CLOSURE OF TRACHEOESOPHAGEAL FISTULAS WITH PRIMARY CHEMOTHERAPY IN PATIENTS WITH ESOPHAGEAL CANCER

Background. In patients with tracheoesophageal fistula, radiation is t hought to be contraindicated because cytoreduction enlarges the size o f the fistula. The same caveat should also apply to cytoreduction with chemotherapy, but there are few data addressing this issue. Methods. The records of 16 patients with esophageal cancer who received chemoth erapy in 1991 were evaluated in the Medical Oncology Section of the Ve terans Administration Medical Center, Washington, DC. All patients wer e staged radiographically and endoscopically. Four of these 16 were se en initially with or developed tracheoesophageal fistulas during thera py. Two patients whose fistulas closed during chemotherapy are present ed. Results. All four patients with tracheoesophageal fistulas had mid esophageal squamous cell carcinomas. Objective complete responses with closure of tracheoesophageal fistulas occurred in two of four patient s after three and four cycles of chemotherapy, respectively. One of th ese fistulas first developed, then healed during treatment, whereas th e other presented at the time of diagnosis with fistula.