How do you manage a patient who presents with a tracheoesophageal fistula from a lung or esophageal primary that is non-metastatic?

My experience with this has typically been with primary esophageal cancer presenting with TEF. It's obviously a challenging and individualized situation requiring multidisciplinary input and extensive clinical assessment and discussion. I generally recommend induction chemotherapy since the ideal scenario is for a response and healing of fistula prior to RT. However, if there is no response or healing, then I would still consider proceeding with RT since it may be the only way to prevent further...

In an excellent review article on this topic, (Shamji & Inculet, Thorac Surg Clin 2018, PMID: 30054077) the authors wrote “when a malignant fistula develops between esophagus and trachea, the underlying cancer is invariably incurable, whether the primary site is in the esophagus or in the trachea.” Although I do believe rare long term survivors are possible, my experience has been similar, often with aspiration pneumonia and pulmonary sepsis as the cause of fatality especially if the fistula is ...

Stabilization of the airway is important and should be established before starting treatment and reassessed throughout. For patients who clearly have a TE fistula prior to treatment, I agree with stenting. Even with stents, they may need a PEG to optimize nutrition because they still may not be safe to swallow.

Patients who are diagnosed like this are often very sick. The ones I’ve seen have been in the ICU or on the floor. If they are a candidate for chemotherapy, it is reasonable to start with...

I recently had a similar case and after a sent were able to finish 60 gray with weekly cisplatin- too early to predict outcome?