Clinical Application Of Oral Meglumine Diatrizoate Esophagogram Inscreening For Esophageal Fistula During Radiotherapy For Esophageal Cancer

Abstract

Esophageal fistula is one of the most serious complications of radical radiotherapy for esophageal cancer. It has high mortality, mandating early detection and treatment. The purpose of this study was to investigate the specificity and sensitivity of oral meglumine diatrizoate esophagogram in screening for esophageal fistula during radiotherapy for esophageal cancer, and to find out if the early detection and intervention can improve the prognosis of esophageal fistula. Patients who were diagnosed with pathologically confirmed and inoperable stage I-IV esophageal cancer and received intensity-modulated radiotherapy (IMRT) were included in the study. Weekly oral meglumine diatrizoate esophagogram was performed to screen for esophageal fistula during radiotherapy. When an esophageal fistula was detected, esophago fiberoscopy and computed tomography (CT) was used to confirm the diagnosis; radiotherapy was simultaneously stopped, and the patient received intervention. The esophagogram underwent a weekly review to assess the recovery of the esophageal fistula. If the fistula healed, the patient completed the radiotherapy sessions. The statistical software IBM SPSS 22.0 was used for statistical analysis, and P < 0.05 was considered statistically significant. Two hundred and six subjects with pathologically confirmed inoperable esophageal cancer were enrolled; this included 205 patients with esophageal squamous cell carcinoma. During radiotherapy, 10 cases of esophageal fistula were detected or suspected based on the oral meglumine diatrizoate esophagography findings, and 8 cases were confirmed by CT and esophagoscopy; the incidence of esophageal fistula was 3.88% (8/206).All patients with esophageal fistula received intervention; among them, 62.5%(5/8) recovered after 1-2 weeks of treatment and continued radiotherapy to completion. The sensitivity and specificity of oral meglumine diatrizoate esophagography in screening for esophageal fistula during radiotherapy was 100% and 98.9%, respectively. Approximately 60% of esophageal fistulas were observed to occur during the15th to20th fractions (32.25-43Gy) of radiotherapy. The median follow-up time was 18.1 months (6-30 months). Kaplan-Meier survival analysis showed that the median survival period of patients with esophageal fistula was 6.4 months (1.3-18.1 months). Oral meglumine diatrizoate esophagography has high sensitivity and specificity in screening for esophageal fistulas during radiotherapy and little side effect. Early diagnosis and timely intervention can significantly improve the prognosis and prolong the survival period of patients. It can be used in esophageal cancer patients with high risk of esophageal fistula during radiotherapy.