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

Eyun Song; Kyung Mee Song; Won Gu Kim; Chang Min Choi

doi:10.11106/ijt.2016.9.2.210

Journal List > Int J Thyroidol > v.9(2) > 1082750

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Song, Song, Kim, and Choi: Development of Tracheoesophageal Fistula after the Use of Sorafenib in Locally Advanced Papillary Thyroid Carcinoma: a Case Report

Case Report

Int J Thyroidol 2016;9(2):210-214.

Published online: 20 November 2016

DOI: https://doi.org/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

Eyun Song, Kyung Mee Song, Won Gu Kim, Chang Min Choi

Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence: Won Gu Kim, MD, PhD, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: 82-2-3010-5883, Fax: 82-2-3010-6962, E-mail: wongukim@amc.seoul.kr

Received 20 August 2016 Revised 14 November 2016 Accepted 17 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Tracheoesophageal fistula, Sorafenib, Thyroid cancer, Papillary

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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).

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