Is Radiation Dose Escalation a Risk Factor for Acquired Tracheoesophageal Fistula Formation in Esophageal Cancer? A Single-Institution Preliminary Experience

Chia-Chun Huang ； Tung-Hao Chang ； Mu-Tai Liu

《The Changhua Journal of Medicine》 17卷2期 (2019/06) Pp. 59-63

https://doi.org/10.6501/CJM.201906_17(2).0002

摘要

Tracheoesophageal (TE) fistula is a rare but fatal complication in esophageal cancer. An early diagnosis followed by anti-neoplasm treatment could contribute to this adverse effect. This study was performed to investigate whether radiotherapy dose is a factor affecting TE fistula formation in esophageal cancer under definitive or preoperative concurrent chemoradiation therapy (CCRT). In total, 192 patients diagnosed with squamous cell carcinoma of the esophagus were included in this study. All received definitive or preoperative CCRT. The median age was 55 years. The clinical T stage was T1 in one patient (1%), T2 in 71 patients (37%), T3 in 95 patients (49%), and T4 in 25 patients (13%). The median irradiation dose was 5,940 cGy. The chemotherapy regimens were Cisplatin and 5-Fluorouracil. A thoracic computed tomography scan and/or bronchoscopy was performed to evaluate the tumor response and to confirm whether formation of a TE fistula occurred after completion of treatment. Three of the 192 patients developed a TE fistula (1.5%) during the follow-up period. These three patients were initially of clinical T4b stage with trachea invasion; i.e., three of the 15 patients in the advanced stage T4b (trachea invasion) subgroup developed a TE fistula (20%) after CCRT. There was no statistically significant correlation between radiation (RT) dose and TE fistula formation in the initial clinical T4b stage with trachea invasion subgroup according to the results of bivariate (Pearson) correlation analysis (p = 0.396). The incidence of acquired TE fistula was 1.5% (three of 192 patients) in this study of esophageal cancer patients after CCRT. All three patients expired, with a mean duration to death of 54 days from TE fistula diagnosis. Our preliminary data indicated that TE fistula formation appeared to be unrelated to RT dose, especially in the initial clinical T4b stage with trachea invasion subgroup. Further study of more cases is warranted.

關鍵字

acquired tracheoesophageal fistula ； esophageal cancer ； radiation dose escalation