Esophagitis due to adriamycin and radiation therapy for childhood malignancy

Esophagitis occurred in seven patients receiving mediastinal radiation and chemotherapy including adriamycin for non-Hodgkin's lymphoma, osteogenic sarcoma, and acute lymphocytic leukemia. Radiation doses were 500-2500 rad, below the reported esophageal tolerance dose. With subsequent adriamycin, recall esophagitis occurred in three of five patients at risk, two of whom developed strictures. Comparison to patients similarly treated without developing esophagitis revealed no specific risk factors, but suggested that the complication was less likely to occur if adriamycin therapy were completed more than two months before starting radiation. Adriamycin and radiation potentiate and recall each other's toxic effects on the esophagus. The interaction both increases the severity and lowers the radiation dose threshold for inflammation and stricture.