51
|
Kawakami T, Tsushima T, Omae K, Ogawa H, Shirasu H, Kito Y, Yoshida Y, Hamauchi S, Todaka A, Machida N, Yokota T, Yamazaki K, Fukutomi A, Onozawa Y, Yasui H. Risk factors for esophageal fistula in thoracic esophageal squamous cell carcinoma invading adjacent organs treated with definitive chemoradiotherapy: a monocentric case-control study. BMC Cancer 2018; 18:573. [PMID: 29776344 PMCID: PMC5960135 DOI: 10.1186/s12885-018-4486-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/08/2018] [Indexed: 12/01/2022] Open
Abstract
Background Standard treatment for unresectable esophageal squamous cell carcinoma (ESCC) without distant metastasis is definitive chemoradiotherapy (dCRT), in which the incidence of esophageal fistula (EF) is reported to be 10–12%. An ad hoc analysis of JCOG0303, a phase II/III trial of dCRT for patients with unresectable ESCC (including non-T4b), suggested that esophageal stenosis is a risk factor for EF. However, risk factors for EF in patients limited to T4b ESCC treated with dCRT have yet to be clarified. The aim of this study was to investigate risk factors for EF in T4b thoracic ESCC treated with dCRT. Methods We retrospectively analyzed the data of consecutive T4b thoracic ESCC patients who were treated with dCRT (cisplatin and fluorouracil) at Shizuoka Cancer Center between April 2004 and September 2015. Results Excluding 8 patients with esophageal fistula clearly attributable to other iatrogenic interventions, the data of 116 patients who met the inclusion criteria were analyzed. Esophageal fistula was observed in 28 patients (24%). Although the fistula was closed in 5 patients, overall survival was significantly shorter in patients who experienced esophageal fistula (8.0 vs. 26.8 months; p < 0.0001). Among four potential variables extracted in univariate analysis, namely, total circumferential lesion, elevated CRP level, elevated white blood cell count, and anemia, the first two were revealed as risk factors for esophageal fistula in multivariate analysis. Conclusions This study demonstrated that total circumferential lesion and CRP ≥1.00 mg/dL are risk factors for esophageal fistula in T4b thoracic ESCC treated with dCRT. Trial registration This study was retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12885-018-4486-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Takeshi Kawakami
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan. .,Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagizumi-cho, Sunto-gun, Shizuoka, 411-0934, Japan.
| | - Katsuhiro Omae
- Clinical Research Promotion Unit, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiromichi Shirasu
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yosuke Kito
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yukio Yoshida
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Satoshi Hamauchi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nozomu Machida
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Fukutomi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yusuke Onozawa
- Division of Clinical Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| |
Collapse
|
52
|
Geng L, Wu R, Hu H, Zhao Y, Fan L, Zhao Z, Liao D, Li M, Xiang M, Ma Y, Du X. Clinical application of oral meglumine diatrizoate esophagogram in screening esophageal fistula during radiotherapy for esophageal cancer. Medicine (Baltimore) 2018; 97:e0668. [PMID: 29718892 PMCID: PMC6393137 DOI: 10.1097/md.0000000000010668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Esophageal fistula is a serious and common complication of radiotherapy for esophageal cancer. Therefore, early diagnosis and treatment is necessary. Because of side effect of barium esophagography, it cannot be used to screening esophageal fistula during radiotherapy. Meglumine diatrizoate is an ionic contrast agent, its adverse reactions were rarely seen when it was used in the body cavity. The purpose of this trial is identified the sensitivity and specificity of oral meglumine diatrizoate in an esophagogram for screening esophageal fistula during radiotherapy. METHODS/DESIGN This trial was a prospective, multicenter, diagnostic clinical trial. A total of 105 patients with esophageal cancer will swallowed meglumine diatrizoate and underwent a radiographic examination weekly during radiotherapy, medical personnel observed the esophageal lesions to determine whether an esophageal fistula formed. If an esophageal fistula was observed, esophagofiberoscopy and/or computer tomography was used to further confirm the diagnosis. And the sensitivity and specificity of meglumine diatrizoate should be calculated for screening esophageal fistula during radiotherapy. DISCUSSION To our knowledge, this study protocol is the first to identify the sensitivity and specificity of oral meglumine diatrizoate in an esophagogram for screening esophageal fistula during radiotherapy. If oral meglumine diatrizoate can be used to screening esophageal fistula, more patients will benefit from early detection and treatment.
