Predictive Factors for Esophageal Stricture Following Definitive Chemoradiotherapy in Esophageal Carcinoma

Concurrent Chemo-radiotherapy (CRT) offers attractive approaches providing the opportunity of cure, as well as organ preservation for patients with esophageal cancer and has now become the standard treatment for locally advanced unresectable esophageal cancers. However, one of the major concerns associated with CRT is the potential for treatment-related side effects, including strictures and fistula formation. This study aims to identify the predictors of stricture formation following definitive CRT in esophageal carcinoma.

79 patients who underwent definitive CRT for carcinoma esophagus, post cricoid area and gastro-esophageal junction (GEJ), from 2013 to 2023 were included in the study. The medical records of these patients were reviewed to collect data including the following parameters: age, gender, grade of dysphagia at presentation, stage of the disease, circumferential involvement by disease, treatment technique used, dose of radiation, and concurrent chemotherapy used. These factors were then correlated to development of radiation induced stricture.

The median follow-up period was 22.5 months in survivors. Median overall survival was 47 months. The post-treatment stricture occurred in 22 patients (27.85%). The median time to develop a stricture after completing treatment was 4.5 months. In multivariate analysis, factors significantly correlated with post treatment stenosis were stage T4 (P = 0.012) and concurrent chemotherapy with carboplatin and paclitaxel (p=0.034). Other factors like patient age, sex, stage group, length of the involved segment, maximum tumor thickness, RT technique, and radiation dose were not associated with stricture risk.

This study suggested that patients with T4 stage and patients receiving concurrent carboplatin and paclitaxel chemotherapy have higher risk of developing treatment-related esophageal stenosis.