Arteriotracheal fistula as a fatal complication after tracheal resection and twice-a-day-irradiation for thyroid carcinoma

Background The arteriotracheal fistula is a severe, and mostly fatal complication in the treatment of patients with head and neck cancer. Methods We report a case of fatal haemorrhage from a fistula between the right brachiocephalic trunk and the trachea after radical thyroidectomy, resection of the frontal wall of the cervical trachea, and twice-a-day-irradiation. Results Compared to conventional irradiation therapy, twice-a-day-irradiation seems to be the major cause of this fatal complication. Conclusions Therefore we prefer conventional irradiation therapy to twice-a-day-irradiation in patients with R0 resection (curative tumor removal) and reconstructive surgery of the trachea and/or esophagus. In patients where R0 resection is impracticable, a reconstructive approach to the trachea or esophagus has to be avoided. In these cases, early postoperative twice-a-day-irradiation may prevent early tumor recurrence.