Collapse
Affiliation(s)
- Lidan Geng
- Department of Oncology, Mianyang Central Hospital, Mianyang
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nan Chong
| | - Rong Wu
- Department of Oncology, Mianyang Central Hospital, Mianyang
| | - He Hu
- Department of Oncology, Yan Ting County Cancer Hospital, Yan Ting
| | | | - Lingli Fan
- Department of Oncology, Mianyang Central Hospital, Mianyang
| | - Zhenhua Zhao
- Department of Oncology, Mianyang Central Hospital, Mianyang
| | - Dongbiao Liao
- Department of Oncology, Mianyang Central Hospital, Mianyang
| | | | - Miao Xiang
- Department of Oncology, Mianyang Central Hospital, Mianyang
| | - Ying Ma
- Department of Scientific Research and Education, Mianyang Central Hospital, Mianyang, People's Republic of China
| | - Xiaobo Du
- Department of Oncology, Mianyang Central Hospital, Mianyang
| |
Collapse
|
53
|
Zhang Y, Li Z, Zhang W, Chen W, Song Y. Risk factors for esophageal fistula in patients with locally advanced esophageal carcinoma receiving chemoradiotherapy. Onco Targets Ther 2018; 11:2311-2317. [PMID: 29731639 PMCID: PMC5923220 DOI: 10.2147/ott.s161803] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to investigate risk factors for esophageal fistula in patients with locally advanced esophageal carcinoma receiving chemoradiotherapy. Subjects and methods The study prospectively enrolled 212 esophageal carcinoma patients undergoing chemoradiotherapy and evaluated 16 clinical parameters. The best cut-off values were determined by receiver operating characteristics curves. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated by the Cox proportional hazards model. Kaplan-Meier analysis was used to evaluate the cumulative probability. Results In total, 22 patients (10.38%) developed esophageal fistula, of whom 9 experienced fistula during treatment and the other 13 patients developed fistula after chemoradiotherapy. The median time until occurrence was 5.75 months (range 0.6-8 months). In univariate analysis, the evaluated significant factors were Karnofsky performance status, smoking status, esophageal stenosis, T stage, fraction dose, and carcinoembryonic antigen (CEA). In addition, esophageal stenosis (HR=4.089, 95% CI 1.451-11.527, p=0.008), T stage (HR=2.663, 95% CI 1.019-6.960, p=0.046), and CEA (HR=0.309, 95% CI 0.124-0.768, p=0.011) were revealed as risk parameters in further multivariate analysis. Conclusion This is the first prospective study to evaluate factors associated with fistula formation in patients with esophageal carcinoma receiving chemoradiotherapy. More attention should be given to patients with esophageal stenosis, stage T4 disease, and high levels of CEA.
Collapse
Affiliation(s)
- Yang Zhang
- Department of Radiation Oncology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, People's Republic of China
| | - Zongjuan Li
- Department of Radiation Oncology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, People's Republic of China
| | - Wei Zhang
- Department of Radiation Oncology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, People's Republic of China
| | - Wei Chen
- Department of Radiation Oncology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, People's Republic of China
| | - Yipeng Song
- Department of Radiation Oncology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, People's Republic of China
| |
Collapse
|
54
|
Zheng H, Ren W, Pan X, Zhang Q, Liu B, Liu S, He J, Zhou Z. Role of intravoxel incoherent motion MRI in early assessment of the response of esophageal squamous cell carcinoma to chemoradiotherapy: A pilot study. J Magn Reson Imaging 2018; 48:349-358. [PMID: 29297204 DOI: 10.1002/jmri.25934] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/07/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Since definitive concurrent chemoradiotherapy (CRT) is standard therapy for inoperable esophageal squamous cell carcinoma (ESCC), early evaluation of treatment response is crucial for patients and would be useful in assessing response, especially in patients with severe side effects. PURPOSE To explore the feasibility of intravoxel incoherent motion (IVIM) MRI in the early assessment of treatment response to CRT. STUDY TYPE Prospective. POPULATION Twenty-three inoperable ESCC patients. SEQUENCE IVIM 3T MRI of nine b values (0, 25, 50, 75, 100, 150, 200, 500 and 800 s/mm2 ) was performed at four timepoints: pre-CRT (within 5 days before CRT), mid-CRT (2-3 weeks after the start of CRT), end-CRT (within 5 days after the end of CRT), and post-CRT (1 month after the end of CRT). ASSESSMENT IVIM-based parameters and ADC were analyzed independently by two radiologists and treatment response was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST). STATISTICAL TESTS Analyses of variance for repeated measurements were conducted to observe dynamic changes of IVIM-based parameters (D, f, and D*) and ADC during CRT. The parameters and their change percentages (Δ%) were compared between complete response (CR) and partial response (PR) by Mann-Whitney U-test. Diagnostic performance of parameters in predicting response was tested with receiver-operating characteristic curve analysis. RESULTS ADC, D, and f increased significantly during CRT (P < 0.001, < 0.001, and 0.001, respectively). ADC, f, Δ%ADC, and Δ%D at mid-CRT in CR group were significantly higher than those in the PR group (P = 0.002, 0.013, 0.005, and 0.011, respectively). D combined with f and ADC had highest area under curve (0.917) in identifying CR from PR. DATA CONCLUSION IVIM parameters proved useful in assessing response to definitive concurrent CRT for inoperable ESCC and combined with ADC at an early stage of treatment was a good predictor of response. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 4 J. MAGN. RESON. IMAGING 2018;48:349-358.
