High incidence of esophageal fistula on patients with clinical T4b esophageal squamous cell carcinoma who received chemoradiotherapy: A retrospective analysis

Highlights: • Satisfactory survival outcomes for T4b ESCC patients with the median OS and 3- year OS rates of 12.2 months and 29.9% was observed in a cohort including 136 patients who were treated with CRT. • One third (30.1%) of the patients developed esophageal fistula and those patients that developed fistula had a significantly shorter OS. • Tumor ulceration and bronchus/trachea invasion are the two independent risk factors for developing esophageal fistula after CRT in T4b ESCC. Despite definitive chemoradiotherapy (CRT) being a recommended therapeutic method for patients with T4b esophageal squamous cell carcinoma (ESCC), treatment response and complications remain unclear. Esophageal fistula is a severe CRT-related complication when treating locally advanced ESCC, but data on risk factors that lead to esophageal fistula formation are limited. The aim of this analysis is to characterize the outcomes of T4b ESCC treated by CRT and investigate the risk factors of esophageal fistula.