|Results of treating primary tumors of the trachea with
Chao MW, Smith JG, Laidlaw C, Joon DL, Ball D. Int J Radiat Oncol Biol Phys.
1998 Jul 1;41(4):779-85.
Division of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria,
The medical records of patients treated at the Peter MacCallum Cancer
Institute in the period 1962 to 1995 were reviewed. Forty-two patients were eligible for
the study and were treated with radiotherapy. Squamous cell carcinoma (SCC) was the
commonest subtype and patients generally presented with long-standing respiratory
symptoms. Eleven patients were planned for treatment with at least 50 Gy to the primary,
while the rest were treated with lower doses. RESULTS:
The estimated median survival for
all patients was 5.7 months, with 13% surviving at 2 years. Univariate analysis revealed
performance status, weight loss, and lymph node or distant metastatic involvement as
significant prognostic factors. Patients planned for treatment with at least 50 Gy
survived longer than patients treated with less than 50 Gy, but this was probably due to
selection of patients with better prognostic factors for higher dose treatment.
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
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
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
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
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.
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
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
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
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.