Concurrent chemoradiotherapy for esophageal cancer with malignant fistula.
BACKGROUND
We reviewed clinical results of chemoradiotherapy (CRT) in the treatment of patients with advanced esophageal cancer with fistulae that developed before or during CRT.


METHODS
The study group included 16 patients with fistulous esophageal cancer treated by means of CRT between 1999 and 2006. Nine patients had fistulae before CRT, whereas 7 developed fistulae during CRT. The group included 12 men and four women with a median age of 55 years (range, 37-77 years). There were 9 patients with Stage III disease and 7 with Stage IV disease. All tumors were squamous cell carcinomas. Two courses of concurrent chemotherapy were combined with radiation therapy; 60 Gy/30 fractions/7 weeks (1-week split). For 15 patients, low-dose protracted chemotherapy with 5-fluorouracil (250-300 mg/m(2) x 14 days) and cisplatin (7 mg/m(2) x 10 days) was administered, whereas full-dose cisplatin and 5-fluorouracil were administered to the remaining patient.


RESULTS
The planned dose of 60 Gy was delivered to 11 patients (69%), whereas radiation therapy was terminated early in 5 patients (40-58 Gy) because of acute toxicities, including two treatment-related deaths. Disappearance of fistulae was noted during or after CRT in 7 patients (44%). All three esophagomediastinal fistulae were closed, but only four of 13 esophagorespiratory fistulae were closed by CRT. For patients with Stage III, 1- and 2-year survival rates were 33% and 22%, respectively. Median survival time was 8.5 months.


CONCLUSIONS
Despite significant toxicity, concurrent CRT appears effective at closing esophageal malignant fistulae.
Koike
Ryuta
R
Department of Radiation Oncology, Kinki University School of Medicine, Osaka, Japan.
Nishimura
Yasumasa
Y
Nakamatsu
Kiyoshi
K
Kanamori
Shuichi
S
Shibata
Toru
T
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D004937:Esophageal Fistula / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012074:Remission Induction
D002945:Cisplatin; D005472:Fluorouracil