The aim of this study was to analyze the risk factors and prognosis for patients with
esophageal perforation occurring during or after
radiotherapy for esophageal
carcinoma. We retrospectively analyzed 322 patients with esophageal
carcinoma. These patients received
radiotherapy for unresectable esophageal
tumors,
residual tumors after operation, or local recurrence. Of these, 12 had
radiotherapy to the esophagus before being admitted, 68 patients had
concurrent chemoradiotherapy (CRT), and 18 patients had
esophageal perforation after RT (5.8%). Covered
self-expandable metallic stents were placed in 11 patients. Two patients continued RT after stenting and control of
infection; one of these suffered a new perforation, and the other had a massive
hemorrhage. The median overall survival was 2 months (0-3 months) compared with 17 months in the non-perforation group. In univariate analysis, the Karnofsky performance status (KPS) being ≤ 70, age younger than 60, T4 stage, a second course of
radiotherapy to the esophagus, extracapsular lymph nodes (LN) involving the esophagus, a total dose >100 Gy (biologically effective dose-10), and CRT were risk factors for perforation. In multivariate analysis, age younger than 60, extracapsular LN involving the esophagus, T4 stage, and a second course of
radiotherapy to the esophagus were risk factors. In conclusion, patients with T4 stage, extracapsular LN involving the esophagus, and those receiving a second course of RT should be given particular care to avoid perforation. The prognosis after perforation was poor.