Closure of tracheoesophageal fistulas with primary chemotherapy in patients with esophageal cancer

Abstract

In patients with tracheoesophageal fistula, radiation is thought to be contraindicated because cytoreduction enlarges the size of the fistula. The same caveat should also apply to cytoreduction with chemotherapy, but there are few data addressing this issue. The records of 16 patients with esophageal cancer who received chemotherapy in 1991 were evaluated in the Medical Oncology Section of the Veterans Administration Medical Center, Washington, DC. All patients were staged radiographically and endoscopically. Four of these 16 were seen initially with or developed tracheoesophageal fistulas during therapy. Two patients whose fistulas closed during chemotherapy are presented. All four patients with tracheoesophageal fistulas had midesophageal squamous cell carcinomas. Objective complete responses with closure of tracheoesophageal fistulas occurred in two of four patients after three and four cycles of chemotherapy, respectively. One of these fistulas first developed, then healed during treatment, whereas the other presented at the time of diagnosis with fistula. The findings indicated that patients with tracheoesophageal fistulas should not be excluded from chemotherapy solely on the basis of having this condition. The treatment of patients with tracheoesophageal fistulas with chemotherapy needs to be reexamined.