title: Radiation induced esophageal adenocarcinoma in a woman previously treated for breast cancer and renal cell carcinoma.
abstract: BACKGROUND
  Secondary radiation-induced cancers are rare but well-documented as long-term side effects of radiation in large populations of breast cancer survivors. Multiple neoplasms are rare. We report a case of esophageal adenocarcinoma in a patient treated previously for breast cancer and clear cell carcinoma of the kidney.
  
  
  METHODS
  A 56 year-old non smoking woman, with no alcohol intake and no familial history of cancer; followed in the National Institute of Oncology of Rabat Morocco since 1999 for breast carcinoma, presented on consultation on January 2011 with dysphagia. Breast cancer was treated with modified radical mastectomy, 6 courses of chemotherapy based on CMF regimen and radiotherapy to breast, inner mammary chain and to pelvis as castration. Less than a year later, a renal right mass was discovered incidentally. Enlarged nephrectomy realized and showed renal cell carcinoma. A local and metastatic breast cancer recurrence occurred in 2007. Patient had 2 lines of chemotherapy and 2 lines of hormonotherapy with Letrozole and Tamoxifen assuring a stable disease. On January 2011, the patient presented dysphagia. Oesogastric endoscopy showed middle esophagus stenosing mass. Biopsy revealed adenocarcinoma. No evidence of metastasis was noticed on computed tomography and breast disease was controlled. Palliative brachytherapy to esophagus was delivered. Patient presented dysphagia due to progressive disease 4 months later. Jejunostomy was proposed but the patient refused any treatment. She died on July 2011.
  
  
  CONCLUSIONS
  We present here a multiple neoplasm in a patient with no known family history of cancers. Esophageal carcinoma is most likely induced by radiation. However the presence of a third malignancy suggests the presence of genetic disorders.
authors.affiliation: Medical Oncology Department, National Institute of Oncology, Rabat, Morocco. soundouss13@hotmail.com
authors.forename: Soundouss
authors.initials: S
authors.lastname: Raissouni
authors.forename: Ferdaous
authors.initials: F
authors.lastname: Raissouni
authors.forename: Ghizlane
authors.initials: G
authors.lastname: Rais
authors.forename: Meryem
authors.initials: M
authors.lastname: Aitelhaj
authors.forename: Siham
authors.initials: S
authors.lastname: Lkhoyaali
authors.forename: Rachida
authors.initials: R
authors.lastname: Latib
authors.forename: Amina
authors.initials: A
authors.lastname: Mohtaram
authors.forename: Fadoua
authors.initials: F
authors.lastname: Rais
authors.forename: Hind
authors.initials: H
authors.lastname: Mrabti
authors.forename: Nawal
authors.initials: N
authors.lastname: Kabbaj
authors.forename: Naima
authors.initials: N
authors.lastname: Amrani
authors.forename: Hassan
authors.initials: H
authors.lastname: Errihani
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005720:Gamma Rays; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000175:diagnosis* / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D011878:Radiotherapy / Q000009:adverse effects