Tracheal Involvement Research Articles

Papillary thyroid tumor with tracheal involvement: a case report

Papillary thyroid tumor with tracheal involvement: a case report

Outcomes of Total Thyroidectomy in Large Goiters With Retrosternal Extension and Tracheal Compression: A Multivariate Analysis.

Large retrosternal goiters often cause tracheal compression and deviation, leading to respiratory symptoms and complicating surgical treatment. Total thyroidectomy is the treatment of choice though it carries a risk of complications due to the altered anatomy and its proximity to vital structures. This study examines the outcomes of total thyroidectomy in patients with retrosternal goiters and assesses the impact of tracheal compression on clinical results. This retrospective study included 32 patients treated with total thyroidectomy for retrosternal goiter between January 2018 and June 2024. Patient records were analyzed for clinical presentation, tracheal status, extent of retrosternal extension, intubation details, surgery performed, intraoperative findings, and postoperative complications. Tracheal compression and deviation were noted by preoperative imaging and flexible fiberoptic bronchoscopy. A correlation between difficult intubation and tracheal status was attempted. Complications such as hypocalcemia, recurrent laryngeal nerve palsy, and tracheomalacia were assessed alongside surgical variables. Among the 32 patients, tracheal deviation was noted in 62.5% (n=20), and tracheal compression occurred in 43.8% (n=14). Complications included hypocalcemia in 43.8% (n=14) of cases, recurrent laryngeal nerve palsy in 6.25% (n=2), and tracheomalacia in 15.6% (n=5). Advanced airway management techniques such as flexible fiberoptic-assisted intubation were often required, particularly in cases with significant tracheal compression. Malignant goiters showed a higher incidence of tracheal deviation and postoperative complications but overall complication rates were comparable to benign cases. Large retrosternal goiters carry the risk of airway compromise and surgical complications, particularly in the presence of tracheal compression. Hence, preoperative assessment of tracheal involvement and tailored surgical approaches are essential to manage airway complications and improve postoperative outcomes. A multidisciplinary approach is recommended for the management of these cases to enhance patient outcomes.

Acute myeloid leukemia: An unusual manifestation of the trachea.

Hematologic malignancy involving the trachea is rare. It is even less common for tracheal involvement to be the initial manifestation of this disease. We present a case report highlighting an unusual diagnosis of acute myeloid leukemia (AML) that first presented with prominent tracheal manifestations. There have been only three other published case reports of extramedullary AML with involvement of the trachea. We discuss direct laryngoscopy and bronchoscopy findings, including pinkish-white irregular lesions, which were similar to findings described in the available literature for tracheal AML. Laboratory findings from our case are reported, including peripheral smear demonstrating 57% blasts and bone marrow biopsy confirming the diagnosis of AML, and the relevance of these findings is discussed. In patients with unusual airway lesions, laboratory testing and a comprehensive airway evaluation including biopsy are necessary to narrow the differential diagnosis. 5.

Clinical Characteristics of Tracheobronchopathia Osteochondroplastica: A Retrospective Study of 33 Patients.

