Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2022; 10(11): 3527-3532
Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3527
Double tracheal stents reduce side effects of progression of malignant tracheoesophageal fistula treated with immunotherapy: A case report
Chang-An Li, Wei-Xia Yu, Lin-Yang Wang, Hang Zou, Cheng-Jun Ban, Hong-Wu Wang
Chang-An Li, Wei-Xia Yu, Lin-Yang Wang, Hang Zou, Cheng-Jun Ban, Hong-Wu Wang, Department of Respiratory, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing 100700, China
Author contributions: Li CA, Ban CJ, and Wang HW designed the report; Yu WX, Wang LY, and Zou H collected the patient’s clinical data; Li CA and Ban CJ wrote the paper.
Supported by National Natural Science Foundation of China, No. 81973784.
Informed consent statement: Written informed consent was obtained from the patient and his family for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Jun Ban, PhD, Assistant Professor, Department of Respiratory, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, No. 5 Haihaicang, Dongcheng District, Beijing 100700, China. banchengjun3326@163.com
Received: September 11, 2021
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

Appropriately-sized tracheal stent placement combined with immune checkpoint inhibitors may improve the quality of life and survival of patients with MTEF.

Keywords: Immunotherapy; Rapid progression; Malignant tracheoesophageal fistula; Esophagus carcinoma; Double tracheal stents; Case report

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.