3. Evolving Management and Outcome of Esophageal Cancer with Airway Involvement
Pendleton Alexander*, Gregory Trachiotis, Timothy Lipman, Robert Wadleigh
George Washington University and Washington, DC VAMC
Washington, District of Columbia, USA
BACKGROUND
Esophageal cancer with airway involvement, including patients with esophagorespiratory fistula (ERF), has been associated with a poor prognosis. Multimodality treatment, self-expanding metal stents (SEMS), and improved supportive therapy may be impacting outcome in these patients. There is concern for the development of ERF during therapy.
MATERIAL AND METHODS
We retrospectively studied 49 consecutive male patients at a single institution presenting between January 1988 and December 1996 with bronchoscopic, endoscopic, or radiographic confirmation of airway involvement with esophageal cancer, including 15 patients with ERF. Comparison was made between the first 24 patients (Group I) and the last 25 patients (Group II) with regard to antineoplastic therapy, stent placement, and survival.
RESULTS
Treatment in Group I included supportive care in 17/24 patients, plastic stent in 4/24 patients, and radiation and/or chemotherapy in 7/24 patients. In Group II, radiation and/or chemotherapy was offered to 23/25 patients, and SEMS was placed in 5/9 patients with ERF. Surgical resection was possible following neoadjuvant therapy in 14/25 patients in Group II, including two initially presenting with ERF. Median survival in Group I was 4.1 months and in Group II was 10.7 months. Comparison of Kaplan-Meier survival estimates using log rank testing demonstrated improved survival in Group II (P=0.02). Long- term survival in four Group II patients initially presenting with ERF and receiving multimodality treatment was observed. Development of ERF during treatment occurred in three Group II patients. Treatment failure was predominantly local in Group I, and local and distant in Group II.
CONCLUSION
More aggressive treatment, SEMS, and supportive measures favorably influence outcome in esophageal cancer with airway invasion. Long- term survival and the development of ERF during therapy occurred at similar rates.
