Radiotherapy for primary carcinoma of the trachea.

Cheung AY.   Radiother Oncol. 1989 Apr;14(4):279-85.

Department of Radiation Oncology, University of Western Ontario, London, Canada.

Between 1940 and 1985, 24 cases of primary carcinoma of the trachea were registered at the London Regional Cancer Centre. The most common presenting symptoms were hoarseness, haemoptysis and cough. Twenty patients had epidermoid carcinoma and four had adenoid cystic carcinoma. Because of different clinical behaviours, the two histologies were separately analyzed. Of the 20 patients with epidermoid carcinoma, 19 received radiotherapy as primary treatment and one patient did not receive radiotherapy because of advanced disease. Radiation doses ranged from 4000 to 6000 cGy and most patients had megavoltage irradiation. Treatment result was disappointing. Only one patient remained disease-free at 15-month follow-up and all other patients had persistent or recurrent tracheal tumour. Median survival for all 20 patients was 5 months (range 1 to 19 months). Of the four patients with adenoid cystic carcinoma, two had primary surgery and postoperative radiotherapy and two had primary radiotherapy. Two patients died of disease, at 5 months and 8 years from diagnosis. Two surviving patients had 15-month follow-up: one had persistent disease and the other was free from recurrence. In this study, radiotherapy within the range of doses given was found to be an ineffective primary treatment for tracheal carcinoma.

Primary tumors of the trachea. Results of radiation therapy.

Fields JN, Rigaud G, Emami BN.   Cancer. 1989 Jun 15;63(12):2429-33.

Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, MO 63110.

From 1959 to 1986, 24 patients with primary malignant tumors of the trachea received radiotherapy as all or part of treatment. Common presentations included respiratory symptoms in 20 patients and hemoptysis in 15. Thirteen patients had squamous carcinomas with undifferentiated and adenoid cystic cancers in five and four patients, respectively. Overall actuarial survival was 45% at 1 year, 25% at 5 years, and 13% at 10 years. Survival was significantly correlated to histologic type (adenoid cystic versus squamous, P less than 0.03), but not to tumor extent or to patient age or sex. Local control was attained in 10 of 24 patients overall and was more frequent for patients with tumors localized to the trachea and for patients who were treated with combined surgery and radiotherapy. For the 18 patients treated with radiotherapy alone, complete response (CR) was seen to be significantly (P less than 0.001) related to dose: six of seven (86%) patients receiving greater than or equal to 6000 cGy attained CR versus one of 11 (9%) receiving less than 6000 cGy. Three patients developed complications related to radiotherapy. Radiotherapy can provide durable local control of localized tracheal tumors and should be considered for medically inoperable patients with localized tumors and for patients with high risk of recurrence after resection.\

Radiotherapy of primary malignant tumors of the trachea. Apropos of 31 cases

Guerin RA, Touboul E, Catach E, Benoit P, Terrier L, Malhaire JP, Bachot M, Nizri D.   Rev Mal Respir. 1984;1(4):227-31.

We report 31 cases of primary malignant tumours of the trachea, treated with radiotherapy at the Tumour Centre, Pitie-Salpetriere, from June 1968 to January 1982. Three patients received complementary post-operative irradiation: one had an epidermoid carcinoma, operated by incomplete resection and anastomosis, and survived 12 months after irradiation with 60,00 grays in 6 weeks (local recurrence of tumour and mediastinal extension); the other two had cylindromas of the trachea with complete resection and anastomosis: the first remains alive 6 years after an irradiation of 65,00 grays over 6 weeks, the second is alive 5 years after post-operative irradiation of 60,00 grays in 6 weeks. These two latter tumours evolved slowly and local recurrence may occur after five years and sometimes longer, after local treatment. 28 other cases presenting with an epidermoid carcinoma of the trachea received radiotherapy exclusively, when a surgical cure was impossible. Irradiation was interrupted in two patients: one after a dose of 12,00 grays for sudden massive haemoptysis, the other after a dose of 22,00 grays for an oesophago-tracheal fistula. An apparent complete remission was obtained in 80% of cases, judged by a tracheo-bronchial endoscopic examination carried out in the six weeks following the treatment. Two deaths were seen from intercurrent disease: one at two months from a granulocytosis caused iatrogenically from medication and the other at five months from bilateral bronchopneumonia. One patient was alive at 9 months in apparent complete local remission, but lost to follow up

Treatment of primary tracheal carcinoma. The role of external and endoluminal radiotherapy.

Harms W, Latz D, Becker H, Gagel B, Herth F, Wannenmacher M.  Strahlenther Onkol. 2000 Jan;176(1):22-7.

Department of Clinical Radiology, University of Heidelberg, Germany. wolfgang_harms@ukl.uni-heidelberg.de

