P2.04-049 Treatment for Three Cases Tracheal Carcinoma of Low-Grade Malignancy: Topic: Esophageal Cancer and Other Malignancies

Abstract

Tracheal carcinoma of low grade malignancy is rare and experience of respiratory doctors on this tumor is limited. Therefore, the diagnostic and therapeutic experiences of doctors need to be discussed at major conferences. We encountered 3 cases of tracheal carcinoma, two were adenoid cystic carcinoma and one was mucoepidermoid carcinoma. All patients visited the hospital because severe of dyspnea. Case 1. A 40-year-old woman had tracheal adenoid cystic carcinoma at the level of the sternal notch. After intubation using 5-mm tracheal tube, resection of five tracheal rings and reconstruction were completed through a cervical approach. She survived for 12 years postoperatively without recurrence. Case 2. A 44-year-old man with adenoid cystic carcinoma at the mid-trachea underwent resection of eight tracheal rings and reconstruction through mid-sternotomy. He survived for 14 years postoperatively without recurrence. Case 3. A 79-year-old woman with cardiac pacemaker had a tumor on the right lower tracheal wall extending to the right main bronchus, causing airway compromise due to stenosis. Upon admission, she had middle lobe pneumonia and heart failure. After stabilizing these conditions, intraluminal tumor debulking using snare and Nd-YAG laser was performed. Complete surgical resection was not attempted because her performance status was poor and reconstruction would have been difficult and the risk for severe complications was not low. Instead, three-dimensional 60-Gy radiotherapy was chosen for treatment. Five years after the first therapy, regrowth of the tumor caused recurrent dyspnea. On inspection, the intraluminal tumor obstructed the lower trachea through the right main bronchus, but there was no tumor extension beyond the tracheal wall. This was treated successfully by additional laser therapy. Tracheal carcinoma of low grade malignancy limited extension, complete surgical resection and reconstruction were effective. For narrowed airway due to intraluminal tumor, laser therapy was effective in dilating the stenosis. Complete tumor resection might be the best treatment option for tracheal tumors, but it is important to note that some cases may be difficult and risky to perform due to the limited length of the large airway wall and poor performance status. Risks for anastomotic complication after extensive resection have been reported. However, the efficacy of radiotherapy for low-grade tracheal carcinoma needs further evidence. Accumulation of knowledge on diagnosis and treatment is required for each respiratory doctor.