Broncho-oesophageal fistula after lung cancer treatment

Correspondence to Dr Hiroshi Sugimoto; dr.sugimoto@gmail.com Description A 67-year-old Japanese man with locally advanced squamous cell lung cancer developed radiation pneumonitis after radical radiotherapy with concurrent carboplatin and paclitaxel followed by durvalumab. During the steroid treatment for radiation pneumonitis, he experienced a cough that worsened after drinking liquids. The causes of acquired broncho-oesophageal fistula include malignancy, infections and trauma.1 In patients with malignancy, broncho-oesophageal fistula results from direct invasion of oesophageal or lung cancer or as a complication of cancer treatment, such as surgery, radiation, chemotherapy and instrumentation including oesophageal stents.2 The incidence of broncho-oesophageal fistula secondary to lung cancer is 0.3% and is relatively high after radiotherapy.3 Cough is the most common symptom of broncho-oesophageal fistula (56%) and coughing while eating or drinking (Ono’s sign) is typical.2 3 Although broncho-oesophageal fistula can be treated with surgery, oesophageal or bronchial stenting and endoscopic closure, most patients die of infection or bleeding within 3 months from onset.3 4 Furthermore, this patient had some risk factors for fatal hemoptysis such as squamous cell carcinoma and major cavitation.5 We should diagnose the broncho-oesophageal fistula promptly especially in the patient with squamous cell lung cancer after radiotherapy, then, determine the appropriate treatment for broncho-oesophageal fistula via multidisciplinary discussion.