MALIGNANT TRACHEOESOPHAGEAL FISTULA IN PATIENTS WITH ESOPHAGEAL CANCER

Background. Patients with esophageal cancer and a malignant tracheoeso phageal fistula (TEF) have an extremely poor prognosis. Additionally, these patients often are denied treatment with radiation therapy becau se there is concern that these treatments may increase the size and as sociated problems of the TEF. Methods. To determine the appropriate tr eatment (use of radiation therapy) for patients with esophageal cancer and malignant TEF, a review was performed of all such cases seen at t he Mayo Clinic between 1971 and 1991. Results. Between 1971 and 1991, 41 patients with malignant TEF arising as a result of esophageal cance r were seen at the Mayo Clinic in Rochester. Twenty-eight of these can cers were locally recurrent, and this group of patients had a uniforml y poor outcome (median survival time, 1.4 months). Thirteen patients h ad a malignant TEF and had not received previous treatment for their e sophageal cancer. The median survival length was 4 months for this gro up of patients. Of the 41 patients in this study, 10 received radiatio n therapy for their malignant TEF (30-66 Gy). The median survival leng th of this group of patients was 4.8 months. Six of these 10 patients died of metastatic disease (median survival length, 9 months), and the re was no evidence of progression of the local tumor. Four of these 10 patients died of local progression of the malignancy (median survival length, 3 months). Conclusions. Radiation therapy did not increase th e severity of the TEF. The authors conclude that radiation therapy can be administered safely in patients with TEF resulting from esophageal cancer. In some patients, radiation treatment may contribute to stabi lization of the local tumor process (60% of patients treated with radi ation therapy died of metastatic disease without local progression of tumor); however, all patients in this study eventually died of esophag eal cancer.