title: Risk factors and clinical courses of chemoradiation-related arterio-esophageal fistula in esophageal cancer patients with clinical invasion of the aorta.
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.
authors.affiliation: Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Sunto-gun, Shizuoka, 411-8777, Japan. h.taniguchi@scchr.jp
authors.forename: Hiroya
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamazaki
authors.forename: Narikazu
authors.initials: N
authors.lastname: Boku
authors.forename: Taro
authors.initials: T
authors.lastname: Funakoshi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hamauchi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tsushima
authors.forename: Akiko
authors.initials: A
authors.lastname: Todaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Hideharu
authors.initials: H
authors.lastname: Tomita
authors.forename: Nozomu
authors.initials: N
authors.lastname: Machida
authors.forename: Keisei
authors.initials: K
authors.lastname: Taku
authors.forename: Akira
authors.initials: A
authors.lastname: Fukutomi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Onozawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tsubosa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishimura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yasui
mesh_terms: D000368:Aged; D001011:Aorta / Q000473:pathology; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002784:Cholesterol / Q000097:blood; D004937:Esophageal Fistula / Q000453:epidemiology* / Q000209:etiology; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D002784:Cholesterol