Case Report
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 21, 2007; 13(15): 2250-2254
Published online Apr 21, 2007. doi: 10.3748/wjg.v13.i15.2250
Chemoradiotherapy for a patient with a giant esophageal fistula
Takuma Nomiya, Kazuhide Teruyama, Hitoshi Wada, Kenji Nemoto
Takuma Nomiya, Kazuhide Teruyama, Department of Radiation Oncology, Hiraka General Hospital, Japan
Hitoshi Wada, Kenji Nemoto, Department of Radiation Oncology, Yamagata University Hospital, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Takuma Nomiya, MD, PhD, Department of Radiation Oncology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. nomiya@rad.med.tohoku.ac.jp
Telephone: +81-22-7177312 Fax: +81-22-7177316
Received: January 24, 2007
Revised: February 10, 2007
Accepted: March 8, 2007
Published online: April 21, 2007
Abstract

We describe our experience of treatment for a giant esophageal malignant fistula, which has not been reported previously. A 36-year-old woman who was diagnosed as having massive esophageal small cell carcinoma with metastases was treated with chemoradiotherapy. However, a giant esophagomediastinal fistula appeared due to shrinkage of the massive tumor, and all anti-cancer treatment was suspended. However, chemoradiotherapy was restarted at the request of the patient despite the presence of the fistula. After restarting treatment, the giant esophageal fistula was naturally closed despite intensive chemoradiotherapy, and the patient became able to eat and drink. Although the patient finally died, her QOL and prognosis seemed to be improved by the chemoradiotherapy. Anti-cancer treatment could be safely performed despite the presence of a giant fistula. The giant fistula closed while intensive chemotherapy was administered to the patient. Therefore, the presence of a fistula may not be a contraindication for curative chemoradiotherapy. Completion of treatment with proper management and maintenance of patients would be of benefit to patients with fistula.

Keywords: Esophageal malignancy; Esophageal fistula; Chemotherapy; Radiation therapy; Small cell carcinoma