Gschossmann J M, Bonner J A, Foote R L, Shaw E G, Martenson J A, Su J
Division of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Cancer. 1993 Sep 1;72(5):1513-21. doi: 10.1002/1097-0142(19930901)72:5<1513::aid-cncr2820720504>3.0.co;2-g.
Patients with esophageal cancer and a malignant tracheoesophageal fistula (TEF) have an extremely poor prognosis. Additionally, these patients often are denied treatment with radiation therapy because there is concern that these treatments may increase the size and associated problems of the TEF.
To determine the appropriate treatment (use of radiation therapy) for patients with esophageal cancer and malignant TEF, a review was performed of all such cases seen at the Mayo Clinic between 1971 and 1991.
Between 1971 and 1991, 41 patients with malignant TEF arising as a result of esophageal cancer were seen at the Mayo Clinic in Rochester. Twenty-eight of these cancers were locally recurrent, and this group of patients had a uniformly poor outcome (median survival time, 1.4 months). Thirteen patients had a malignant TEF and had not received previous treatment for their esophageal cancer. The median survival length was 4 months for this group of patients. Of the 41 patients in this study, 10 received radiation therapy for their malignant TEF (30-66 Gy). The median survival length of this group of patients was 4.8 months. Six of these 10 patients died of metastatic disease (median survival length, 9 months), and there was no evidence of progression of the local tumor. Four of these 10 patients died of local progression of the malignancy (median survival length, 3 months).
Radiation therapy did not increase the severity of the TEF. The authors conclude that radiation therapy can be administered safely in patients with TEF resulting from esophageal cancer. In some patients, radiation treatment may contribute to stabilization of the local tumor process (60% of patients treated with radiation therapy died of metastatic disease without local progression of tumor); however, all patients in this study eventually died of esophageal cancer.
患有食管癌且伴有恶性气管食管瘘（TEF）的患者预后极差。此外，这些患者常被拒绝接受放射治疗，因为担心这些治疗可能会增大TEF的尺寸并引发相关问题。
为确定食管癌合并恶性TEF患者的合适治疗方法（放射治疗的应用），对1971年至1991年间在梅奥诊所就诊的所有此类病例进行了回顾。
1971年至1991年间，罗切斯特的梅奥诊所共诊治了41例因食管癌导致的恶性TEF患者。其中28例为局部复发癌，这组患者的预后均很差（中位生存时间为1.4个月）。13例患者有恶性TEF且此前未接受过食管癌治疗。这组患者的中位生存时长为4个月。本研究中的41例患者中，10例因恶性TEF接受了放射治疗（30 - 66 Gy）。这组患者的中位生存时长为4.8个月。这10例患者中有6例死于转移性疾病（中位生存时长为9个月），且无局部肿瘤进展的证据。这10例患者中有4例死于恶性肿瘤的局部进展（中位生存时长为3个月）。
放射治疗并未增加TEF的严重程度。作者得出结论，对于因食管癌导致TEF的患者，可以安全地进行放射治疗。在一些患者中，放射治疗可能有助于稳定局部肿瘤进程（接受放射治疗的患者中有60%死于转移性疾病，而肿瘤无局部进展）；然而，本研究中的所有患者最终均死于食管癌。
