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Ali O, Challa SR, Siddiqui OM, Ali S, Kim RE. A rare cause of esophagopleural fistula due to intensity-modulated proton therapy: a case report and review of literature. Clin J Gastroenterol 2021; 14:955-960. [PMID: 33905092 DOI: 10.1007/s12328-021-01388-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/12/2021] [Indexed: 12/22/2022]
Abstract
Esophagopleural fistula (EPF), initially described in 1960, is an abnormal communication between the esophagus and the pleural cavity which can occur due to congenital malformation or acquired due to malignancy or iatrogenic treatment. The most common presenting symptoms are of a respiratory infection, such as fever, chest tenderness, cough and imaging findings consistent with pleural fluid consolidation. In this report, we present a 59-year-old man who exhibited shortness of breath, productive cough, and significant weight loss for 2 weeks. His medical history was significant for smoking-related lung disease and pulmonary squamous cell carcinoma (SCC). His SCC (T4N0) was diagnosed 6 years prior to this presentation and was treated with chemoradiotherapy. The cancer recurred a year ago and he was treated with intensity-modulated proton therapy (IMPT) and consolidation chemotherapy. During admission, he was found to have an EPF by CT scan after initially failing antibiotic treatment for suspected complicated pneumonia and pleural effusion. Multiple attempts of esophagopleural fistula closure were made using endoscopic self-expandable metallic stents and placement of an esophageal vacuum-assisted closure device. However, these measures ultimately failed and, therefore, he required an iliocostalis muscle flap (Clagett window) procedure for closure. Esophageal pulmonary fistulae should be suspected whenever patients have undergone thoracic IMPT and may present with acute pulmonary complications, particularly pneumonia refractory to antibiotic treatment. This case reviews the current literature, potential complications, and treatment options for esophagopleural fistulas.
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Affiliation(s)
- Osman Ali
- University of Maryland Medical Center Midtown Campus, Baltimore, MD, 21201, USA
| | | | - Osman M Siddiqui
- University of Maryland Medical Center, Baltimore, MD, 21201, USA
| | - Sukaina Ali
- American University of Antigua College of Medicine, Coolidge, WI, Antigua and Barbuda
| | - Raymond E Kim
- University of Maryland Medical Center Midtown Campus, Baltimore, MD, 21201, USA.
- University of Maryland Medical Center, Baltimore, MD, 21201, USA.
- Department of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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Castro-Varela A, Molina S, Grosu HB. Tracheomediastinal Fistula Formation After Endobronchial Ultrasound Transbronchial Needle Aspiration While on Bevacizumab Treatment. Cureus 2021; 13:e14189. [PMID: 33936899 PMCID: PMC8083991 DOI: 10.7759/cureus.14189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 63-year-old male with non-small-cell lung cancer (NSCLC) developed a tracheomediastinal fistula after endobronchial ultrasound transbronchial needle aspiration while on treatment with bevacizumab. This vascular endothelial growth factor-specific angiogenesis inhibitor is a first-line treatment for unresectable or metastatic NSCLC and has been reported to cause fatal non-gastrointestinal fistulas. Respiratory tract fistulas are a known rare complication after bevacizumab therapy characterized by a high mortality rate.
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Affiliation(s)
- Alejandra Castro-Varela
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.,School of Medicine and Health Sciences, Tecnológico de Monterrey, Monterrey, MEX
| | - Sofia Molina
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA
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Deng P, Hu C, Li Y, Cao L, Yang H, Li M, An J, Jiang J, Gu Q. Bronchial Fistula: Rare Complication of Treatment with Anlotinib. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:858-865. [PMID: 32987493 PMCID: PMC7583880 DOI: 10.3779/j.issn.1009-3419.2020.102.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anlotinib is a newly developed small molecule multiple receptor tyrosine kinase (RTK) inhibitor that was approved for the treatment of patients with lung cancer in China. We aim to report 3 cases of rare complication of anlotinib-bronchial fistula (BF) during the treatment of lung cancer patients and summarize the possible causes. METHODS We collected three patients who developed BF due to anlotinib treatment, and conducted a search of Medline and PubMed for medical literature published between 2018 and 2020 using the following search terms: "anlotinib," "lung cancer," and "fistula." RESULTS Our literature search produced two case reports (three patients) which, in addition to our three patients. We collated the patients' clinical characteristics including demographic information, cancer type, imaging features, treatment received, risk factors for anlotinib related BF, and treatment-related outcomes. The six patients shared some common characteristics: advanced age, male, concurrent infection symptoms, diabetes mellitus (DM), advanced squamous cell and small cell lung cancers, centrally located tumors, tumor measuring ≥5 cm in longest diameter, and newly formed tumor cavitation after multi-line treatment especially after receiving radiotherapy. Fistula types included broncho-pericardial fistula, broncho-pleural fistula, and esophago-tracheobronchial fistula. Six patients all died within 6 months. CONCLUSIONS Although anlotinib is relatively safe, it is still necessary to pay attention to the occurrence of BF, a rare treatment side effect that threatens the quality of life and overall survival of patients. Anlotinib, therefore, requires selective use and close observation of high-risk patients.
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Affiliation(s)
- Pengbo Deng
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuanyuan Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Liming Cao
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Huaping Yang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jian An
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Juan Jiang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Qihua Gu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China.,Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha 410008, China
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