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A patient with tracheoesophageal fistula and esophageal cancer after radiotherapy

Nature Reviews Gastroenterology & Hepatology volume 7, pages 702–706 (2010)Cite this article

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Abstract

Background. A 63-year-old woman presented with dysphagia owing to proximal esophageal stenosis 27 years after she received radiation therapy for Hodgkin disease. She had previously experienced various other complications of this treatment, including myelopathy, hypothyroidism, and cardiomyopathy.

Investigations. Medical history and physical examination, pathology and immunohistochemistry, bronchoscopy, esophagogastroscopy, chest and abdominal PET–CT scan, examination of the thorax during open right thoracotomy.

Diagnosis. Large tracheoesophageal fistula and poorly differentiated squamous cell carcinoma of the esophagus.

Management. The stenosis was treated with endoscopic dilatations and brachytherapy, but persisted and became a tracheoesophageal fistula despite repeated placement of esophageal stents. Definitive surgical treatment comprised combined transabdominal and thoracic esophagectomy with creation of a gastric tube and cervical esophagogastrostomy, and repair of the trachea with a pericardial patch and intercostal muscle flap.

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Figure 1: Images obtained during tracheobronchoscopy, esophagoscopy, and CT showing the tracheal defect in the patient at the time of admission to tertiary care.
Figure 2: Images obtained during esophagectomy and repair of the tracheal defect (the bottom of the images is caudal, the top of the images is cranial).
Figure 3: Pathological analysis of the patient's tissues.

References

  1. Coia, L. R., Myerson, R. J. & Tepper, J. E. Late effects of radiation therapy on the gastrointestinal tract. Int. J. Radiat. Oncol. Biol. Phys. 31, 1213–1236 (1995).

    Article  CAS  Google Scholar 

  2. Greven, K. M. & Evans, L. S. The occurrence and management of esophageal fistulas resulting from Hodgkin's disease. Cancer 69, 1031–1033 (1992).

    Article  CAS  Google Scholar 

  3. Ling, D. & Bushunow, P. Tracheoesophageal fistula in a patient with recurrent Hodgkin's disease. A case for hope or despair. Chest 109, 850–851 (1996).

    Article  CAS  Google Scholar 

  4. Valenti, V., Martínez-Cecilia, D., Priego, P., Cohen, P. & Martínez-Isla, A. Bronchoesophageal fistula in a patient with non-Hodgkin's lymphoma. Clin. Transl. Oncol. 10, 377–379 (2008).

    Article  CAS  Google Scholar 

  5. Ahn, S. J. et al. Dosimetric and clinical predictors for radiation-induced esophageal injury. Int. J. Radiat. Oncol. Biol. Phys. 61, 335–347 (2005).

    Article  Google Scholar 

  6. Anscher, M. S. et al. Recent progress in defining mechanisms and potential targets for prevention of normal tissue injury after radiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 62, 255–259 (2005).

    Article  Google Scholar 

  7. Swerdlow, A. J. et al. Risk of second malignancy after Hodgkin's disease in a collaborative British cohort: the relation to age at treatment. J. Clin. Oncol. 18, 498–509 (2000).

    Article  CAS  Google Scholar 

  8. van Leeuwen, F. E. et al. Long-term risk of second malignancy in survivors of Hodgkin's disease treated during adolescence or young adulthood. J. Clin. Oncol. 18, 487–497 (2000).

    Article  CAS  Google Scholar 

  9. Micke, O., Schäfer, U., Glashorster, M., Prott, F. J. & Willich, N. Radiation-induced esophageal carcinoma 30 years after mediastinal irradiation: case report and review of the literature. Jpn J. Clin. Oncol. 29, 164–170 (1999).

    Article  CAS  Google Scholar 

  10. Miller, P. R., Jackson, S. L., Pineau, B. C. & Levine, E. A. Radiation-induced gastrointestinal stromal sarcoma of the esophagus. Ann. Thorac. Surg. 70, 660–662 (2000).

    Article  CAS  Google Scholar 

  11. Siersema, P. D. Treatment options for esophageal strictures. Nat. Clin. Pract. Gastroenterol. Hepatol. 5, 142–152 (2008).

    Article  Google Scholar 

  12. Renard, P. et al. Cancer of the esophagus after mediastinal radiotherapy for Hodgkin's disease. Apropos of a case [French]. Ann. Gastroenterol. Hepatol. (Paris) 25, 299–300 (1989).

    CAS  Google Scholar 

  13. Vanagunas, A., Jacob, P. & Olinger, E. Radiation-induced esophageal injury: a spectrum from esophagitis to cancer. Am. J. Gastroenterol. 85, 808–812 (1990).

    CAS  PubMed  Google Scholar 

  14. Fékété, F., Mosnier, H., Belghiti, J., Uribe, M. & Sauvanet, A. Esophageal cancer after mediastinal irradiation. Dysphagia 8, 289–291 (1993).

    Article  Google Scholar 

  15. Abboud, B. et al. Radiation-induced esophageal cancer. Presentation of a case and review of the literature [French]. Gastroenterol. Clin. Biol. 21, 987–989 (1997).

    CAS  PubMed  Google Scholar 

  16. Perrier, G. et al. Squamous cell carcinoma of the thoracic esophagus following radiation therapy for breast cancer. Hepatogastroenterology 45, 2197–2201 (1998).

    CAS  PubMed  Google Scholar 

  17. Audebert, A., Sauvanet, A., Mauvais, F. & Belghiti, J. Radiation-induced esophageal carcinoma: report of 11 cases [French]. Ann. Chir. 127, 289–296 (2002).

    Article  CAS  Google Scholar 

  18. Hulscher, J. B. et al. Injury to the major airways during subtotal esophagectomy: incidence, management, and sequelae. J. Thorac. Cardiovasc. Surg. 120, 1093–1096 (2000).

    Article  CAS  Google Scholar 

  19. Coussens, L. M. & Werb, Z. Inflammation and cancer. Nature 420, 860–867 (2002).

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Laurie Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands

    Jeroen Hagendoorn

  2. Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands

    Marguerite E. I. Schipper

  3. Department of Cardiothoracic Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands

    Faiz Z. Ramjankhan

  4. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands

    Peter D. Siersema

  5. Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands

    Richard van Hillegersberg

  6. Department of Internal Medicine, Orbis Medisch Centrum, Dr H. van der Hoffplein 1, 6162 BG, Sittard, The Netherlands

    Arjan Cloïn

Authors
  1. Jeroen Hagendoorn
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Contributions

All authors contributed equally to researching data for this article. J. Hagendoorn, M. E. I. Schipper, P. D. Siersema and R. van Hillegersberg provided substantial contributions to discussion of the content. J. Hagendoorn wrote the article. J. Hagendoorn and R. van Hillegersberg reviewed and edited the manuscript before submission.

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Correspondence to Richard van Hillegersberg.

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The authors declare no competing financial interests.

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Hagendoorn, J., Schipper, M., Cloïn, A. et al. A patient with tracheoesophageal fistula and esophageal cancer after radiotherapy. Nat Rev Gastroenterol Hepatol 7, 702–706 (2010). https://doi.org/10.1038/nrgastro.2010.171

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