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

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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.

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Authors and Affiliations

  1. Department of Medical Oncology, Tokyo Saiseikai Mukojima Hospital, Tokyo, Japan

    Tomoko Katsui Taniyama

  2. Department of Clinical Oncology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

    Takashi Tsuda, Hiroyuki Arai, Ayako Doi, Mami Hirakawa, Yoshiki Horie, Takuro Mizukami, Naoki Izawa, Takashi Ogura, Yu Sunakawa & Takako Eguchi Nakajima

  3. Department of Radiology, St. Marianna University School of Medicine, Kanagawa, Japan

    Kunihisa Miyakawa

Authors
  1. Tomoko Katsui Taniyama
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  2. Takashi Tsuda
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  3. Kunihisa Miyakawa
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  4. Hiroyuki Arai
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  5. Ayako Doi
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  6. Mami Hirakawa
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  7. Yoshiki Horie
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  8. Takuro Mizukami
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  9. Naoki Izawa
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  10. Takashi Ogura
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  11. Yu Sunakawa
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  12. Takako Eguchi Nakajima
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Correspondence to Takashi Tsuda.

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Ethical Statement

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

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All authors declare that they have no conflict of interest.

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Taniyama, T.K., Tsuda, T., Miyakawa, K. et al. Analysis of fistula formation of T4 esophageal cancer patients treated by chemoradiotherapy. Esophagus 17, 67–73 (2020). https://doi.org/10.1007/s10388-019-00691-y

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  • DOI: https://doi.org/10.1007/s10388-019-00691-y

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