low, generally quoted as less that 1% over 15 to 30 years. The authors state that the range of secondary sarcomas in irradiated patients are 0.03% to 2.6%, while the paper they cite to strongly support their argument states a range of 0.03% to 0.8% [2]. The authors go on to state that many patients receiving radiotherapy, of the 60% overall whom are treated for any malignancy, are at potential risk for developing a secondary malignancy. Although this is true in theory, a treatment-related complication of less than 1% over decades of follow-up is certainly compatible with the risk of morbidity and mortality associated with general anesthesia. The authors finally state that radiation-induced sarcomas of the esophagus may become more common in the future as more chemoradiotherapy is being offered for the curative management of esophageal carcinomas. Working the numbers alone should demonstrate the failure of this argument. Based on the authors’ comment that approximately 50% of patients who develop a GIST will have a surgical cure, and a GIST occurs in 1% of patients irradiated, then only 0.5% of patients would die from a radiation-induced GIST. The literature suggests that perioperative mortality associated with an esophagectomy ranges from 2% to 12%, depending on the institution’s experience [3, 4]. If the authors are indeed implying that chemoradiotherapy is a suspicious option based on the potential risk of a secondary malignancy, the risk of mortality from surgery far outweighs the risk of a nonoperative treatment complication. As the reference these authors chose to cite [2] stated, "post-irradiation sarcomas should not be a major factor influencing treatment decisions in patients with cancer." A 9-year survivor from esophageal cancer should be a reason to celebrate, not an excuse for concern.

References

1. Miller P.R., Jackson S.L., Pineau B.C., Levine E.A. Radiation-induced gastrointestinal stromal sarcoma of the esophagus. Ann Thorac Surg 2000;70:660-662.[Abstract/Free Full Text]
2. Mark R.J., Poen J., Tran L.M., Fu Y.S., Selch M.T., Parker R.G. Postirradiation sarcomas: a single-institution study and review of the literature. Cancer 1993;73:2653-2662.
3. Wong J. Esophageal resection for cancer: the rationale of current practice. Am J Surg 1987;153:18-24.[Medline]
4. Bolton J.S., Fuhrman G.M., Richardson W.S. Esophageal resection for cancer. Surg Clin NA 1998;78:773-793.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pollock, J. Search for Related Content PubMed PubMed Citation Articles by Pollock, J. Related Collections Esophagus - cancer Related Article