Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma

Abstract

The aim of this study was to analyze the risk factors and prognosis for patients with esophageal perforation occurring during or after radiotherapy for esophageal carcinoma. We retrospectively analyzed 322 patients with esophageal carcinoma. These patients received radiotherapy for unresectable esophageal tumors, residual tumors after operation, or local recurrence. Of these, 12 had radiotherapy to the esophagus before being admitted, 68 patients had concurrent chemoradiotherapy (CRT), and 18 patients had esophageal perforation after RT (5.8%). Covered self-expandable metallic stents were placed in 11 patients. Two patients continued RT after stenting and control of infection; one of these suffered a new perforation, and the other had a massive hemorrhage. The median overall survival was 2 months (0–3 months) compared with 17 months in the non-perforation group. In univariate analysis, the Karnofsky performance status (KPS) being ≤70, age younger than 60, T4 stage, a second course of radiotherapy to the esophagus, extracapsular lymph nodes (LN) involving the esophagus, a total dose >100 Gy (biologically effective dose−10), and CRT were risk factors for perforation. In multivariate analysis, age younger than 60, extracapsular LN involving the esophagus, T4 stage, and a second course of radiotherapy to the esophagus were risk factors. In conclusion, patients with T4 stage, extracapsular LN involving the esophagus, and those receiving a second course of RT should be given particular care to avoid perforation. The prognosis after perforation was poor.

Survival and prognostic factors of patients with esophageal fistula in advanced esophageal squamous cell carcinoma

“…First, it was found in the present study that therapies for ESCC before the development of fistula was statistically significant in the univariate analysis. In a study conducted by Chen et al, the tumor shrinks during radiation therapy, resulting in the formation of a fistula in the lesion that connects the esophagus to adjacent organs [32]. Therefore, acute necrosis of cancerous tissues can be caused by radiation; therefore, the difficulty of regeneration of normal damaged tissues would be increased leading to more difficulties in healing, infection and bleeding after the occurrence of esophageal fistula.…”

Efficacy and Toxicity of Re-irradiation for Esophageal Cancer Patients with Locoregional Recurrence: a retrospective analysis

“…Patients with RFI≤ 12 months, esophageal stenosis and fat space between tumor and adjacent tissue disappeared had a higher risk of EP through our present analysis. There is no prediction of risk factors for EP caused by re-RT in the past, but the risk factors were similar to patients who received radiotherapy for the rst time [16,30]. Other risk factors for EP in patients undergoing RT for the rst time have also been reported [31][32][33], further study on the risk of EP in re-RT is expected to be included in analysis.…”

“…For the surgery group, the median OS was 38.0 months (Fig.1C) and the 1-, 3-, and 5-year OS rates were 95.3%, 51.4%, and 27.0%, respectively. The median ARS of the 85 patients were 16.0 months ( Fig.1D) and the 6-, 12-, and 24-month ARS rates were 82.2%, 56.0%, and 28.8%, respectively.…”

“…The planning target volume (PTV) for re-RT was de ned as the GTV plus a 0.5-1.0 cm margin in all directions. The biological effectiveness of radiation schedule was calculated by the biologically effective dose formula: BED = n × d (1 + d/ (α/β)) [16]. The total dose to the spinal cord was limited not to exceed the maximal dose of 45 Gy except for a few patients, considering the time interval between primary RT and re-RT.…”

Self-Expandable Metallic Stents in Oesophago-Respiratory Fistulas Treatment in Neoplasms—Case Reports and Literature Review

“…In the group of 1943 patients with oesophageal cancer, EFR were diagnosed in 5% of them, whereas in the group of 5714 bronchial cancer patients, EFR were found in 0.2% of patients [1]. EFR can develop in about 5.8% of patients after radiotherapy [2]. The development of oesophageal carcinoma as well as proliferation of bronchial cancer into the oesophagus cause the symptoms of dysphagia in the first instance.…”