Evolving management and outcome of esophageal cancer with airway involvement

Background. Esophageal cancer with airway involvement, including patients w ith esophagorespiratory fistula (ERF), has been associated with a poor prog nosis. Multimodality treatment, self-expanding metal stents, and improved s upportive therapy may be impacting outcome in these patients. There is conc ern for the development of ERF during therapy. Methods. We retrospectively studied 74 consecutive male patients at a singl e institution presenting between 1/85 to 12/98 with bronchoscopic, endoscop ic or radiographic confirmation of airway involvement with esophageal cance r, including 35 patients with ERF. Comparison was made between the first 35 patients (group I) and the last 39 patients (group II) with regard to anti neoplastic therapy, stent placement, and survival. Results. Treatment in group I included supportive care in 17 of 35 patients , plastic stent in 7 of 35 patients, and radiation or chemotherapy in 9 of 35 patients. In group II, radiation or chemotherapy was offered to 33 patie nts, and self-expanding metal stents were placed in 10 of 39 patients. Surg ical resection was possible after neoadjuvant therapy in 13 of 39 patients in group II, including 2 initially presenting with ERF. Median survival in group I was 16 weeks and in group II was 37 weeks. Comparison of Kaplan-Mei er survival estimates using log rank testing demonstrated improved survival in group II (p = 0.0026). Long-term survival in 4 group II patients initia lly presenting with ERF and receiving multimodality treatment was observed. Development of ERF during treatment occurred in 3 group II patients. Treat ment failure was predominantly local in group I and local and distant in gr oup II. Conclusions. More aggressive treatment may favorably influence outcome in e sophageal cancer with airway invasion. Long-term survival and the developme nt of ERF during therapy occurred at similar rates. (Ann Thorac Surg 2001;7 1:1640-4) (C) 2001 by The Society of Thoracic Surgeons.