Three cases of esophagorespiratory fistula following neoadjuvant DCF therapy for resectable esophageal cancer

Neoadjuvant chemotherapy with 5-FU, cisplatin, and docetaxel (DCF) is standard for resectable esophageal cancer in Japan but is linked to severe adverse events. We report three cases of esophagorespiratory fistulas (ERFs) occurring during DCF therapy. Case 1: A 72-year-old woman (cStage II) developed fever after two DCF cycles. CT and esophagography confirmed an ERF. An esophageal stent was placed, but she later opted for best supportive care. Case 2: A 53-year-old man (cStage IIIB) developed pneumatosis intestinalis and pneumonia nine days into DCF. Imaging confirmed an ERF. He received a stent on day 19 and continued chemotherapy for over a year. Case 3: A 65-year-old man (cStage IIIA) presented with dyspnea eight days after starting DCF. CT revealed pneumothorax and pyothorax. A stent was placed on day 19. His condition initially improved but later declined, leading to best supportive care. DCF therapy may enhance survival but carries significant risk for ERFs. Early recognition of symptoms and rapid intervention are critical to managing complications.