Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Medicine (Hemato-oncology), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Radiat Oncol. 2018 Dec 14;13(1):245. doi: 10.1186/s13014-018-1196-6.
Oesophageal cancer with airway invasion presents a challenge for therapy and often has serious complications. We analysed the clinical outcomes of radiation therapy (RT) in patients with clinical T4b oesophageal cancer with airway invasion.
We retrospectively reviewed the medical records of 73 patients with oesophageal cancer who had clinical T4 disease and who received RT between January 1994 and June 2017. Among them, 47 patients with clinical T4b disease with airway invasion were included in this study; 31 had gross invasion on bronchoscopy and 16 had extrinsic compression with mucosal change. We investigated the survival outcomes, clinical courses, and toxicities.
The median survival (MS) time was 9 months. The 1- and 2-year overall survival (OS) rates were 41.4 and 27.4%, respectively. The MS times for patients treated with curative or palliative aims were 15 and 4 months, respectively (p = 0.001). Seven patients (14.9%) had fistulae at diagnosis; after RT, three had no change in size, three closed, and one had increased. Newly developed oesophageal fistulae after treatment were observed in 13 patients (27.7%). The median time to a newly developed fistula was 3 months (range, 1-15). Among them, a fistula was closed in only one patient. Death from aspiration pneumonia occurred in one patient who had a fistula at diagnosis and in nine patients who newly developed fistulae after treatment. Severe oesophageal bleeding causing death occurred in two patients. Patients with gross invasion on bronchoscopy had a higher risk of developing a fistula than did patients with mucosal change (37.5% vs. 25.0%, respectively).
Even for clinical T4b disease with airway invasion, RT with a curative aim showed acceptable survival outcomes in patients with good performance status and no distant metastasis at initial diagnosis. However, the risk of fistula development associated with fatal events remains high. Further study is warranted to decrease the risks of treatment and improve clinical outcomes.
Retrospectively registered.
食管气道侵犯的癌症治疗具有挑战性，且常伴有严重并发症。我们分析了气道侵犯的临床 T4b 期食管鳞癌患者的放射治疗（RT）的临床结果。
我们回顾性分析了 1994 年 1 月至 2017 年 6 月间接受 RT 的 73 例临床 T4 期食管鳞癌患者的病历资料。其中 47 例临床 T4b 期气道侵犯患者纳入本研究；47 例患者中，43 例支气管镜下见肿瘤直接侵犯气道，16 例为气道外压迫伴黏膜改变。我们研究了生存结果、临床过程和毒性。
中位生存时间（MS）为 9 个月。1 年和 2 年总生存率（OS）分别为 41.4%和 27.4%。以根治性和姑息性为治疗目的的患者 MS 时间分别为 15 个月和 4 个月（p=0.001）。7 例（14.9%）患者初诊时存在瘘管；RT 后，3 例瘘管大小无变化，3 例瘘管闭合，1 例瘘管增大。治疗后新发食管瘘 13 例（27.7%）。新发瘘的中位时间为 3 个月（范围 1-15），其中仅 1 例瘘管闭合。初诊时有瘘管和治疗后新发瘘的患者各有 1 例因吸入性肺炎死亡，9 例因新发瘘死亡。2 例因严重食管出血死亡。支气管镜下见肿瘤直接侵犯的患者发生瘘的风险高于仅见气道外压迫伴黏膜改变的患者（分别为 37.5%和 25.0%）。
即使是气道侵犯的临床 T4b 期，对于初诊时一般状态良好且无远处转移的患者，以根治性为目的的 RT 仍可获得可接受的生存结果。然而，与致命事件相关的瘘管发生风险仍然较高。有必要开展进一步研究以降低治疗风险并改善临床结局。
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