Radiation-Induced Esophagitis Exacerbated by Everolimus
A 63-year-old man was diagnosed with RCC (papillary cell carcinoma) and underwent a nephrectomy in December 2006. Four years later, lung metastases were found and a lung metastasectomy was performed. However, the lung metastases recurred in June 2011, and sunitinib therapy was initiated. The lung metastases improved, and the sunitinib treatment was continued for 12 months. In July 2012, the patient complained of back pain, and magnetic resonance imaging and a technetium bone scintigraphy examination revealed multiple vertebral metastases. Treatment with everolimus (10 mg daily) was initiated as second-line systemic therapy, and nonsteroidal anti-inflammatory drugs as well as oxycodone analgesics were also administered. One week later, the patient's back pain persisted, and we temporarily discontinued the everolimus treatment and initiated irradiation to the T6–10 vertebrae at 30 Gy in 10 fractions over a 2-week period. Everolimus (10 mg daily) was reinitiated immediately after the completion of the radiotherapy. One week after receiving the everolimus, the patient complained of dysphagia, nausea and vomiting. An endoscopic examination of the esophagus showed erosive esophagitis in the middle to lower portions of his thoracic esophagus (fig. ), corresponding to the irradiation field (fig. ). Everolimus was discontinued, and his symptoms gradually resolved. One month later, a repeat endoscopy showed a remarkable improvement in the esophageal erosions (fig. ).\nWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent form is available for review by the editor of this journal.