Development Of Tracheoesophageal Fistula Research Articles

Difficulties in the Treatment of Complications and Rehabilitation after COVID-19. A Clinical Case

The severe course of the new coronavirus infection (COVID-19) is associated with multiple life-threatening complications that lead to delayed initiation of active rehabilitation and unfavorable long-term treatment outcomes. Tracheoesophageal fistula is one of these complications. The specific feature of this event in COVID-19 is delayed tissue regeneration which requires a non-standard approach to management of such patients.The article presents a clinical case of a pregnant patient after a complicated severe course of COVID-19 with the development of tracheoesophageal fistula, sepsis, and weakness syndrome acquired in ICU. The combination of complications of the disease led to a prolonged (about five months) period of rehabilitation.Modern standard components of intensive therapy of such patients including regular monitoring of endotracheal/tracheostomy tube cuff pressure, dynamic assessment of nutritional status and its correction, rational antimicrobial therapy, screening of psychiatric disorders and early rehabilitation, will minimize the number of both early and delayed complications of COVID-19.

Usefulness of flexible bronchoscopy for securing the airway in traumatic tracheal perforation during tracheostomy with development of tracheo-esophageal fistula

Usefulness of flexible bronchoscopy for securing the airway in traumatic tracheal perforation during tracheostomy with development of tracheo-esophageal fistula

Efficacy and Safety of Induction Chemotherapy in Esophageal Cancer with Airway Involvement.

Esophageal cancer with tracheobronchial involvement (TBI) has a poor prognosis. Radical therapy carries the risk of inducing tracheoesophageal fistula (TEF) and treatment-related mortality. Induction chemotherapy followed by reassessment for radical therapy may decrease morbidity and improve outcome. This is a retrospective analysis of esophageal cancer patients with TBI who received induction chemotherapy. Airway involvement was defined as bronchoscopic appearance of a bulge into the lumen, restricted or immobile mucosa, frank infiltration, TEF, or stridor, which was clinically due to airway obstruction from the esophageal lesion. Eighty-three patients were included over 5years; 97.6% had squamous histology. All patients received taxane and platinum combination induction chemotherapy; 90.5% of patients received chemotherapy without dose delays, and 77.8% patients did not require a dose reduction or modification. The 31.7% patients had a clinically significant ≥grade 3 toxicity. The objective response rate was 67% among the patients who underwent restaging scans following induction chemotherapy; 79.5% of the patients could receive radical intent therapy, either concurrent chemoradiotherapy, or radiation alone, or surgery in one patient. The TEF complication rate was 6% during the course of therapy. At a median follow-up of 28months in surviving patients, the estimated median PFS was 8months (95% CI 5.5-10.5) and the estimated median OS was 17months (95% CI 5.6-28.4). Patients who received radical therapy had a significantly better PFS and OS, p = 0.000. Induction chemotherapy may improve the outcome of patients with esophageal cancer involving the airway and may help select patients for curative treatment and lower the risk of TEF development.

Development of Tracheoesophageal Fistula after the Use of Sorafenib in Locally Advanced Papillary Thyroid Carcinoma: a Case Report

Development of Tracheoesophageal Fistula after the Use of Sorafenib in Locally Advanced Papillary Thyroid Carcinoma: a Case Report

Tracheoesophageal Fistula Development and Concurrent Chemoradiation and Bevacizumab in Non—Small-Cell Lung Cancer

BackgroundWe previously reported the development of tracheoesophageal (TE) fistulae in patients with small-cell lung cancer (SCLC) treated with chemoradiation and concurrent and sequential bevacizumab (J Clin Oncol 2008; 26(15 suppl):410s [Abstract 7554]). In this phase II trial, we evaluated concurrent chemoradiation and bevacizumab in patients with unresectable stage III non—small-cell lung cancer (NSCLC) and observed similar fistula development. Patients and MethodsThis was a phase II trial designed to enroll 50 patients, with a primary aim of achieving a 40% improvement in historical 10-month median time to progression (α, .05; β, .20). Patients with newly diagnosed unresectable nonsquamous stage III NSCLC, measurable disease, Eastern Cooperative Oncology Group performance status 0/1, signed informed consent, and no pleural or pericardial effusions were eligible. Hemoptysis or need for anticoagulation were exclusion factors. Treatment was composed of induction, consolidation, and maintenance phases. Induction treatment included carboplatin area under the curve (AUC) = 5 intravenous (I.V.), pemetrexed 500 mg/m2 I.V., and bevacizumab 15 mg/kg I.V. weeks 1 and 4. Radiation was administered concurrently 1.8 Gy per day to 61.2 Gy. After a break in therapy from weeks 8 to 16, consolidative therapy commenced and included carboplatin AUC = 6 I.V., pemetrexed 500 mg/m2 I.V., and bevacizumab 15 mg/kg I.V. weeks 16, 19, and 22. Maintenance therapy was composed of bevacizumab 15 mg/kg every 3 weeks for 9 cycles. Patients were restaged after induction and consolidation phases (per Response Evaluation Criteria in Solid Tumors). ResultsEnrollment was staggered in groups of 5 for safety monitoring beginning in February 2007. Among the first 5 patients, 2 patients developed TE fistulae. Patient 1 developed a TE fistula 34 weeks into therapy (during the fourth maintenance bevacizumab and 26 weeks after chemoradiation). Patient 2 developed a TE fistula 40 weeks into therapy (during the sixth maintenance bevacizumab and 32 weeks after chemoradiation). Both patients experienced antecedent severe esophagitis. Both patients were managed with stents and are alive. The other 3 patients have not developed TE fistulae to date and are alive. The trial was subsequently closed for safety in December 2007. ConclusionTE fistula development has occurred in both SCLC and NSCLC trials where chemotherapy, bevacizumab, and radiation were administered. Strategies to safely incorporate novel therapies into standard chemoradiation lung cancer regimens are needed.