J Cancer 2020; 11(12):3693-3700. doi:10.7150/jca.39033 This issue

Research Paper

Risk Factors Associated with Esophageal Fistula after Radiotherapy for Esophageal Squamous Cell Carcinoma

Bing Hu1,4, Feng Jia2, Haiyan Zhou3, Tao Zhou4, Qian Zhao4, Yiru Chen4, Baosheng Li4, Wei Huang4✉

1. School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong province, China
2. Department of Oncology, Jinxiang people's hospital, Shandong province, China
3. Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong province, China
4. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong province, China

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Citation:
Hu B, Jia F, Zhou H, Zhou T, Zhao Q, Chen Y, Li B, Huang W. Risk Factors Associated with Esophageal Fistula after Radiotherapy for Esophageal Squamous Cell Carcinoma. J Cancer 2020; 11(12):3693-3700. doi:10.7150/jca.39033. Available from https://www.jcancer.org/v11p3693.htm

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Abstract

Purpose: The aim of this study was to investigate risk factors for esophageal squamous cell carcinoma (ESCC) treated with radiotherapy (RT) with or without chemotherapy to guide how to reduce the occurrence of esophageal fistula (EF).

Methods: 414 patients with ESCC who underwent RT with or without chemotherapy were collected in Shandong Cancer Hospital from February 2012 to June 2018 retrospectively. The clinical characters and dosimetric parameters were recorded. Univariate and multivariate logistic regression analyses were provided to determine the risk factors associated with EF.

Results: The cumulative incidences of EF were 11.1% (46/414 patients). The median follow-up period was 15.8 months (range: 0.2-82.6months). The median survival time (MST) of patients with EF was 5.3 months. In univariate analysis, age, T4 stage, N3 stage, chemotherapy regimens, re-RT, ulcerative esophageal cancer (EC), esophageal stenosis, the maximum thickness of the tumor and the length of tumor had a correlation with the prevalence of EF. In multivariable logistic regression analysis, T4 stage, N3 stage, re-RT, ulcerative EC, esophageal stenosis, the maximum thickness of the tumor was confirmed as risk factors for EF.

Conclusion: This study revealed that T4 stage, N3 stage, re-RT, ulcerative EC, esophageal stenosis, the maximum thickness of the tumor were risk factors associated with EF. We ought to attach importance to the prevention of EF. Patients with risk factors for EF should be paid close attention.

Keywords: esophageal squamous cell carcinoma, esophageal fistula, radiotherapy, risk factor, side effect