Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3527
Peer-review started: September 11, 2021
First decision: January 25, 2022
Revised: January 31, 2022
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: April 16, 2022
Processing time: 209 Days and 4.1 Hours
The protective effect of tracheal stents is reported to relieve airway obstruction and reduce side effects of rapid progression of malignant tracheoesophageal fistula (MTEF) after immunotherapy in this case with 10 mo follow-up.
Two kinds of silicone stents were placed in the main airway of a 58-year-old male to relieve the airway obstruction caused by advanced esophageal carcinoma. The patient then received four doses of toripalimab. Subsequently, rapid, progressive deterioration of the original fistula was found. Although the fistula enlarged rapidly after immunotherapy, it remained covered completely, and likely because of this, his condition remained stable. Therefore, immunotherapy could be continued to treat the primary tumor. Despite these efforts, the patient died of the advancement of his esophageal cancer.
Appropriately-sized tracheal stent placement combined with immune checkpoint inhibitors may improve the quality of life and survival of patients with MTEF.
Core Tip: A 58-year-old male was diagnosed with advanced esophageal carcinoma and malignant tracheoesophageal fistula. For treatment, two kinds of silicone stents were placed in the main airway, followed by administration of four doses of toripalimab. Follow-up scans showed the original fistula to have rapidly increased in size between the upper trachea and esophagus. The fistula was still covered due to the appropriately-sized stents, which were likely protective, as no serious lung infections occurred and the patient remained stable. Accordingly, immunotherapy could be continued to treat the primary tumor. Unfortunately, however, the patient died of the esophageal cancer in February of 2021.