Int J Thyroidol.  2016 Nov;9(2):210-214. 10.11106/ijt.2016.9.2.210.

Development of Tracheoesophageal Fistula after the Use of Sorafenib in Locally Advanced Papillary Thyroid Carcinoma: a Case Report

• Song E
• Song KM
• Kim WG
• Choi CM

• KMID: 2362361
• DOI: http://doi.org/10.11106/ijt.2016.9.2.210

Abstract

Sorafenib, an oral multi-kinase inhibitor, is used for the treatment of patients with radioactive iodine (RAI) refractory differentiated thyroid carcinoma (DTC) with favorable outcomes. Some unusual but fatal adverse effects are known for this drug and tracheoesophageal fistula (TEF) is one of them, which has never been reported in thyroid cancer patients. We present a successfully treated patient who had developed TEF associated with rapid tumor regression during sorafenib treatment for locally advanced papillary thyroid carcinoma (PTC). Sorafenib was discontinued and feeding jejunostomy tube was placed for nutritional support. 3 months later, the TEF had successfully healed and there was no visible fistula track or interval change of the viable tumor during 15 months of follow-up. Identifying patients at high risk for this potential complication and paying special attention when prescribing anti-angiogenics to these patients are crucial to prevent associated morbidity and mortality.

Keyword

Tracheoesophageal fistula; Sorafenib; Thyroid cancer; Papillary

MeSH Terms

Fistula
Follow-Up Studies
Humans
Iodine
Jejunostomy
Mortality
Nutritional Support
Thyroid Gland*
Thyroid Neoplasms*
Tracheoesophageal Fistula*
Iodine

Figure

• 

  Fig. 1. Locally advanced papillary thyroid carcinoma in the tracheoesophageal groove with esophagus and tracheal invasion before sorafenib treatment (A, B). (A) Neck CT image. (B) Bronchoscopic ima-ge. After 1 month of treatment with sorafenib, the metastatic tumor significantly decreased in size (C, D). (C) Neck CT image. (D) Bronchoscopic ima-ge.

• 

  Fig. 2. Development of tracheoesophageal fistula (TEF) at 4 months after sorafenib treatment (A, B). (A) Tracheobronchial CT image. (B) Three-dimensional reconstruction image. (C) Successful insertion of a feeding jejunostomy tube. Regression of TEF at 3 months after discontinuation of sorafenib and jejunostomy in esophagography (D), tracheobronchial CT image (E), and 3-dimensional reconstruction image (F).

Reference

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