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

Abstract

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.

Quantitative CT Analysis to Predict Esophageal Fistula in Patients With Advanced Esophageal Cancer Treated by Chemotherapy or Chemoradiotherapy

“…It was proved that T stage was a signi cant risk factor for stula in accordance with previous results [24] , which had a certain relationship with wall thickness in esophageal SCC. Another mentioned risk factors were deep ulcer presence and ulcer-to-tumor ratio in our study.…”

“…Another study by Tsushima et al [14] demonstrated that 89% of patients with esophageal stula presented ulcerative esophageal carcinoma. Hu et al [24] indicated that ulcerative esophageal cancer was associated with esophageal stula. The advantage of this study was that quantitative CT analysis assessing deep ulcers was more accurate in predicting esophageal stula.…”

High incidence of esophageal fistula on patients with clinical T4b esophageal squamous cell carcinoma who received chemoradiotherapy: A retrospective analysis

“…In our multivariate analysis, tumors with ulcerations detected by endoscopy or barium esophagography was one of the two independent predictors of fistula development for T4b lesion. Of interest, the OR for fistula formation was 2.206 (95% CI: 1.188-4.094) among esophageal carcinoma patients with esophageal ulceration in a cohort of 414 ESCC patients when compared to those without ulceration [22]. Similarly, other studies also reported ulcerative-type cancer among cases of ESCC with fistula ranging from 64.7% [23] to 89% [18].…”

Addition of camrelizumab to docetaxel, cisplatin, and radiation therapy in patients with locally advanced esophageal squamous cell carcinoma: a phase 1b study

“…T4 stage and ulcerative ESCC were risk factors associated with esophageal fistula. 32 , 33 High esophageal fistula rates of 22% (31/140), 34 24% (28/116) 35 and 30.1% (41/136) 36 were reported in patients with ESCC and receiving definitive chemoradiotherapy, which accounted for 76%, 34 100% 35 and 100% 36 in all patients with T4 or T4b tumors, individually. Relative low rate of 10.38% (22/212) was also reported in ESCC patients who received definitive chemoradiotherapy, which accounted for 15.09% in T4 patients.…”