Collapse
Affiliation(s)
- Huanhuan Zheng
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wei Ren
- Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Xia Pan
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qinglei Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Baorui Liu
- Comprehensive Cancer Center of Drum Tower Hospital, Medical School of Nanjing University and Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Song Liu
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| |
Collapse
|
55
|
Hata M, Koike I, Miyagi E, Numazaki R, Asai-Sato M, Kaizu H, Mukai Y, Takano S, Ito E, Sugiura M, Inoue T. Radiation therapy for stage IVA uterine cervical cancer: treatment outcomes including prognostic factors and risk of vesicovaginal and rectovaginal fistulas. Oncotarget 2017; 8:112855-112866. [PMID: 29348871 PMCID: PMC5762556 DOI: 10.18632/oncotarget.22836] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/27/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of radiation therapy for stage IVA uterine cervical cancer and to identify an optimal radiation regimen. Results Seventeen of the 28 patients developed recurrence after radiation therapy (local recurrence in 10 and distant metastasis in 12). The local control and distant metastasis-free rates at 3 years in all patients were 61% and 49%, respectively. Fourteen patients died after radiation therapy, and all but 2 died of tumor progression. The disease-free, cause-specific, and overall survival rates at 3 years in all patients were 32%, 49%, and 45%, respectively, and the estimated median survival time was 32 months. Tumor size (P = 0.007) and involvement in the lower third of vagina (P = 0.006) were significant prognostic factors for local control. Older age (P = 0.018) and performance status (P = 0.020) were significant prognostic factors for distant metastasis. The presence of hydronephrosis was the sole significant prognostic factor for survival (P = 0.026). Only 2 patients developed grade 3 late toxicities (vesicovaginal fistula and radiation proctitis, respectively). Materials and Methods Twenty-eight patients with stage IVA uterine cervical cancer received radiation therapy. All patients initially received external pelvic irradiation at a median dose of 50.4 Gy in 28 fractions. Twenty patients also received high-dose-rate intracavitary brachytherapy at a median dose of 22 Gy in 4 fractions. These fraction sizes were lower than conventional sizes. The total median dose for all 28 patients was 68.7 Gy. Conclusions Radiation therapy is safe and effective for treatment of stage IVA uterine cervical cancer. The reduced radiation dose per fraction may contribute to the prevention of vesicovaginal fistula formation.
Collapse
Affiliation(s)
- Masaharu Hata
- Division of Radiation Oncology, Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.,Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Izumi Koike
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Etsuko Miyagi
- Division of Gynecologic Oncology, Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.,Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Reiko Numazaki
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.,Department of Obstetrics and Gynecology, Yokohama Minami Kyousai Hospital, Yokohama, Kanagawa, Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hisashi Kaizu
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Yuki Mukai
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Shoko Takano
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Eiko Ito
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Madoka Sugiura
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Tomio Inoue
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| |
Collapse
|
56
|
Morimoto H, Fujiwara Y, Lee S, Amano K, Hosono M, Miki Y, Osugi H. Treatment results of neoadjuvant chemoradiotherapy followed by radical esophagectomy in patients with initially inoperable thoracic esophageal cancer. Jpn J Radiol 2017; 36:23-29. [PMID: 29080946 DOI: 10.1007/s11604-017-0693-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/06/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE We evaluated the effectiveness of neoadjuvant chemoradiotherapy (CRT) followed by esophagectomy for cT4 esophageal cancer or lymph node metastases (LNM) invading adjacent structures. MATERIALS AND METHODS We retrospectively evaluated 42 consecutive patients with thoracic esophageal cancer who underwent CRT followed by esophagectomy between 2008 and 2013. All were initially considered to be unresectable because of cT4 (n = 32) disease or LN invasion (n = 10). Radiotherapy was administered at 41.4 Gy/23 fr with concurrent chemotherapy. At completion of CRT, restaging was performed using computed tomography (CT). RESULTS All cT4 tumors were downstaged, LNM invading to adjacent structures were considered to be released, and subtotal esophagectomy was performed. The median follow-up period was 42 months. The curative resection (R0) rate was 94% in cT4 group and 70% in LN invasion group. The 3-year overall survival (OS) and 3-year locoregional control (LRC) rates were 65-80% in the cT4 group and 50-67% in LN invasion group, respectively. CONCLUSIONS The cT4 group showed good rates of R0, OS, and LRC. Surgical resection should be an effective option when downstaging is achieved by CRT for patients with initially inoperable thoracic esophageal cancer.