Tracheobronchopathia osteochondroplastica (TO) is a relatively rare benign tracheobronchial disease, which is often misdiagnosed or missed. To date, there is no specific treatment for TO. The aim of this study was to investigate the clinical manifestations, imaging features, bronchoscopy results, pathological findings, and diagnostic points of TO. A total of 33 patients diagnosed with TO were enrolled. Clinical data were collected using retrospective methods in the period from January 2021 and November 2022. Descriptive analysis was used. Patients included 17 (51.5%) male and 16 (48.5%) female, with a median age of 54 years. The main clinical manifestations included cough in 15 cases, fever in 6 cases, chest tightness in 4 cases, haemoptysis in 3 cases, and chest pain in 4 cases. The time from the onset of symptoms to diagnosis was 1 week to 96 months. Some patients were diagnosed with other lung diseases, including 16 patients with tuberculosis, 2 patients with lung cancer, 3 patients with nontuberculous mycobacteriosis, 3 patients with tuberculous pleurisy, 2 patients with bronchiectasis, and 1 patient with pneumonia. Chest computed tomography (CT) scan demonstrated calcified nodules in 10 (30.3%) patients. In bronchoscopy, entire tracheal involvement was found in 21 (63.6%) patients, 12 (36.4%) patients were found to have involvement of only part of the trachea. The patients were divided into three groups according to the bronchoscopic presentation, the largest proportion was stage II (19/33), followed by stage I (8/33) and stage III (6/33). Histopathological findings showed squamous metaplasia, cartilaginous, and bony tissues. TO is a slowly progressing disease with non-specific clinical symptoms and a low positive rate of imaging diagnosis, making it susceptible to misdiagnosis and missed diagnosis. The disease needs to be diagnosed by combining imaging features, fiberoptic bronchoscopy, and pathological findings.

A-146 TRACHEAL RECONSTRUCTION IN ADVANCED THYROID CANCER USING STENTED AORTIC MATRICES

Abstract Background Extensive airway involvement in thyroid cancer is associated with poor prognosis and constitutes one of the main causes of mortality. Airway replacement based on the implantation of stented aortic matrices emerges as a novel tool in the treatment of primary tracheobronchial malignancies and tracheal involvement in advanced thyroid cancer. Methods We conducted a retrospective cohort study including patients who had tracheal replacement with a stented aortic matrix for advanced thyroid cancer with (crico)-tracheal invasion at our centre. Cryopreserved aortic allografts were used for tracheal reconstruction. To prevent airway collapse, silicone stents were placed inside the grafts. The bioprostheses were covered with local muscle flaps. No immunosuppressive therapy was required. Results Over 5 years, 10 patients underwent tracheal replacement with stented aortic matrices. 2 patients underwent a concomitant thyroidectomy with neck dissection and 8 had thyroidectomy prior to airway replacement and presented with recurrence. A R0 resection was achieved in all patients. There were no cases of perioperative mortality. At a median follow-up of 19 months, 8 patients were alive and breathing and speaking normally. 2 patients died of causes unrelated to the graft. De novo generation of pseudocartilage was observed within the grafts. Conclusion Tracheal resection using stented aortic allografts is a simple and efficient technique of tracheal replacement that is becoming part of standard care at our institution. This approach allows for a R0 resection in advanced thyroid malignancies considered thus far as non-resectable.

Severe tracheal involvement in type XVII collagen junctional epidermolysis bullosa.

In COLXVII-junctional epidermolysis bullosa, mucosal involvement remains inconsistent and is limited to the oral cavity and the oesophagus. We documented the observation of a patient presenting with tracheal damage.

