A Case of Tracheoesophageal Fistula in a Non-metastatic Site During Lenvatinib Treatment for Hepatocellular Carcinoma.

Abstract

We report a case of tracheo-esophageal fistula at a non-metastatic site during lenvatinib treatment of hepatocellular carcinoma with multiple bone metastases. A 58-year-old male patient was diagnosed with hepatocellular carcinoma with multiple bone metastases and was treated with atezolizumab-bevacizumab. However, as the bone metastasis progressed, palliative radiation therapy was administered to the third thoracic vertebra, and lenvatinib was administered as a second-line treatment. The patient was hospitalized for aspiration pneumonia five months later. Chest computed tomography and bronchoscopy revealed a 5 cm tracheoesophageal fistula located 3 cm cranial to the carina. We diagnosed a benign tracheoesophageal fistula due to lenvatinib because his previous CT scan showed no metastases at the site of the fistula, and we performed esophageal bypass surgery 4 weeks after discontinuation of the lenvatinib. To the best of our knowledge, this is the first case report of tracheoesophageal fistula at a nonmetastatic site during lenvatinib treatment for hepatocellular carcinoma.