Concurrent Chemoradiation therapy Associated With Enteral Nutrition Support: A Radical Treatment Option for Esophageal Squamous Cell Carcinoma Patients With Malignant Fistulae

Abstract

To assess the therapeutic efficacy and toxicity of aggressive concurrent chemoradiation therapy (CCRT) associated with enteral nutrition support in esophageal squamous cell carcinoma (ESCC) patients with malignant fistulae. Treatment outcome and toxicity were retrospectively evaluated in 40 ESCC patients with malignant fistulae. All patients were treated with 3DCRT-based CCRT (median radiation dose 60Gy) and combined with enteral nutrition support. Twenty-two patients received nasogastric tube and 18 had percutaneous endoscopic gastrostomy feeding. Median energy intake was 2166kcal/day and median protein intake was 1.53/kg/day. Treatment response was evaluated at 1-3 months after completion of CCRT. With a median follow-up of 18 months (range, 3-39 months), the 1-year overall survival (OS) rate of all the patients was 62.5% and the estimated OS time was 25.5 months. Univariate analysis showed that, after completion of CCRT, Nutrition Risk Screening (NRS) score (p = 0.001), improvement of NRS score (p = 0.016), hemoglobin levels (p = 0.044), fistula closure (p = 0.005), and response to treatment (p = 0.000) had significant associations with OS. Multivariate analysis showed that, after completion of CCRT, tumor response (p = 0.002) and improvement of NRS score (p = 0.037) were independent predictors of OS. G3 vomiting was observed in 8 out of 40 patients (20.0%). G3 neutropenia occurred in 11 out of 40 patients (27.5%). G3 esophagitis was observed in 2 patients (2/40, 5.0%). G3 cough was recorded in 13 patients (13/40, 32.5%). Two patients (2/40, 5.0%) died of massive bleeding during treatment. CCRT associated with enteral nutrition support is effective in ESCC patients with malignant fistulae. Patients that obtained CR and improvement of NRS score appeared to achieve long-term OS. Prospective studies are needed to validate the therapeutic efficacy of our treatment option.