A RARE CASE OF HUMAN PAPILLOMAVIRUS-ASSOCIATED TRACHEAL SMALL CELL CARCINOMA

A RARE CASE OF HUMAN PAPILLOMAVIRUS-ASSOCIATED TRACHEAL SMALL CELL CARCINOMA

Surgical treatment of papillary thyroid carcinoma involving larynx and trachea

Objective: To evaluate the efficacy of surgical treatment of papillary thyroid carcinoma (PTC) involving larynx and trachea. Methods: A total of 1 436 cases of thyroid malignant tumors were admitted to the Department of Otolaryngology, Qilu Hospital of Shandong University from 2004 to 2019, including 110 cases of PTC involving larynx and trachea, and of which 105 cases with complete follow-up data were retrospectively analyzed. There were 42 males and 63 females, with a male/female ratio of 1∶1.5, aged from 28 to 81 years. All lesions involved trachea, including 11 cases involving both trachea and larynx. Of those 83 cases underwent laryngeal and airway wall tumor excision, and 22 cases underwent radical tumor excision plus laryngeal and trachea repair. Extubation rate was analyzed and the postoperative survival curve of patients was analyzed by Kaplan-Meier method. Results: Among 105 cases, 16 cases underwent tracheotomy and 12 cases were successfully extubated. The overall 3- 5- and 10-year survival rates were 100.0%, 86.4% and 72.5%, and the disease-free survival rates were 93.1%, 81.6% and 57.7%, respectively. There was significant difference in survival curve between the two groups (χ2=4.21, P=0.040). The 5-year and 10-year survival rates were 94.6% and 77.3% in laryngeal and tracheal tumor exclusion group, and 85.7% and 51.4% in the radical tumor resection group. There was no significant difference in the survival curves between the two groups (χ2=3.50, P=0.061). Conclusion: PTC patients with laryngeal and tracheal involvement can achieve long survival and good quality of life through reasonable surgical treatment.

Comparison of relapsing polychondritis patients with and without respiratory involvement based on chest computed tomography: a retrospective cohort study.

BackgroundRelapsing polychondritis (RP) patients with tracheal cartilage involvement are different from other patients. The objective of this study was to compare the clinical features and disease patterns between a respiratory involvement subgroup and a non-respiratory involvement subgroup according to chest computed tomography.MethodWe performed a retrospective cohort study collecting RP patients hospitalized at the Beijing Chao-Yang Hospital between January 2012 and August 2021.ResultsRespiratory involvement affected 59.7% of patients in our cohort. The incidence of costochondritis was more common in RP patients with respiratory involvement (p = 0.03); the incidence of inflammatory eye disease (p = 0.001) and auricular chondritis (p = 0.001) was less frequent in RP respiratory involvement patients.. Compared with the non-respiratory involvement subgroup the incidence of pulmonary infection marginally increased in the respiratory involvement subgroup (p = 0.06). Inflammatory indexes except for C-reactive protein to albumin ratio (CAR) were significantly higher in the respiratory involvement subgroup; analysis revealed no significant relationship between inflammatory indexes and pulmonary infection.ConclusionRP patients with respiratory involvement had a greater incidence of costochondritis and pulmonary infectionand lesser incidence of inflammatory eye diseases and auricular chondritis compared to non-respiratory involvement. Increasing inflammatory indexes suggests that patients with respiratory involvement had a higher disease activity index of RP. The difference in probability of survival was insignificant between subgroups.

A phase II study of pembrolizumab for HPV-associated papilloma patients with laryngeal, tracheal, and/or pulmonary involvement.

2590 Background: Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV) types 6 & 11. RRP proliferates in the squamous epithelium lining the respiratory tract impacting breathing, swallowing, and voice and carries a 3-5% risk of malignant transformation. Given the multi-focality of the disease and tolerized host immune response against HPV, in part through upregulation of the PD1:PDL1 axis, the safety and efficacy of systemic pembrolizumab (pembro) as a novel treatment for this benign tumor patient (pt) population was evaluated in a phase II clinical trial. Methods: RRP pts > 12 years of age were treated with pembro 200mg every 3 weeks. Primary endpoints were best overall response (ORR) (measured by endoscopic lesional burden) and safety. Greater than 5 pts with disease response out of 21 (assuming > 1 of first n = 11 with disease in response) provided 86% power to distinguish between a 15% and a 38% ORR (one-sided 8% binomial test). HPV-specific CD8+ T cell frequency and functional states and biomarkers of response and immune resistance are being evaluated in serial tissue and liquid biopsies (up to 8 biopsies/patient over the 24 months of treatment). Results: The Simon two-stage, stage 1 criteria was met. A total of 21 patients were enrolled and all are now off treatment. Median age (range) was 45 (19-68), 57% (12/21) were male and 67% (14/21) were white. 48% (10/21) had Juvenile-onset (Jo)-RRP, 57% (12/21) had pulmonary RRP involvement, and 19% (4/21) had SCC derived from their RRP. 62% (13/21) completed 24 months of treatment. Reasons for discontinuation included disease progression (14%, 3/21), treatment related adverse event (TRAEs) (14%, 3/21), and study withdrawal (10%, 2/21). A partial response (≥25% reduction in endoscopic tumor burden score) was observed in 57% (12/21) (95% CI: 34%-78.2%) of pts (7 of 10 with Jo-RRP and 5 of 11 with Adult-onset (Ao)-RRP disease responded). Stable disease was observed in 33% (7/21). No complete responses were observed. Fatigue was the most frequent TRAEs; Grade 3 TRAEs included uveitis and hypophysitis, both of which were reversible upon pembro discontinuation and steroid use. At a median follow-up: 25.6 (6.2-38.1 months), the mean number of surgical interventions was reduced by 7 surgeries/year (p = 0.004) in pts treated on the trial for > 12 months, and, upon treatment completion, durable clinical benefit was observed with no additional treatment needed for the duration of the clinical trial follow-up for some pts. Conclusions: Pembro reduces the need for routine surgical interventions based on the durable response rates being achieved. Further study of pembro +/- other agents is warranted to achieve and sustain complete responses in this population. Clinical trial information: NCT02632344.

