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SA Journal of Radiology

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Vertebral height as the measure of lesion length in carcinoma of the oesophagus — is it accurate?

V Sharma, B Donde, M Muhiuddin, BS Rabin, U Majeed, D Chetty, C Nyongensa, A Msemo, D van der Merwe, R Glynn-Thomas

Abstract


The majority of patients with carcinoma of the oesophagus present with advanced disease and difficulty in swallowing as their main symptom.
These patients receive intraluminal radiation therapy for quick relief of
dysphagia as one of the main palliative options. Presently lesion length is estimated depending on the filling defect seen on Hexabrix swallow,whic h is measured against the number of vertebrae the lesion spans (each vertebra is taken to measure 2.5 cm).We have devised a modification of the technique for the intraluminal procedure, with patients having a localisation film with Hexabrix at the simulator using a magnification graticule,with the grid projecting at 1 cm intervals at the isocentre.Ten consecutive patients underwent the procedure and the lesion length was calculated using the modified as well as the earlier technique. The mean and median differences in lengths calculated were 1.72 cm and 1.5 cm respectively (range 1.25 - 2.50 cm). The length of the lesion was longer when the number of vertebrae was used for an estimation of the length.With the modified technique it was possible to decrease treatment
length and the number of normal oesophageal mucosa in the treatment
volume,ther eby reducing the chance of treatment-related complications
such as strictures and ulceration.



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