Collapse
Affiliation(s)
- Hideyuki Morimoto
- Department of Radiation Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Yushi Fujiwara
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kosuke Amano
- Department of Radiation Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masako Hosono
- Department of Radiation Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yukio Miki
- Department of Radiation Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Harushi Osugi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
57
|
Uno K, Koike T, Takahashi S, Komazawa D, Shimosegawa T. Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature. Clin J Gastroenterol 2017; 10:393-402. [PMID: 28766283 DOI: 10.1007/s12328-017-0762-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/06/2017] [Indexed: 12/15/2022]
Abstract
Aorto-esophageal fistula (AEF) is a rare and lethal entity, and the difficulty of making diagnosis of AEF is well-known. As promising results in the short-term effectiveness of thoracic endovascular aortic repair (TEVAR) promote its usage, the occurrence of AEF after TEVAR (post-TEVAR AEF) increases as one of the major complications. Therefore, we provide a review concerning the management strategy of post-TEVAR AEF. Although its representative symptom was reported as the triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis, the symptom-free interval between sentinel hemorrhage and massive exsanguination is unpredictable. However, the physiological condition represents a surgical contraindication. Accordingly, early diagnosis is important, but either CT or esophago-gastro-duodenoscopy rarely depicts a typical image. The formation of post-TEVAR AEF might be associated with the infection of micro-organisms, which is uncontrollable with anti-biotic administration. The current first-line strategy is combination therapy as follows, (1) to control bleeding by TEVAR in the urgent phase, and (2) radical debridement and aortic/esophageal re-construction in the semi-urgent phase. In view of the high mortality and morbidity rate, it is proposed that the choice in treatment strategies might be affected by patient`s condition, size of the wall defects and the etiology of AEF. Practically, we should keep in mind the importance of making an early diagnosis and, once a suspicious symptom has occurred in a patient with a history of TEVAR, the existence of post-TEVAR AEF should be suspected. A prospective registry together with more developed technologies will be needed to establish a future strategy.
Collapse
Affiliation(s)
- Kaname Uno
- Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 981-8574, Japan. .,Department of Gastrointestinal and Community Medicine, Tohoku University, 16 Kuzehara Uchigo-mimaya cho, Iwaki, Fukushima, 973-8555, Japan.
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 981-8574, Japan
| | - Seiichi Takahashi
- Department of Gastrointestinal and Community Medicine, Tohoku University, 16 Kuzehara Uchigo-mimaya cho, Iwaki, Fukushima, 973-8555, Japan
| | - Daisuke Komazawa
- Department of Gastrointestinal and Community Medicine, Tohoku University, 16 Kuzehara Uchigo-mimaya cho, Iwaki, Fukushima, 973-8555, Japan
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Hospital, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 981-8574, Japan
| |
Collapse
|
58
|
Tajima T, Haruki S, Usui S, Ito K, Matsumoto A, Matsuhisa A, Takiguchi N. Transcatheter arterial embolization for intercostal arterio-esophageal fistula in esophageal cancer. Surg Case Rep 2017; 3:70. [PMID: 28510809 PMCID: PMC5433956 DOI: 10.1186/s40792-017-0345-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/09/2017] [Indexed: 01/05/2023] Open
Abstract
Background While esophageal fistula formation in the adjacent organs is associated with high rates of morbidity and mortality, the management of non-aortic arterio-esophageal fistula has not been frequently reported. Case presentation A 69-year-old Japanese man who had undergone definitive chemoradiotherapy for esophageal cancer was admitted to our hospital with hematemesis. He was diagnosed with mediastinal abscess caused by esophageal perforation, and esophageal bypass surgery was performed. After 3 days, he presented with fatal hemoptysis. As angiography revealed an intercostal artery pseudoaneurysm, transcatheter arterial embolization was performed. Conclusions When patients with esophageal cancer, especially those with a history of radiotherapy and/or mediastinitis, present with hematemesis and/or hemoptysis, the possibility of non-aortic arterio-esophageal fistula should be considered. Transcatheter arterial embolization is an effective treatment for non-aortic arterio-esophageal fistula.
Collapse
Affiliation(s)
- Tetsuya Tajima
- Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
| | - Shigeo Haruki
- Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Shinsuke Usui
- Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Koji Ito
- Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Akiyo Matsumoto
- Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Akiyuki Matsuhisa
- Department of Radiology, Saitama Cancer Center, 780 Komuro, Inamachi, Kitaadachi-gun, Saitama, 362-0806, Japan
| | - Noriaki Takiguchi
- Department of Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ootsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| |
Collapse
|