Risk factors for the recurrence of relapsing polychondritis

BackgroundAlthough the survival rates of patients with relapsing polychondritis (RP) have increased remarkably, the high recurrence rate remains a significant concern for physicians and patients. This retrospective study aimed to investigate the risk factors for RP recurrence.MethodsPatients with RP who presented to Kyoto University Hospital from January 2000 to March 2020 and fulfilled Damiani’s classification criteria were included. Patients were classified into recurrence and non-recurrence groups. Risk factors for RP recurrence were analysed using a Cox proportional hazards model, and Kaplan–Meier survival curves were drawn.ResultsThirty-four patients were included. Twenty-five patients (74%) experienced 64 recurrences (mean: 2.56 recurrences per patient). The median duration before the first recurrence was 202 [55−382] days. The median prednisolone dose at the initial recurrence was 10 [5−12.75] mg/day. Tracheal involvement was significantly more frequent in the recurrence group at the initial presentation (44.0% vs. 0.0%, p=0.0172) than in the non-recurrence group, and pre-treatment C-reactive protein levels were significantly higher in the recurrence group than in the non-recurrence group (4.7 vs 1.15 mg/dL, p=0.0024). The Cox proportional hazards model analysis revealed that tracheal involvement (hazard ratio [HR] 4.266 [1.535−13.838], p=0.0048), pre-treatment C-reactive protein level (HR 1.166 [1.040−1.308], p=0.0085), and initial prednisolone monotherapy (HR 4.443 [1.515−16.267], p=0.0056) may be associated with recurrence. The median time before the initial recurrence was significantly longer in patients who received combination therapy with prednisolone and immunosuppressants or biologics (400 vs. 70 days, p=0.0015).ConclusionsTracheal involvement, pre-treatment C-reactive protein level, and initial prednisolone monotherapy were risk factors for recurrence in patients with RP. Initial combination therapy with prednisolone and immunosuppressants may delay recurrence.

Neoadjuvant tyrosine kinase inhibitor therapy in locally advanced differentiated thyroid cancer: a series

