2222 - Treatment Mode and Prognostic Factors of Radiotherapy-Related Esophageal Fistula in Patients with Eesophageal Squamous Cell Carcinoma: A Retrospective Cohort Study
Presenter(s)
H. Si1,2, Q. An1, Y. Jia1, H. Ji1, Y. Wang1, J. Yan1, Z. Zhang1, Y. Su1, M. Liu1, C. Zhen1, P. Zhang1, and Z. Zhou1; 1Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, 2Department of Oncology, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
Purpose/Objective(s): To explore treatment mode and prognostic factors of radiotherapy-related (RT-related) esophageal fistula (EF) in esophageal squamous cell carcinoma (ESCC).
Materials/Methods: A total of 91 esophageal fistula patients were retrospectively enrolled from January 2016 to July 2023. Based on the fistula type, 39 patients presented with TEF and 52 with EMF. The treatment after EF included nutritional support therapy and subsequent radiotherapy (RT). Survival analyses utilized Kaplan-Meier method. Multivariable Cox analysis was employed to identify prognosis of EF.
Results: At the last follow-up date June 30, 2025, all patients had died. The median survival time after EF was 3.1 months, and their 3-month, 6-month and 1-year survival rates were 51.6%, 18.7% and 5.5%, respectively. All EF patients received nutritional support therapy, including nasogastric feeding (n=61), esophageal stent (n=10), gastrostomy/jejunostomy (n=12), and parenteral hydration alone (n=8). Gastrostomy/jejunostomy was associated with the highest survival rates after EF (3-month: 83.3%, 6-month: 41.7%, 12-month: 25.0%), while parenteral hydration alone was associated with the lowest survival rates after EF (3-month: 25.0%, 6-month: 0%, P=0.0061). In TEF, esophageal stent provided comparable 3-month survival rates after EF to gastrostomy/jejunostomy (71.4% vs. 75.0%). RT-related EF patients were classified into four groups: EF after primary RT, EF during primary RT, EF after re-RT, and EF during re-RT. Among 21 patients who had EF during primary RT, those completing the planned RT after receiving nutritional support therapy achieved superior fistula closure rates compared to treatment discontinuation (77.8% vs. 25.0%). Multivariable Cox analysis identified re-RT, parenteral hydration alone, persistent fistula, hemoglobin < 120 g/L and albumin < 30 g/L as independent unfavorable prognostic factors for RT-related EF patients.
Conclusion: For RT-related EF patients in ESCC, gastrostomy/jejunostomy is associated with improved survival. Esophageal stent represents a viable short-term palliative option for TEF patients. Completing planned RT may promote fistula closure for EF during primary RT. Hemoglobin and albumin levels serve as accessible prognostic biomarkers.