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Esophagus

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Analysis of fistula formation of T4 esophageal cancer patients treated by chemoradiotherapy

  • Tomoko Katsui Taniyama
  • Takashi TsudaEmail author
  • Kunihisa Miyakawa
  • Hiroyuki Arai
  • Ayako Doi
  • Mami Hirakawa
  • Yoshiki Horie
  • Takuro Mizukami
  • Naoki Izawa
  • Takashi Ogura
  • Yu Sunakawa
  • Takako Eguchi Nakajima
Original Article
  • 35 Downloads

Abstract

Background and aim

Fistula is one of the known complications of T4 esophageal cancer (T4-EC). The standard treatment for T4-EC is chemoradiotherapy, but detailed data about fistula resulting from chemoradiotherapy in this condition are limited. In particular, radiographic findings of T4-EC with fistula have not been reported. This study assessed the risk factors of fistula based on clinical information on patients with chemoradiotherapy for T4-EC.

Methods

We retrospectively reviewed the clinical data of 59 T4-EC patients who had squamous cell carcinoma without any fistula before receiving definitive or palliative chemoradiotherapy.

Results

A fistula was observed in 18 patients (31%) throughout their clinical course. The overall survival in the fistula group was significantly shorter than that in the non-fistula group (259 vs. 346 days; p = 0.0341). The axial tumor size on computed tomography (CT) was confirmed as an independent risk factor for esophageal fistula in multivariate analysis of stepwise methods [OR 1.226; 95% CI 1.109–1.411; p < 0.0001]. Twelve out of 14 patients with an axial tumor size of 50 mm or greater had developed a fistula.

Conclusions

A large tumor size on the axial plane on CT is a risk factor for fistula formation.

Keywords

Esophageal cancer T4 Fistula Radiographic findings Axial size 

Notes

Compliance with ethical standards

Ethical Statement

The study was reviewed and approved by the institutional review boards of St. Marianna University School of Medicine.

