• Tao Zhang, Yin Yang, Guowei Cheng, Ping Chen, and Nan Bi.
• Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College.
• Medicine (Baltimore). 2020 Apr 1; 99 (17): e19878.

IntroductionTracheoesophageal Fistula (TF) is a rare complication of Bevacizumab. Thoracic radiotherapy may be a contributing factor to TF formation. To the best of our knowledge, we report the first case of Chinese patient with non-small cell lung cancer (NSCLC) who developed TF after completion of chemotherapy with bevacizumab and thoracic radiotherapy.Patient ConcernsA 54-year-old male patient was diagnosed with NSCLC. He received definitive thoracic radiotherapy with concurrent pemetrexed and cisplatin chemotherapy. Two months after the treatment, the disease progressed with enlargement of right inguinal lymph node and chemotherapy of docetaxel, carboplatin and bevacizumab was administrated. Eighteen days after 4 cycles, the patient presented a sudden onset of acute cough after drinking.DiagnosisEsophageal barium swallow revealed a TF. Gastroscopy confirmed a fistula in the esophagus.InterventionsA jejunal feeding tube was placed for nutrition for a month. After that a covered esophageal stent was placed in the esophagus.OutcomesAt the 6-month follow-up visit, the patient recovered well and had not developed any complication related to the stent placement.ConclusionTF is a rare but life-threatening complication of bevacizumab. Careful observation is imperative for those patients who are administered bevacizumab, particularly in patients treated previously with thoracic radiotherapy.

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