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Risk factors for esophageal fistula in esophageal squamous cell carcinoma invading adjacent organs (T4b) treated with definitive chemoradiotherapy

Date

08 Oct 2016

Session

Poster Display

Presenters

Takeshi Kawakami

Citation

Annals of Oncology (2016) 27 (6): 207-242. 10.1093/annonc/mdw371

Authors

T. Kawakami1, T. Tsushima1, K. Hayashi1, H. Shirasu1, M. Kawahira1, S. Kawai1, Y. Kito1, Y. Yoshida1, S. Hamauchi1, A. Todaka1, N. Machida1, K. Yamazaki1, T. Yokota1, A. Fukutomi1, Y. Onozawa2, H. Yasui1

Author affiliations

  • 1 Gastrointestinal Oncology, Shizuoka Cancer Center, 411-8777 - Shizuoka/JP
  • 2 Medical Oncology, Shizuoka Cancer Center, 411-8777 - Shizuoka/JP
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Background

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.

Methods

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).

Results

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

Conclusions

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

Takahiro Tsushima

Funding

Shizuoka Cancer Center

Disclosure

All authors have declared no conflicts of interest.

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