Conflict of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Tachimori Y, Ozawa S, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan, 2009. Esophagus. 2016;13:110–37.CrossRefGoogle Scholar
  2. 2.
    Chak A, Canto M, Gerdes H, et al. Prognosis of esophageal cancers preoperatively staged to be locally invasive (T4) by endoscopic ultrasound (EUS): a multicenter retrospective cohort study. Gastrointest Endosc. 1995;42:501–6.CrossRefGoogle Scholar
  3. 3.
    Akutsu Y, Kono T, Uesato M, et al. Is the outcome of a salvage surgery for T4 thoracic esophageal squamous cell carcinoma really poor? World J Surg. 2014;38:2891–7.CrossRefGoogle Scholar
  4. 4.
    Shimoji H, Karimata H, Nagahama M, et al. Induction chemotherapy or chemoradiotherapy followed by radical esophagectomy for T4 esophageal cancer: results of a prospective cohort study. World J Surg. 2013;37:2180–8.CrossRefGoogle Scholar
  5. 5.
    Pimiento JM, Weber J, Hoffe SE, et al. Outcomes associated with surgery for T4 esophageal cancer. Ann Surg Oncol. 2013;20:2706–12.CrossRefGoogle Scholar
  6. 6.
    Seto Y, Chin K, Gomi K, et al. Treatment of thoracic esophageal carcinoma invading adjacent structures. Cancer Sci. 2007;98:937–42.CrossRefGoogle Scholar
  7. 7.
    Shinoda M, Ando N, Kato K, et al. Randomized study of low-dose versus standard-dose chemoradiotherapy for unresectable esophageal squamous cell carcinoma (JCOG0303). Cancer Sci. 2015;106:407–12.CrossRefGoogle Scholar
  8. 8.
    Kaneko K, Ito H, Konishi K, et al. Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus. Br J Cancer. 2003;88:18–24.CrossRefGoogle Scholar
  9. 9.
    Ishida K, Iizuka T, Ando N, et al. Phase II study of chemoradiotherapy for advanced squamous cell carcinoma of the thoracic esophagus: nine Japanese institutions trial. Jpn J Clin Oncol. 1996;26:310–5.CrossRefGoogle Scholar
  10. 10.
    Nishimura Y, Suzuki M, Nakamatsu K, et al. Prospective trial of concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil and cisplatin for T4 esophageal cancer with or without fistula. Int J Radiat Oncol Biol Phys. 2002;53:134–9.CrossRefGoogle Scholar
  11. 11.
    Ohtsu A, Boku N, Muro K, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol. 1999;17:2915–21.CrossRefGoogle Scholar
  12. 12.
    Ishida K, Ando N, Yamamoto S, et al. Phase II study of cisplatin and 5-fluorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the esophagus: a Japan Esophageal Oncology Group (JEOG)/Japan Clinical Oncology Group trial (JCOG9516). Jpn J Clin Oncol. 2004;34:615–9.CrossRefGoogle Scholar
  13. 13.
    Honing J, Smit JK, Muijs CT, et al. A comparison of carboplatin and paclitaxel with cisplatinum and 5-fluorouracil in definitive chemoradiation in esophageal cancer patients. Ann Oncol. 2014;25:638–43.CrossRefGoogle Scholar
  14. 14.
    Taniguchi H, Yamazaki K, Boku N, et al. Risk factors and clinical courses of chemoradiation-related arterio-esophageal fistula in esophageal cancer patients with clinical invasion of the aorta. Int J Clin Oncol. 2011;16:359–65.CrossRefGoogle Scholar
  15. 15.
    Chen HY, Ma XM, Ye M, et al. Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma. J Radiat Res. 2014;55:940–7.CrossRefGoogle Scholar
  16. 16.
    Tsushima T, Mizusawa J, Sudo K, et al. Risk factors for esophageal fistula associated with chemoradiotherapy for locally advanced unresectable esophageal cancer: a supplementary analysis of JCOG0303. Medicine. 2016;95:e3699.CrossRefGoogle Scholar
  17. 17.
    Kawakami T, Tsushima T, Omae K, et al. Risk factors for esophageal fistula in thoracic esophageal squamous cell carcinoma invading adjacent organs treated with definitive chemoradiotherapy: a monocentric case-control study. BMC Cancer. 2018;18:573–9.CrossRefGoogle Scholar
  18. 18.
    Moss AA, Schnyder P, Thoeni RF, et al. Esophageal carcinoma: pretherapy staging by computed tomography. AJR Am J Roentgerol. 1981;136:1051–6.CrossRefGoogle Scholar
  19. 19.
    Picus D, Balfe DM, Koehler RE, et al. Computed tomography in the staging of esophageal carcinoma. Radiology. 1983;146:433–8.CrossRefGoogle Scholar
  20. 20.
    Ishikura S, Ohtsu A, Shirao K, et al. A phase I/II study of nedaplatin and 5-fluorouracil with concurrent radiotherapy in patients with T4 esophageal cancer: Japan Clinical Oncology Group trial (JCOG 9908). Esophagus. 2005;2:133–7.CrossRefGoogle Scholar
  21. 21.
    Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) Phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol. 2001;20:1167–74.CrossRefGoogle Scholar
  22. 22.
    Miyata H, Yamasaki M, Kurokawa Y, et al. Clinical relevance of induction triplet chemotherapy for esophageal cancer invading adjacent organs. J Surg Oncol. 2012;106(4):441–7.CrossRefGoogle Scholar
  23. 23.
    Satake H, Tahara M, Mochizuki S, et al. A prospective, multicenter phase I/II study of induction chemotherapy with docetaxel, cisplatin and fluorouracil (DCF) followed by chemoradiotherapy in patients with unresectable locally advanced esophageal carcinoma. Cancer Chemother Pharmacol. 2016;78(1):91–9.CrossRefGoogle Scholar
  24. 24.
    Yokota T, Kato K, Hamamoto Y, et al. Phase II study of chemoselection with docetaxel plus cisplatin and 5-fluorouracil induction chemotherapy and subsequent conversion surgery for locally advanced unresectable oesophageal cancer. Br J Cancer. 2016;115:1328–34.CrossRefGoogle Scholar
  25. 25.
    Yamashita H, Takenaka R, Omori M, et al. Involved-field radiotherapy (IFRT) versus elective nodal irradiation (ENI) in combination with concurrent chemotherapy for 239 esophageal cancers: a single institution retrospective study. Radiat Oncol. 2015;10:171.CrossRefGoogle Scholar

Copyright information

© The Japan Esophageal Society 2019

Authors and Affiliations

  • Tomoko Katsui Taniyama
    • 1
  • Takashi Tsuda
    • 2
    Email author
  • Kunihisa Miyakawa
    • 3
  • Hiroyuki Arai
    • 2
  • Ayako Doi
    • 2
  • Mami Hirakawa
    • 2
  • Yoshiki Horie
    • 2
  • Takuro Mizukami
    • 2
  • Naoki Izawa
    • 2
  • Takashi Ogura
    • 2
  • Yu Sunakawa
    • 2
  • Takako Eguchi Nakajima
    • 2
  1. 1.Department of Medical OncologyTokyo Saiseikai Mukojima HospitalTokyoJapan
  2. 2.Department of Clinical OncologySt. Marianna University School of MedicineKawasakiJapan
  3. 3.Department of RadiologySt. Marianna University School of MedicineKanagawaJapan

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