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Risk factors and clinical courses of chemoradiation-related arterio-esophageal fistula in esophageal cancer patients with clinical invasion of the aorta

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Abstract

Background

Although concurrent chemoradiotherapy (CRT) is a standard treatment for esophageal cancer invading adjacent structures (T4-EC), arterio-esophageal fistula (AEF) occurs occasionally as a critical adverse event of T4-EC with CRT. The frequency, clinical course, and risk factors of AEF related to CRT are not well known.

Methods

We retrospectively analyzed 48 patients with T4-EC invasion of the aorta who were treated with 5-fluorouracil, cisplatin, and concurrent radiotherapy at our institution between September 2002 and April 2009. Treatment-related AEF was defined as AEF without obvious tumor progression. We evaluated the frequency, clinical courses, and risk factors of AEF.

Results

The median survival time was 10.6 months with a median follow-up time of 33.3 months. The 2-year survival rate was 25%. Treatment-related AEF was observed in 7 patients (14.6%) and 4 of them died of massive bleeding due to aortic AEF. In the other 3 patients with non-aortic AEF, hemorrhage could be arrested by transcatheter arterial embolization (TAE). In the univariate analysis of risk factors for AEF, lower serum cholesterol level was a risk factor for AEF (OR 14.7; 95% CI 1.58–137; P = 0.008).

Conclusions

Although CRT has a curative potential even for patients with T4-EC invading the aorta, we should be aware of the relatively high incidence of treatment-related AEF. TAE may be successful in rescuing a non-aortic AEF patient. Low serum cholesterol level may be a risk factor for AEF, but further investigation is needed.

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Acknowledgments

This work was partly supported by the Japanese Ministry of Education, Culture, Sports, Science and Technology.

Conflict of interest

No author has any conflict of interest.

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Authors and Affiliations

  1. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, 411-8777, Japan

    Hiroya Taniguchi, Kentaro Yamazaki, Narikazu Boku, Taro Funakoshi, Satoshi Hamauchi, Takahiro Tsushima, Akiko Todaka, Takeshi Sakamoto, Hideharu Tomita, Nozomu Machida, Keisei Taku, Akira Fukutomi, Yusuke Onozawa & Hirofumi Yasui

  2. Division of Esophageal Surgery, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan

    Yasuhiro Tsubosa & Hiroshi Sato

  3. Division of Radiation Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, Japan

    Tetsuo Nishimura

  4. Department of Clinical Oncology, School of Medicine, St. Marianna University, Kawasaki, Kanagawa, Japan

    Narikazu Boku

Authors
  1. Hiroya Taniguchi
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  2. Kentaro Yamazaki
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  3. Narikazu Boku
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  4. Taro Funakoshi
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  5. Satoshi Hamauchi
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  6. Takahiro Tsushima
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  7. Akiko Todaka
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  8. Takeshi Sakamoto
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  9. Hideharu Tomita
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  10. Nozomu Machida
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  11. Keisei Taku
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  14. Yasuhiro Tsubosa
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  15. Hiroshi Sato
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  16. Tetsuo Nishimura
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  17. Hirofumi Yasui
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Corresponding author

Correspondence to Hiroya Taniguchi.

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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 16, 359–365 (2011). https://doi.org/10.1007/s10147-011-0192-8

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  • DOI: https://doi.org/10.1007/s10147-011-0192-8

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