Bevacizumab-induced esophageal pleural fistula during maintenance therapy without radiation in lung cancer.

BACKGROUND: Esophageal pleural fistula (EPF) is a rare but fatal complication associated with bevacizumab use; however, cases reports of EPF caused by bevacizumab have not been previously published. CASE PRESENTATION: A 66-year-old male patient diagnosed with stage IV lung adenocarcinoma on April 24, 2020 received 6 cycles of platinum-containing dual chemotherapy combined with bevacizumab followed by three cycles of bevacizumab monotherapy. Five days before admission, he experienced chest tightness, dyspnea, and right chest pain. Bed-side X-ray examination revealed a massive right hydrothorax, and food was found in the extracted pleural effusion. EPF was further confirmed by upper gastrointestinal radiography after oral administration of iohexol. The patient underwent jejunostomy as the distal esophagus could not be identified on gastroscopy, and eventually died of septic shock on January 16, 2021. CONCLUSIONS: It is necessary to pay attention to EPF during bevacizumab use in patients with or without risk factors.

Aerodigestive fistula formation as a rare side effect of antiangiogenic tyrosine kinase inhibitor therapy for thyroid cancer.

BACKGROUND: In the past decade, targeted therapy with antiangiogenic drugs has become standard of care for most types of metastatic, progressive thyroid cancer. While these drugs were thought initially to be less toxic than traditional chemotherapy, they can have rare but serious and fatal toxicities. Once such toxicity that has been reported in other tumor types is upper airway fistula formation, which can be life-threatening. SUMMARY: Here, we describe three patients treated with antiangiogenic tyrosine kinase inhibitors at two academic institutions who developed aerodigestive fistula. All three patients had risk factors for fistula formation, which included external beam radiation and/or large tumor with invasion of the tracheal wall. CONCLUSIONS: Fistula formation is a known but rare side effect of antiangiogenic tyrosine kinase inhibitors. Knowledge of the risk factors that may predispose thyroid cancer patients to this serious adverse event is vital prior to prescribing antiangiogenics. Particular caution should be observed when using these drugs in patients undergoing radiation therapy or surgery, or in patients whose tumor is invading vital structures of the neck, as they may be at higher risk of developing this rare complication. In these patients, antiangiogenic tyrosine kinase inhibitors should be used cautiously, patients should be aware of the risk, and physicians should monitor patients for symptoms of fistula.

Medication-induced oesophageal injury leading to broncho-oesophageal fistula.

Medication-induced oesophageal injury is one of the least recognised side-effects of oral medication and, in contrast to other oesophageal pathologies, is rarely considered in the differential diagnosis of chest pain. We describe a case of medication-induced oesophageal injury with a rare complication in which the diagnosis was not considered until the characteristic features were demonstrated at endoscopy.

Bronchoesophagopleural fistula after photodynamic therapy for malignant mesothelioma.

A 66-year-old woman presented with a bronchoesophagopleural fistula 10 weeks after thoracic photodynamic therapy for malignant mesothelioma. This is the third reported case of an esophagopleural fistula developing subsequent to photodynamic therapy for mesothelioma. We review the literature on this topic and report our successful management of this complication.

Esophagopleural fistula: a complication of photodynamic therapy.

Mesothelioma of the pleura remains an incurable disease for which novel treatments are being investigated. One of these is intraoperative photodynamic therapy (PDT), using the principle of cell cytotoxicity produced by light-activated sensitization. We report a complication of this therapy that defined the maximal tolerated dose of PDT, ie, esophagopleural fistula, in two consecutive patients who had received the same dose of PDT at the time of extrapleural pneumonectomy.

[Surgical treatment of esophago-pleural fistula caused by chemotherapy for lung cancer].

A 72-year-old woman was admitted for cough and dyspnea. Bronchofiberscopy examination revealed lung cancer at the right main bronchus. Plain chest X-ray and chest CT revealed that the tumor had invaded to the mediastinum and esophagography demonstrated stenosis of the thoracic esophagus without fistula. Because pulmonary resection was contraindicated, chemotherapy for lung cancer was initiated. Complete response was noted, but an esophago-pleural fistula developed as a consequence of chemotherapy. After intrathoracic tube drainage, a permanent endoesophageal tube was inserted through a small incision in the stomach under general anesthesia. However, it migrated into the thoracic empyema after 4-postoperative days. Because the lung cancer was well-controlled, a second operation to reconstruct the esophagus was performed without resection of the thoracic esophagus or fistula. After the operation, thoracic empyema was washed out with povidone iodine and pure alcohol. The chest tube was removed 3 months after the second operation. We conclude that in cases of esophago-pleural fistula caused by chemotherapy for lung cancer, if complete response to chemotherapy is noted, reconstruction of the esophagus should be considered.

[Late sequelae of caustic esophagitis]. / Le sequele tardive delle esofagiti da caustici.

The caustic burns of the oesophagus still play a significant role in the framework of oesophageal conditions, both in terms of therapeutic approach in the acute phase, when high morbidity and mortality rates are recorded, and of long-term consequences. These are as follows: stenoses of varying extent, carcinoma, wall deformation, oesophago-bronchial fistulae and motor disturbances. This paper is concerned with the clinical, diagnostic and therapeutic implications of these late consequences.

Broncho-oesophageal fistula: a late complication of endoscopic variceal sclerotherapy.

A case is reported of delayed broncho-oesophageal fistula presenting several weeks after fibreoptic injection sclerotherapy for oesophageal varices in a patient with chronic active hepatitis who eventually died from bronchopneumonia. Such serious complications of injection sclerotherapy should be kept in mind with the increasing popularity of this method of early treatment of bleeding oesophageal varices.