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

As a for instance, a centrally located primary tumor with mediastinal adenopathy that results in a TE fistula? Currently we would recommend esophageal stenting and chemotherapy. Would you ever add radiation?
4 Answers
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Radiation Oncology · Memorial Sloan Kettering Cancer Center
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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 sc...

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Radiation Oncology · University of Vermont Cancer Center
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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.” ...

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Radiation Oncology · University of Utah School of Medicine
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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...

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

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