Standard treatment for unresectable esophageal squamous cell carcinoma (ESCC) without distant metastasis is definitive chemoradiotherapy (dCRT). The frequency of esophageal fistula (EF) is 10–12% in patients (pts) receiving dCRT for T4b ESCC and the prognosis for pts harboring EF is poor. However, its risk factors are still unclear. Therefore, we investigated risk factors for EF in T4b ESCC treated with dCRT.
We retrospectively analyzed the data of consecutive T4b ESCC pts who received dCRT with cisplatin plus fluorouracil (CF) at Shizuoka Cancer Center between Sep. 2004 and Apr. 2015. All data were collected from electronic medical records. EF was diagnosed by radiological or endoscopic examination, and/or clinical course. Inclusion criteria were as follows: (1) ECOG performance status (PS) 0–1; (2) histologically proven SCC; (3) clinically T4b (TNM 7th); (4) no EF before dCRT; and (5) CCr ≥50 mL/min. dCRT consisted of intravenous infusion of 70 mg/m2 cisplatin on days 1 and 29, continuous infusion of 700 mg/m2 fluorouracil on days 1–4 and 29–32, and concomitant radiation of 50–60 Gy (2 Gy/Fr).
In total, 143 pts who met the inclusion criteria were analyzed, excluding 6 with EF due to iatrogenic intervention. With a median follow-up time of 31 months in censored cases, EF was observed in 34 pts (24%). The median time to EF was 2.5 months. Characteristics of pts who experienced EF versus those who did not were as follows: median age (range), 64 (41–75) vs. 65 (40–80) years; PS 0/1, 22/12 vs. 71/38 pts; circumferential lesion (CL), 24 vs. 52 pts; aorta invasion, 16 vs. 46 pts; trachea or bronchus invasion, 23 vs. 77 pts; Hb
CL and CRP ≥1.00 mg/dL seemed to be risk factors for EF in T4b ESCC treated with dCRT. A new treatment strategy may be needed for pts with such factors.
Clinical trial identification
Legal entity responsible for the study
Shizuoka Cancer Center
All authors have declared no conflicts of interest.