An analysis of risk factors for esophageal fistula and fatal bleeding after intensity-modulated radiotherapy for esophageal cancer

Abstract

Objective To evaluate the incidence of and risk factors for esophageal fistula and fatal bleeding after intensity-modulated radiotherapy (IMRT) for esophageal cancer. Methods Clinical data were collected from 128 patients with esophageal cancer who received radical IMRT in our hospital from January 2012 to December 2014.According to the incidence of esophageal fistula and fatal bleeding, those patients were divided into control group (n=105) and severe complications group (n=23). In the severe complications group, 12 patients had esophageal fistula and 11 fatal bleeding. Between-group comparison was made by χ2 test. The Cox model was used for the multivariate analysis. Results Chest and back pain in the initial diagnosis, clinical stage cT4, tumor type (ulcerative), gross tumor volume (GTV)>50 cm3, and GTV maximum diameter>2.45 cm were risk factors for esophageal fistula and fatal bleeding after radiotherapy for esophageal cancer (P=0.042, 0.042, 0.019, 0.046, 0.002). The multivariate analysis showed that tumor type (ulcerative) and GTV maximum diameter were independent risk factors for esophageal fistula and fatal bleeding (P=0.010, HR=0.329, 95% CI: 0.142-0.763; P=0.009, HR=3.805, 95% CI: 1.404-10.312). Conclusions The efficacy of IMRT is severely restricted by the incidence of esophageal fistula and fatal bleeding. For patients with an ulcerative type of esophageal cancer or a GTV max diameter of>2.45 cm, the chemoradiotherapy plan should be optimized to reduce the risk of severe complications. Key words: Esophageal neoplasms/intensity-modulated radiotherapy; Esophageal fistular; Bleeding