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

Abstract

In a retrospective study the role of radiation therapy for the treatment of primary tracheal carcinoma was investigated. 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. 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). 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.