Malignant respiratory-digestive fistulas

Malignant tracheoesophageal or bronchoesophageal or, less commonly, esophageal-lung parenchyma fistulas are late developments of advanced cancer of the esophagus, lung or mediastinum. Patients present mainly with intractable cough and repeated respiratory infections. Rapid deterioration and death results if this condition is left untreated.

The use of the antiangiogenesis drug bevacizumab along with radiation therapy have been linked to the development of malignant tracheoesophageal fistula/malignant bronchoesophageal fistula in patients treated for both small-cell and nonsmall-cell lung carcinoma. Three case series have been published during 2009 presenting characteristics, treatment options and associated complications. The best palliation for this malignant condition is achieved with endoscopic placement of esophageal, respiratory or parallel stenting (esophagus and airway). Dual stenting appears to work better than single prosthesis both for palliation and safety. There were also some reports of unusual complications related to prosthesis placement as treatment of this condition. Particular attention has to be paid to tracheal compression/erosion secondary to esophageal stents.

Respiratory-digestive fistulas are devastating complications of advanced cancer. Research has brought new understanding relevant to clinical practice.