Treatment Practice and Morbidities for Oesophageal Cancer Patients With Tracheo-Bronchial Involvement: An Experience From Tertiary Cancer Centre

Background Unresectable Oesophageal squamous cell carcinoma confers a poor prognosis even after curative chemoradiotherapy. In this retrospective study, we have assessed the outcomes of oesophageal cancer with suspicious T4b disease treated with chemoradiotherapy. Methods From April 2018–2024, we included 100 histopathological confirmed oesophageal cancer patients (62 males; median age 60 years) with fibreoptic bronchoscopy (FOB) findings of the extrinsic bulge (n = 54), restricted mobility (n = 41), or mucosal infiltration (n = 13) of the tracheobronchial tree (TBT). The treatment involved either palliative chemotherapy followed by consolidation radiation therapy or upfront chemoradiotherapy. Electronic medical records were reviewed for the patient’s details. FOB findings post-treatment were also retrieved if performed for suspicious tracheoesophageal fistula (TOF). The TOF rates, nasogastric tube dependency (NGT), and stricture rates were evaluated to determine the efficacy of treatment strategies. Results Ninety-eight had squamous histology, 55 had middle 1/3rd, and 29 had upper 1/3rd disease. Fifty patients received upfront chemotherapy (CT) and 50 received upfront CTRT. The median FU was 33.6 months. Of 13 pts with mucosal infiltration, all received CT followed by CTRT, 1 did not complete CTRT, and 1 developed TOF. OF 41 pts with restricted mobility, 24 received NACT f/b CTRT and the rest upfront CTRT. Only 2 pts developed TOF and both received upfront CTRT. At 12 months, 62 patients were alive. Tracheo-oesophageal fistula developed in 10 patients, 15 had NGT dependency and 23 had strictures. Conclusion Advanced oesophageal carcinomas with TBT involvement can be safely treated with careful patient selection and appropriate sequencing of treatment with low morbidity rates.