Abstract
BACKGROUND/OBJECTIVE: Radiotherapy is a common treatment for patients with esophageal cancer. Esophageal fistula (perforation) is a serious complication in patients with advanced esophageal cancer. It is unclear how radio/chemotherapy post-fistula may affect survival in patients with malignant esophageal fistulae with radiotherapy pre-fistula. We sought to evaluate radio/chemotherapy and survival post-fistula in patients with esophageal cancer and radiotherapy pre-fistula. METHODS: In a retrospective cohort study, we reviewed post-fistula treatments and survival in 98 patients with esophageal cancer and prior radiotherapy with or without chemotherapy between 2010/6 and 2023/5 in a regional cancer care centre in Zhengzhou, China. The primary outcome was survival time (months) post-fistula. The inverse of the probability of treatment weighting (IPTW) was applied in Cox regression models in assessing the association between post-fistula radio/chemotherapy and survival accounting for baseline clinical risk factors. RESULTS: The median survival time post-fistula was 3.5 months (inter-quartile range: 1.4-7.8 months). Compared to patients without radio/chemotherapy post-fistula, longer survival was observed in patients with radiotherapy [adjusted HR 0.40 (95% CI 0.20-0.80)], chemotherapy [adjusted HR 0.24 (0.08-0.72)], or chemo and radiotherapy [adjusted HR 0.10 (0.05-0.19)] post-fistula. Among patients with radiotherapy post-fistula, longer survival was observed in patients with both chemo and radiotherapy [adjusted HR 0.18 (0.08-0.36)] than with radiotherapy only. CONCLUSIONS: In patients with malignant esophageal fistulae and radiotherapy pre-fistula, continued radiotherapy post-fistula may improve survival, and combined radio/chemotherapy may be beneficial to optimal survival.