Abstract
BackgroundStandard treatment for unresectable esophageal squamous cell carcinoma (ESCC) without distant metastasis is definitive chemoradiotherapy (dCRT), in which the incidence of esophageal fistula (EF) is reported to be 10–12%. An ad hoc analysis of JCOG0303, a phase II/III trial of dCRT for patients with unresectable ESCC (including non-T4b), suggested that esophageal stenosis is a risk factor for EF. However, risk factors for EF in patients limited to T4b ESCC treated with dCRT have yet to be clarified. The aim of this study was to investigate risk factors for EF in T4b thoracic ESCC treated with dCRT.MethodsWe retrospectively analyzed the data of consecutive T4b thoracic ESCC patients who were treated with dCRT (cisplatin and fluorouracil) at Shizuoka Cancer Center between April 2004 and September 2015.ResultsExcluding 8 patients with esophageal fistula clearly attributable to other iatrogenic interventions, the data of 116 patients who met the inclusion criteria were analyzed. Esophageal fistula was observed in 28 patients (24%). Although the fistula was closed in 5 patients, overall survival was significantly shorter in patients who experienced esophageal fistula (8.0 vs. 26.8 months; p < 0.0001). Among four potential variables extracted in univariate analysis, namely, total circumferential lesion, elevated CRP level, elevated white blood cell count, and anemia, the first two were revealed as risk factors for esophageal fistula in multivariate analysis.ConclusionsThis study demonstrated that total circumferential lesion and CRP ≥1.00 mg/dL are risk factors for esophageal fistula in T4b thoracic ESCC treated with dCRT.Trial registrationThis study was retrospectively registered.
Highlights
Standard treatment for unresectable esophageal squamous cell carcinoma (ESCC) without distant metastasis is definitive chemoradiotherapy, in which the incidence of esophageal fistula (EF) is reported to be 10–12%
Patients We retrospectively collected the data of consecutive ESCC patients who were treated with definitive chemoradiotherapy (dCRT) with cisplatin and fluorouracil at Shizuoka Cancer Center between April 2004 and September 2015
Median age was 65 (41–80) years, median tumor size was 70 (12–200) mm, total circumferential lesion was present in 60 patients, and esophageal stenosis was present in 74 patients
Summary
Standard treatment for unresectable esophageal squamous cell carcinoma (ESCC) without distant metastasis is definitive chemoradiotherapy (dCRT), in which the incidence of esophageal fistula (EF) is reported to be 10–12%. An ad hoc analysis of JCOG0303, which compared the efficacy of low-dose and standard-dose chemoradiotherapy for unresectable ESCC invading adjacent organs and/or distant metastasis, suggested that esophageal stenosis is a risk factor of esophageal fistula [7]. Given the low incidence of esophageal fistula formation upon treatment with dCRT for non-organ-invading tumors, this condition is not clinically relevant This group did not define esophageal stenosis. They judged esophageal stenosis subjectively from clinical symptoms and/or patient reports We conducted this retrospective study to perform more precise investigation of risk factors for esophageal fistula in ESCC invading adjacent organs treated with dCRT
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