|Primary Cancers of the Trachea see review article (go here)
Primary tracheal carcinoma is a rare malignancy of the respiratory tract, accounting for 0.1% to 0.4% of all cancers. Its prognosis is poor: less than 15% of patients survive more than 3 years, 40 to 90% experience local recurrence and 20 to 50% develop distant metastases. For extensive tracheal tumors, life expectancy ranges from 6 to 9 months; for tumors detected early, the overall survival following curative resection ranges from 0 to 60%. Early diagnosis is uncommon, due to the lack of early symptoms and the difficulty in visualization of the tumor by routine chest x-ray. So, tracheal carcinoma has usually been diagnosed with regional spread beyond the trachea. Before 1960, most patients were treated with endoscopic removal or limited resection, followed by external orthovoltage irradiation. Less than 15% of the patients survived more than 1 year . Advances in surgical procedures during the past three decades, such as the ability to fully mobilize the right hilum and pulmonary ligament, detach and reimplant the left main bronchus, perform intrapericardial dissection, and mobilize the cervical trachea have made it possible to resect tracheal carcinomas that might have previously been considered unresectable; surgery has become the most curative, however rarely feasible treatment for tracheal tumors.
The 5-year survival ranges between 20 and 40% after curative resection for epidermoid carcinomas. However, operative morbidity and mortality may be significant, and only 10% of patients have tumors suitable for a curative resection. The survival after surgery has been reported to be better than after irradiation. However, although radiotherapy as primary treatment has yielded varying results and complications, most reported series contained only small numbers of patients, often treated with orthovoltage to low total doses of radiation. Radiotherapeutic techniques have also evolved over recent decades, and reports suggest good local control and potential cure for patients with tumors confined to the trachea. Few institutions have a significant experience in the management of primary tracheal carcinoma. The efficacy of definitive irradiation of tracheal carcinoma has rarely been addressed in the literature due to the rarity of this disease. For some studies on surgical treatment (go here) and for radiation studies (go here.) Some literature summaries of radiation are noted below: