Radiotherapy induced achalasia-like esophageal motor disorder

Akalazya değişik faktörlerin neden olduğu nöromüsküler bir hastalık olarak bilinir. Elli dokuz yaşında erkek hasta dil kökü karsinomu tanısı aldı. Hastaya tümör eksizyonu ve lenf nodu disseksiyonu uygulandı. Yakın cerrahi sınır ve kas invazyonu nedeniyle hastaya adjuvan kemoradyasyon tedavisi uygulandı. Boyun lenf nodlarına ve supraklaviküle fossaya 50 Gray (Gy) ve cerrahi alanına 50 Gy radyasyon uygulandı ayrıca 10 Gy boost radyasyon dozu uygulandı. Kemoradyasyon bitiminden bir ay sonra hasta bozukluğu şikayeti ile başvurdu. Bunun üzerine hastaya üst gastrointestinal sistem endoskopisi ve yüksek çözünürlüklü manometrik çalışma uyguladık. Özofagiyal manometrik çalışmada vigorous akalazya için tipik olan yüksek amplitüdlü koordine olmayan simültane basınç dalgalarının varlığı tespit edildi. Kemoradyoterapi sonrası özellikle erken dönemde özofagiyal motor fonksiyon bozukluklarının ortaya çıkabileceğine dikkat edilmelidir.

Radyoterapiye bağlı gelişen akalazya benzeri özofagiyal motor bozukluk

Achalasia is known as a neuromuscular disease caused by various reasons. A 59 year-old man was diagnosed with tongue base carcinoma. He underwent tumor excision and lymph node dissection. Due to the close surgical margin and muscle invasion, adjuvant chemoradiation was applied. Fifty Gray (Gy) radiation dose was prescribed to the neck lymph nodes and supraclavicular fossa; and 50 Gy radiation dose was applied to the surgical bed with an additional 10 Gy boost dose. One month after the end of the chemoradiation, the patient came with deglutition disorder. We performed an upper gastrointestinal endoscopy and high-resolution manometric study. High amplitude simultaneous pressure waves which were typical for vigorous achalasia were seen on esophageal manometry. Care should be taken about the possiblity of some rare esophageal motility disorders after the chemoradiation therapy especially in the early period.

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