MALIGNANT TRACHEO-ESOPHAGEAL FISTULA IN ADVANCED ESOPHAGEAL CANCER: REPORT OF TWO CASES

Dr Prajwal R

Abstract


Introduction: Malignant tracheo-esophageal stula (TEF), a relatively uncommon entity, can be seen in advanced
esophageal cancer. However, development of TEF in these patients whether due to advancement of disease or due to
medical intervention like radiation therapy (RT), chemotherapy is a matter of debate. Here, we reported two cases of malignant TEF in advanced
esophageal carcinoma. Case Summary: The rst patient was 46-year-old male, with progressive dysphagia diagnosed as middle thoracic
esophageal cancer, squamous cell type. Patient was managed with palliative RT 39 Gy/13 fractions. Within 1-month of RT completion, patient
developed TEF and succumbed to death. The other one was 54-year-old male presented with history of progressive dysphagia and diagnosed as
having upper thoracic squamous cell carcinoma of esophagus. He was given palliative RT 20 Gy/4 fractions. Unfortunately, this patient also
developed TEF on rst follow-up and despite best efforts patient declared dead in ICU. Conclusion: These two cases showed that treating
oncologist should be aware of potential TEF occurrence in cases of advanced esophageal cancer treated vigorously. As, management of
established TEF is cumbersome, precaution should be taken to prevent it. Further case reports and series with different management approach will
enlighten about standard protocol in management of such patients.


Keywords


Esophageal cancer; malignant trachea-esophageal stula; radiation therapy

Full Text:

PDF

References


Kim HS, Khemasuwan D, Diaz-Mendoza J, Mehta AC. Management of tracheooesophageal

stula in adults. Eur Respir Rev. 2020;29(158):200094

Kim IA, Koh HK, Kim SJ, Yoo KH, Lee KY, Kim HJ. Malignant tracheal necrosis and

stula formation following palliative chemoradiotherapy: a case report. J Thorac Dis.

May;9(5):E402–7.

Bhardwaj S, Kaushal V, Paul D. Enigma of Esophageal - Respiratory Fistula in

Advanced Esophageal Cancer. Basic Clin Cancer Res. 2022;13(4):239-44.

Oezcelik A, DeMeester SR. General anatomy of the esophagus. Thorac Surg Clin. 2011

May;21(2):289-97.

Paul D, Kumar P, Dhull AK, Atri R, Dhankhar R, Kaushal V. Retrospective Review of

Esophageal Carcinoma:3-Year Experience from a Tertiary Care Teaching Institute. Int J

Health Sci Res. 2021; 11(7): 111-8. https://doi.org/10.52403/ijhsr.20210716

Nishimura Y, Suzuki M, Nakamatsu K, Kanamori S, Yagyu Y, Shigeoka H. Prospective

trial of concurrent chemoradiotherapy with protracted infusion of 5-uorouracil and

cisplatin for T4 esophageal cancer with or without stula. Int J Radiat Oncol Biol Phys.

;53(1):134-9.

Wang X, Hu B, Chen J, Xie F, Han D, Zhau Q et al. Risk factors of esophageal stula

induced by re-radiotherapy for recurrent esophageal cancer with local primary site.

BMC Cancer. 2022;22(1):207.

Duranceau A, Jamieson GG. Malignant tracheoesophageal stula. Ann Thorac Surg.

;37:346-54.

Czito BG, Palta M, Willett CG. Esophageal Cancer. In: Halperin EC, Wazer DE, Perez

CA, Brady LW, editors. Principles and practice of radiation oncology. 7th ed.

Philadelphia: Wolters Kluwer; 2018. p. 1206-43.

Ajani JA, D'Amico TA, Bentrem DJ, Cooke D, Corvera C, Das P et al. Esophageal and

Esophagogastric Junction Cancers, Version 2.2023, NCCN Clinical Practice Guidelines

in Oncology. J Natl Compr Canc Netw. 2023; 21(4):1-30.

Hu B, Jia F, Zhou H, Zhou T, Zhao Q, Chen Y et al. Risk Factors Associated with

Esophageal Fistula after Radiotherapy for Esophageal Squamous Cell Carcinoma. J

Cancer. 2020;11(12):3693-700.

Zhu C, Wang S, You Y, Nie K, Ji Y. Risk Factors for Esophageal Fistula in Esophageal

Cancer Patients Treated with Radiotherapy: A Systematic Review and Meta-Analysis.

Oncol Res Treat. 2020;43(1-2):34-41.

Ishida K, Ando N, Yamamoto S, Ide H, Shinoda M. Phase II study of cisplatin and 5-

uorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the

esophagus: a Japan Esophageal Oncology Group (JEOG)/Japan Clinical Oncology

Group trial (JCOG9516). Jpn J Clin Oncol. 2004;34(10):615-19.

Kim KR, Shin JH, Song HY, KO GY, Kim JH, Yoon HK et al. Palliative treatment of

malignant esophagopulmonary stulas with covered expandable metallic stents. AJR

Am J Roentgenol. 2009;193(4):W278-82.

Kakuturu J, Dhamija A, Toker A. Malignant tracheoesophageal stula: diagnosis and

management. Curr Chall Thorac Surg. 2022;4(29) 2664-3278

Pao TH, Chen YY, Chang WL, Chang JSM, Chiang NJ, Lin CY et al. Esophageal stula

after denitive concurrent chemotherapy and intensity modulated radiotherapy for

esophageal squamous cell carcinoma. PLoS One. 2021;16(5):e0251811.

Guan X, Liu C, Zhou T, Ma Z, Zhang C, Wang B et al. Survival and prognostic factors of

patients with esophageal stula in advanced esophageal squamous cell carcinoma.

Biosci Rep. 2020;40(1):BSR20193379.

Kim TH, Shin JH, Kim KR, Park JH, Kim JH, Song HY. Treatment of esophagopleural

stulas using covered retrievable expandable metallic stents. J Vasc Interv Radiol.

;25:623-9.

Zhang Y, Li Z, Zhang W, Chen W, Song Y. Risk factors for esophageal stula in patients

with locally advanced esophageal carcinoma receiving chemoradiotherapy. Onco

Targets Ther. 2018;11:2311-17.

Werner-Wasik M, Yorke E, Deasy J, Nam J, Marks LB. Radiation dose-volume effects in

the esophagus. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S86-3.


Refbacks

  • There are currently no refbacks.