Acute Radiation Esophagitis After Chemoradiotherapy Demonstrating "Tube-Like" FDG Uptake on PET-CT: Case Report and...

Radiation esophagitis (RE) is a frequent complication of concurrent chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC). However, its acute-phase imaging features on positron emission tomography-computed tomography (PET-CT) are rarely described in detail. Early identification of such findings may help differentiate RE from other causes of esophageal fluorodeoxyglucose (FDG) uptake.

We report a case of a 75-year-old man with stage IIIA NSCLC who underwent CRT with cisplatin and S-1 alongside intensity-modulated radiation therapy (IMRT). During the acute phase, PET-CT revealed an unusual tube-like pattern of FDG uptake in the esophagus (SUVmax = 5.5), which subsequently resolved. The patient later developed chronic RE presenting as dysphagia, which gradually improved with conservative treatment.

This case highlights an atypical tube-like FDG uptake pattern on PET-CT during acute RE and underscores the need for awareness of this finding. A review of the literature suggests potential overlap with imaging features of chemotherapy-induced or Candida esophagitis. Larger studies are warranted to evaluate whether such PET-CT findings may serve as early markers for acute RE and predictors of chronic complications.