Radiation-induced aortoesophageal fistula: an unusual case of massive upper gastrointestinal bleeding

Sivaraman, Sujith; Drummond, Robert J.

doi:10.1016/s0736-4679(02)00488-2

Cited by 34 publications

(25 citation statements)

References 17 publications

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“…On the one hand, CRT can induce EF which by damaging the walls of the esophagus and adjacent organs. On the other hand, the imbalance between tumor shrinkage and normal tissue repair can lead to EF [9][10][11]. Although the incidence of EF is low (10.4%-13.9%) but the prognosis is poor and the death rate is high Ivyspring International Publisher [12,13].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with Esophageal Fistula after Radiotherapy for Esophageal Squamous Cell Carcinoma

Hu¹,

Feng²,

Zhou³

et al. 2020

J. Cancer

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Purpose: The aim of this study was to investigate risk factors for esophageal squamous cell carcinoma (ESCC) treated with radiotherapy (RT) with or without chemotherapy to guide how to reduce the occurrence of esophageal fistula (EF). Methods: 414 patients with ESCC who underwent RT with or without chemotherapy were collected in Shandong Cancer Hospital from February 2012 to June 2018 retrospectively. The clinical characters and dosimetric parameters were recorded. Univariate and multivariate logistic regression analyses were provided to determine the risk factors associated with EF. Results: The cumulative incidences of EF were 11.1% (46/414 patients). The median follow-up period was 15.8 months (range: 0.2-82.6months). The median survival time (MST) of patients with EF was 5.3 months. In univariate analysis, age, T4 stage, N3 stage, chemotherapy regimens, re-RT, ulcerative esophageal cancer (EC), esophageal stenosis, the maximum thickness of the tumor and the length of tumor had a correlation with the prevalence of EF. In multivariable logistic regression analysis, T4 stage, N3 stage, re-RT, ulcerative EC, esophageal stenosis, the maximum thickness of the tumor was confirmed as risk factors for EF. Conclusion: This study revealed that T4 stage, N3 stage, re-RT, ulcerative EC, esophageal stenosis, the maximum thickness of the tumor were risk factors associated with EF. We ought to attach importance to the prevention of EF. Patients with risk factors for EF should be paid close attention.

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Section: Introductionmentioning

confidence: 99%

Risk Factors Associated with Esophageal Fistula after Radiotherapy for Esophageal Squamous Cell Carcinoma

Hu¹,

Feng²,

Zhou³

et al. 2020

J. Cancer

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“…15 Recent reports by Silvaraman et al and Gabrail et al concluded that radiation was the primary cause, with chemotherapy radiosensitizing and potentiating the radiation effect. 10,16 Radiotherapy probably weakened the mucosa in the current patient, and esophagal dilations may have contributed to further irritation and erosion.…”

Section: Discussionmentioning

confidence: 84%

“…Most involve treatment for esophageal malignancy, with reports of lung cancer being rare. 10,11 Radiation can cause damage to the aorta and other great vessels. [12][13][14][15] Poon et al demonstrated the radiation induced histological changes in a ruptured aorta in 1968, noting endothelial proliferation, intimal thickening, and vasa vasorum thrombosis leading to hyaline necrosis.…”

Section: Discussionmentioning

confidence: 99%

Emergency repair of a radiation-induced aortoesophageal fistula with endograft: Report of a case

et al. 2011

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This report presents the case of the emergency repair of a radiation-induced aortoesophageal fistula (AEF) with an endograft. The patient presented with multiple episodes of upper gastrointestinal bleeding. The fistula was discovered and treated in the operating room. The placement of a temporary aortic endograft was successful. The patient unfortunately exsanguinated while awaiting definitive aortic and esophageal repair. The potential occurrence of AEF should be considered in any patient presenting with massive hematemesis without a clear source of the bleeding. Although the patient succumbed to the fistula, this case illustrates the cryptic nature of an AEF and the difficult issues that are inherent in its treatment.

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“…The three most common etiologies of AEF include thoracic aortic aneurysm (51.2%), foreign body ingestion (18.6%), and esophageal malignancy (17.0%) [16]. Alarmingly, a growing number of cases have been published demonstrating formation of AEF independent of direct tumor involvement, mostly indicating external-beam radiation therapy as the causative agent, perhaps resulting from radiation-related damage to the vasa vasorum of the aorta [11,12,17,18]. Although surgery remains the definitive management of AEF [19], many patients, like this one, are not surgical candidates at presentation.…”

Section: Discussionmentioning

confidence: 99%

Massive hemorrhage following definitive esophageal chemoradiation: teaching case of a fatal aortoesophageal fistula and lessons learned

McGinnis

Holland

Thomas

et al. 2017

Clinical Case Reports

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Radiation-induced aortoesophageal fistula: an unusual case of massive upper gastrointestinal bleeding

Cited by 34 publications

References 17 publications

Risk Factors Associated with Esophageal Fistula after Radiotherapy for Esophageal Squamous Cell Carcinoma

Risk Factors Associated with Esophageal Fistula after Radiotherapy for Esophageal Squamous Cell Carcinoma

Emergency repair of a radiation-induced aortoesophageal fistula with endograft: Report of a case

Massive hemorrhage following definitive esophageal chemoradiation: teaching case of a fatal aortoesophageal fistula and lessons learned

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