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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


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.


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.


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.


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


Esophageal cancer T4 Fistula Radiographic findings Axial size 


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.


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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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