Predictors of post-treatment stenosis in cervical esophageal cancer undergoing high-dose radiotherapy

Table 1 Demographic and treatment data (n = 62)

Characteristics		n (%)
Sex	Female:Male	4:58 (6.5:93.5)
Age		Median 66 yr (range 29-86)
Pathology	Squamous cell carcinoma	56 (90.3)
	Adenocarcinoma	2 (3.2)
	Other	4 (6.5)
T stage	T1	14 (22.6)
	T2	6 (9.7)
	T3	30 (48.4)
	T4	12 (19.3)
Regional node metastasis	N0	14 (22.6)
	N+	48 (77.4)
Tumor length		Median 5.0 cm (range 1-14)
Total length of skip lesions		Median 5.0 cm (range 1-20)
Involved circumference	< 100%	40 (64.5)
	100%	22 (35.5)
Stenosis at diagnosis	No	45 (72.6)
	Yes	17 (27.4)
Radiation dose (EQD1.8)		Median 63 Gy (range 45-90)
Concurrent chemotherapy	Yes	60 (96.8)
	No	2 (3.2)
Endoscopic response	CR	39 (62.9)
	< CR	23 (37.1)

EQD1.8: Biologically equivalent dose in 1.8 Gy fractions; CR: Complete response.

Table 2 Post-radiotherapy toxicity profile

Toxicity		n (%)	RT-event interval (mo)
Esophagitis	RTOG Gr 1	19 (30.6)
	RTOG Gr 2	39 (62.9)
	RTOG Gr 3	4 (6.5)
RT stenosis1	All	16 (25.8)	Median 5.5 (range 1.1-22.5)
	Malignant	7 (11.3)
T-E fistula	All	4 (6.5)	Median 2.6 (range 1.8-5.8)
	Malignant	3 (4.8)

¹Stenosis requiring dilatation. RTOG: Radiation therapy oncology group; T-E: Tracheoesophageal; Gr: Grade; RT: Radiotherapy.

Table 3 Factors influencing occurrence of post-radiotherapy stenosis n (%)

Characteristics	No. of Patients	Stenosis		P value
		No	Yes	Univariate	Multivariate
Age
≤ 65	30	24 (80)	6 (20)	0.236
> 65	32	22 (69)	10 (31)
T stage
T1/2	20	20 (100)	0	0.001	0.998
T3/4	42	26 (62)	16 (38)
Involved circumference
< 100%	40	37 (93)	3 (7)	< 0.0001	0.003
100%	22	9 (41)	13 (59)
Total length
< 5.0	28	22 (79)	6 (921)	0.338
≥ 5.0	34	24 (71)	10 (29)
Stenosis at diagnosis
No	45	37 (82)	8 (18)	0.024	0.995
Yes	17	9 (53)	8 (47)
Dysphagia at diagnosis
≤ 1 mo	36	30 (83)	6 (17)	0.051
> 1 mo	26	16 (62)	10 (38)
RT dose
≥ 60 Gy	37	27 (73)	10 (27)	0.515
< 60 Gy	25	19 (76)	6 (24)
Endoscopic response
CR	39	33 (85)	6 (15)	0.017	0.740
< CR	23	13 (56)	10 (44)

RT: Radiotherapy; CR: Complete response.

Table 4 Patients with post-radiotherapy stenosis or tracheoesophageal fistula (n = 19)

Age/Sex	T stage	Involve circumf	Initial stenosis/ management	RT (Gy)	Response	Toxicity (onset, mo)	Outcome (mo)
29/F	T3	100%	Dysphagia only	59.4	CR	Stenosis (20)	NED, alive (152)
70/M	T3	100%	Total obst/none	59.4	PR	Stenosis (5)	DOOC (12)
64/M	T4a	100%	Dysphagia only	63.0	PR	Stenosis (1)	DM (5), DOD (7)
68/F	T3	100%	Dysphagia only	63.0	CR	Stenosis (1)	NED, alive (21)
75/M	T3	100%	Total obst/none	63.0	PR	Stenosis (2)	DOOC (22)
60/F	T4b	100%	Total obst/stent	70.0	CR	Stenosis (4)	NED, alive (23)
68/M	T3	100%	Dysphagia only	70.2	SD	Stenosis (6)	InF (8), DOD (14)
73/M	T4b	75%	Total obst/stent	90.01	PR	Stenosis (11)	DM (13), DOD (17)
64/M	T3	100%	Dysphagia only	50.4	PR	Stenosis2 (9)	InF (17), DOD (20)
69/M	T4b	100%	Total obst/stent	50.4	SD	Stenosis2 (2)	DOOC (5)
64/M	T4a	100%	Dysphagia only	59.4	PR	Stenosis2 (7)	DM (3)/InF (9), DOD (11)
68/M	T3	100%	Total obst/none	63.0	PR	Stenosis2 (2)	DM (3), DOD (5)
73/M	T3	100%	Total obst/PEG	63.0	PR	Stenosis2 (22)	InF (16), DOD (31)
75/M	T3	40%	Dysphagia only	57.6	CR	Stenosis2 (14)	InF (7), DOD (31)
74/M	T3	50%	Dysphagia only	81.01	CR	Stenosis2 (9)	InF (9), DOD (16)
57/M	T3	100%	Dysphagia only	63.0	PR	TEF (3)	OutF (8), DOD (9)
57/M	T3	100%	Total obst/stent	60.0	CR	Stenosis (1)/TEF2 (6)	InF (8), DOD (14)
72/M	T3	100%	Total obst/stent	63.0	PR	TEF2 (2)	DOOC (5)
51/M	T3	40%	Dysphagia only	63.0	PR	TEF2 (2)	RF (4), DOD (6)

¹Boost RT (18-27 Gy) was delivered to residual tumor 1-2 mo after 63 Gy.

²Malignant complications. Involve circumf: Percent of esophageal circumference involved by tumor; RT: Radiotherapy; obst: Obstruction; PEG: Percutaneous endoscopic gastrostomy; CR: Complete response; PR: Partial response; SD: Stable disease; InF: Infield failure; OutF: Outfield failure; RF: Regional failure; DM: Distant metastasis; DOD: Died of disease; DOOC: Died of other cause; NED: No evidence of disease; TEF: Tracheoesophageal fistula.