Abstract
PurposeThe purpose of the present study was to investigate risk factors for esophageal fistula (EF) in patients with recurrent esophageal cancer receiving re-radiotherapy with or without chemotherapy.MethodsWe reviewed retrospectively the clinical characters and dosimetric parameters of 96 patients with recurrent esophageal cancer treated with re-radiotherapy in Cancer Hospital Affiliated to Shandong First Medical University between August 2014 and January 2021.Univariate and multivariate logistic regression analyses were provided to determine the risk factors of EF induced by re-radiotherapy.ResultsThe median time interval between two radiotherapy was 23.35 months (range, 4.30 to 238.10 months). EF occurred in 19 patients (19.79%). In univariate analysis, age, T stage, the biologically equivalent dose in the re-radiotherapy, total biologically equivalent dose, hyperfractionated radiotherapy, ulcerative esophageal cancer, the length of tumor and the maximum thickness of tumor had a correlation with the prevalence of EF. In addition, age (HR = 0.170, 95%CI 0.030–0.951, p = 0.044), T stage (HR = 8.369, 95%CI 1.729–40.522, p = 0.008), ulcerative esophageal cancer (HR = 5.810, 95%CI 1.316–25.650, p = 0.020) and the maximum thickness of tumor (HR = 1.314, 95%CI 1.098–1.572, p = 0.003) were risk factors of EF in multivariate logistic regression analysis.ConclusionsThe incidence of EF was significantly increased in patients with recurrent esophageal cancer who underwent re-radiotherapy. This study revealed that age, T stage, ulcerative esophageal cancer and the maximum thickness of the tumor were risk factors associated with EF. In clinical work, patients with risk factors for EF ought to be highly concerned and individualized treatment plans should be taken to reduce the occurrence of EF.
Highlights
Loco-regional recurrence is the main type of failure in patients with esophageal cancer (EC) following chemoradiotherapy (CRT)
EF Esophageal fistula, CRTChemoradiotherapy, RT Radiotherapy; re-RT re-radiotherapy, biologically equivalent dose (BED) Biologically equivalent dose, EC Esophageal cancer, esophageal-mediastinum fistula (EMF) Esophagealmediastinum fistula, esophago-respiratory fistula (ERF) Esophago-respiratory fistula, aorto-esophageal fistula (AEF) Aorto-esophageal fistula time (MST) of 77 patients with non-EF was 14.5 months, and the 6-month, 1-year and 2-year overall survival rates were 79.2,59.6 and 32.9%, respectively
The local recurrence after primary RT in patients with EC is a tough challenge for clinical oncologists, it was as high as 66.5% after RT with or without chemotherapy in 2 years [17]
Summary
Loco-regional recurrence is the main type of failure in patients with esophageal cancer (EC) following chemoradiotherapy (CRT). It is difficult to treat those patients with recurrent esophageal cancer (REC) after primary radiotherapy (RT). There are no general treatment guidelines for REC after primary RT. In patients with advanced REC, Wang et al BMC Cancer (2022) 22:207 the effects of tumor recurrence are extremely distressing, and the main purpose of treatment is to relieve the patients’ dysphagia. Chemotherapy is a palliative treatment, which rarely achieves remission of the lesion. Re-radiotherapy (re-RT) appear to be an important treatment for local recurrence of EC after primary RT. The use of re-RT can significantly alleviate the symptoms of dysphagia, thereby improving the survival time and quality of life of patients [8]
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