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Topics:
Lung Cancer • Radiation Oncology • Gastrointestinal Cancers • Thoracic Malignancies • Esophageal Cancer • Non-small cell lung cancer • Small cell lung cancer
How do you manage a patient who presents with a tracheoesophageal fistula from a lung or esophageal primary that is non-metastatic?
As a for instance, a centrally located primary tumor with mediastinal adenopathy that results in a TE fistula?
Currently we would recommend esophageal stenting and chemotherapy. Would you ever add radiation?
Answer from: Radiation Oncologist at Academic Institution
My experience with this has typically been with primary esophageal cancer presenting with TEF. It's obviously a challenging and individualized situation requiring multidisciplinary input and extensive clinical assessment and discussion. I generally recommend induction chemotherapy since the ideal sc...
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Answer from: Radiation Oncologist at Academic Institution
In an excellent review article on this topic, (Shamji & Inculet, Thorac Surg Clin 2018, PMID: 30054077) the authors wrote “when a malignant fistula develops between esophagus and trachea, the underlying cancer is invariably incurable, whether the primary site is in the esophagus or in the ...
Answer from: Radiation Oncologist at Academic Institution
Stabilization of the airway is important and should be established before starting treatment and reassessed throughout. For patients who clearly have a TE fistula prior to treatment, I agree with stenting. Even with stents, they may need a PEG to optimize nutrition because they still may not be safe...
Answer from: Radiation Oncologist at Community Practice
I recently had a similar case and after a sent were able to finish 60 gray with weekly cisplatin- too early to predict outcome?