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Tracheo-oesophageal Fistula — SCE Medical Oncology MCQ

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HardHead & Neck CancerTracheo-oesophageal FistulaSCE Medical Oncology

A 62-year-old man with H&N SCC post-CRT develops a late tracheo-oesophageal fistula. He presents with coughing while eating and recurrent aspiration pneumonia. CT confirms a fistula between the oesophagus and trachea. What are the management options?

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Correct answer: B — Covered self-expanding stent (oesophageal and/or tracheal), surgical repair if fit, or feeding gastrostomy/jejunostomy to prevent aspiration — tracheo-oesophageal fistula (TOF) in post-CRT patients is often radiation-induced and carries poor prognosis; management depends on fitness and goals of care

Post-CRT TOF: rare but devastating complication of thoracic/H&N RT. Management: (1) dual stenting (oesophageal + tracheal covered stents) for palliation; (2) surgical repair ± tissue flap if fit; (3) feeding gastrostomy/jejunostomy to prevent aspiration; (4) multidisciplinary input (ENT, thoracic surgery, palliative care). Prognosis is generally poor (~median survival 3-6 months).

Reference: NICE NG36; BSG; ESMO Supportive Care