Between 1984 and 1997, 25 patients with primary tracheal carcinoma were treated with external beam radiotherapy (17 squamous-cell carcinoma [SCC], 8 adenoid cystic carcinoma [ACC], median dose SCC 60 Gy. ACC 55 Gy). An additional brachytherapy boost was carried out in 10/25 patients (median dose SCC 18 Gy, ACC 15 Gy). Ten patients underwent operative treatment. RESULTS: The median survival (Kaplan-Meier) for patients with SCC was 33 months (ACC 94.2). The 1-, 2- and 5-year survival rates (Kaplan-Meier) for patients with SCC were 64.7% (ACC 85.7%), 64.7% (ACC 85.7%), and 26% (ACC 85.7%). Patients with ACC and patients with a complete remission after treatment had a significantly better survival probability (log rank test, p < 0.05). An excellent or good relief of clinical symptoms was achieved in 88% of the patients with SCC (ACC 88%). Eleven patients were locally controlled at last follow-up (SCC: 5/17; ACC: 6/8). Grade 1 to 2 toxicity (RTOG/EORTC) occurred in 12% (SCC: 2/17, ACC: 1/8) and Grade 3 to 4 toxicity in 8% (SCC: 0/17, ACC: 2/8) of the patients. Persistent or progressive local disease caused complications in 5 patients (fatal hemorrhage n = 2, esophagotracheal fistula n = 2, tracheal necrosis n = 1). CONCLUSION: Radiation therapy is an effective treatment for primary tracheal neoplasms. Surgery followed by adjuvant radiotherapy and primary radiotherapy in inoperable cases represent potentially curative treatment options. Prospective multicenter studies are needed to determine the optimal radiotherapeutic approach.

Radiotherapy for primary squamous cell carcinoma of the trachea.

Jeremic B, Shibamoto Y, Acimovic L, Milisavljevic S.  Radiother Oncol. 1996 Nov;41(2):135-8.

Department of Oncology, University Hospital, Kragujevac, Yugoslavia.

Twenty-two patients with tracheal squamous cell carcinoma were treated by radiotherapy alone. Nine patients were treated with 60 Gy between 1982 and 1987 and 13 with 70 Gy between 1988 and 1993 using conventional fractionation. The median survival was 24 months and the 5-year survival rate was 27%. Patients receiving 70 Gy had a slightly better prognosis than those receiving 60 Gy, but the difference was not significant. Patients with mediastinal lymph node involvement had a significantly worse prognosis. Delayed tracheal toxicity tended to be higher in the 70 Gy group.

Combined treatment of tracheal tumors

Kharchenko VP, Chkhikvadze VD, Kuz'min IV, Pan'shin GA, Bogdanova LN. Med Radiol (Mosk). 1984 Oct;29(10):53-5.

An analysis of short- and long-term results of the combined treatment of tumors of the trachea and adjacent organs with the involvement of the trachea in 100 patients suggests that this method holds promise. In 41 patients the irradiation phase preceded operation, in the rest of 59 patients it followed operation. Radiotherapy was performed daily, 5 fractions every week at a single focal dose of 2-3 Gy. The summary focal dose was 36-48 Gy, for some of the patients 70-80 Gy. Adjuvant radiotherapy did not prevent the performance of complex reconstructive plastic operations with circular, distal or window resection of the trachea. Postoperative complications occurred in 16%, lethal outcome in 4%. Five-year survival following the combined treatment of tracheal tumors was observed in 57%.

Radiation therapy alone in the treatment of tumours of the trachea.

Makarewicz R, Mross M.   Lung Cancer. 1998 Jun;20(3):169-74.

Department of Radiation Oncology, Bydgoszcz Regional Cancer Center, Poland.

A retrospective analysis of 23 patients with tracheal malignancy treated with a radiation therapy alone is reported. All patients were irradiated at Bydgoszcz Cancer Center during the period 1990-1996. To overcome serious damage to normal tissues, a dose escalation combination of external beam irradiation and brachytherapy was used in most cases. Squamous cell carcinoma was the most common type and was seen in 13 cases. Adenoid cystic carcinoma occurred in seven, adenocarcinoma in two and carcinoid in one patient. Eight patients were treated with definitive and 15 with palliative intent. Local control was attained in 8 of 23 patients and was more frequent for patients from curative group treated with doses greater than 60 Gy. The mean survival for all patients was 9.5 months, and 26 and 7.2 months for definitive and palliative group, respectively. Survival was strongly correlated to histologic type and response to radiotherapy.

Role of radiation therapy in the treatment of primary tracheal carcinoma.

Mornex F, Coquard R, Danhier S, Maingon P, El Husseini G, Van Houtte P.    Int J Radiat Oncol Biol Phys. 1998 May 1;41(2):299-305.

Radiation Oncology Department, Centre Leon Berard, Lyon, France.

PURPOSE: The objective of this work is to investigate the role of radiation therapy in the treatment of primary tracheal carcinoma. METHODS AND MATERIALS: From 1963 to 1993, 106 patients presenting with a tracheal carcinoma received a radiation course as part of their treatment in three institutions. Eighty-four patients were treated with megavoltage radiation only, receiving doses ranging from 30 to 70 Gy, with a median dose of 56 Gy. Five patients received high-dose-rate (HDR) brachytherapy, five patients underwent a surgical procedure, and eight received chemotherapy. RESULTS: With a mean follow-up of 141 months, the overall 1-, 2-, and 5-year survival rates are 46%, 21%, and 8%, respectively. Prognostic factors included tumor size (less than 3 cm), performance status, and total radiation dose: the 5-year survival rate dropped from 12% for patients receiving doses greater than 56 Gy to 5% for lower doses. Performance status and radiation doses are the only independent significant factors in multivariate analysis; these results must however be analyzed with precaution in this retrospective study. CONCLUSIONS: Radiation is a good alternative to surgery for primary tracheal cancer. A review of the literature and our current results allow us to recommend a radiation dose greater than 60 Gy for primary irradiation. Collaborative studies are warranted to (1) determine the optimal radiation dose for definitive irradiation, (2) define the potential role of radiation after complete and partial surgery, (3) determine the role and optimal treatment scheme for HDR brachytherapy, (4) describe and record the late effects, (5) establish the potential benefit of chemoradiation.