IntroductionLocally advanced differentiated thyroid cancer (LADTC) management depends on a complex interplay of patient and tumour factors. When primary resection cannot be achieved, neoadjuvant tyrosine kinase inhibitor (TKI) therapy can be considered, but little evidence is available on its success and outcomes. Our aim was to describe a small series of LADTC managed with neoadjuvant TKI therapy.MethodsSuitable patients were prospectively identified in NHS Lothian February 2016 – March 2020.ResultsFour patients were eligible for inclusion, 3 females; 1 male, aged 39–79 years. All were T4a at presentation; three papillary and one Hurthle cell carcinoma. One had pulmonary metastases. Two refused laryngectomy, one was deemed unresectable with extensive tracheal involvement, and one commenced TKI due to COVID-19 related surgical delay. TKI treatment length varied from 1–18 months. There was a marked reduction in tumour volume and local extent in three cases, such that surgical resection without laryngectomy could be achieved. The fourth patient was intolerant of TKI. All ceased TKIs 2 weeks prior to total thyroidectomy, with neck dissection in three, and tracheal resection and re-anastomosis in two. All then had 3700MBq RAI and all patients are currently alive with 14–58 months follow-up. Two patients have no evidence of residual or recurrent disease. The M1 patient has stable low-volume local and distant disease, and one patient has stable low volume indeterminate pulmonary nodules.ConclusionNeoadjuvant TKI therapy in LADTC can be effective in reducing primary tumour extent to potentially facilitate limited surgical resection in a highly selected patient group.

Symptomatic Improvement in Cicatricial Pemphigoid of the Trachea Achieved with Laser Ablation Bronchoscopy

Cicatricial pemphigoid (CP) with tracheal involvement is a rare and potentially deadly condition. Here, we report the first case in which Nd:YAG laser (1064nm) laser ablation bronchoscopy was used to treat CP with tracheal involvement. Our patient is a 71-year-old male with a history of CP refractory to medical therapy affecting his trachea who presented to the emergency department with dyspnea. He ultimately underwent bronchoscopy with Nd: YAG laser (1064nm) laser ablation, which resulted in a temporary alleviation of his respiratory symptoms. A repeat laser ablation was planned in hopes of prolonging the patient’s remission, but due to interval changes in the patient’s airway anatomy, it was deemed unsafe. While our patient’s uniquely advanced disease was not amenable to further laser-mediated intervention, it is possible that patients with less advanced disease may experience better outcomes with similar therapy. This case shows the promise laser ablation could hold for patients with tracheal cicatricial pemphigoid.

Airway Amyloidosis: A Retrospective Analysis of 43 Patients.

Amyloidosis can involve any compartment in the thorax. We aimed to explore the clinical and radiologic presentation, treatment, and clinical course of airway amyloidosis. A computer-assisted search was performed to identify patients who had biopsy-proven airway amyloidosis and were evaluated at Mayo Clinic in Rochester, MN, from January 1, 1997 through December 31, 2019. Demographic, clinical, and radiologic features along with clinical outcomes were analyzed. We identified 43 patients who had airway amyloidosis. Median age was 60 years (range: 33 to 91 y), and 58% were female. Shortness of breath (63% of patients) and cough (44%) were the most common presenting symptoms. Most patients (82%) had localized amyloidosis with light chain being the most common amyloid type; 63% had tracheobronchial amyloidosis, and 23% had tracheal and upper airway involvement. On computed tomography of the chest, the most common findings were airway wall thickening with nodularity (60% of patients), airway calcification (53%), and airway occlusion without collapse (47%). On bronchoscopy (33 patients), the extent of amyloid involvement was most commonly submucosal (n=15) or nodular (n=8). External beam radiotherapy was the most common treatment modality. Among the 30 patients who had follow-up at our institution, the prognosis appeared to depend on the extent of the disease and whether patients had localized or systemic amyloidosis. Computed tomography of the chest, bronchoscopy, and biopsy are needed to establish the diagnosis of airway amyloidosis, and systemic amyloidosis should be ruled out. Treatment of amyloidosis requires a multidisciplinary approach.

Symptomatic Improvement in Cicatricial Pemphigoid of the Trachea Achieved with Laser Ablation Bronchoscopy

Cicatricial Pemphigoid (CP) are a diverse group of subepithelial blistering disorders of the skin and mucous membranes. Here, we report the first case in which Nd:YAG laser (1064nm) laser ablation bronchoscopy was used to treat CP with tracheal involvement. Our patient is a 71-year-old male with a history of CP refractory to medical therapy affecting his trachea who presented with dyspnea. He initially underwent a fiberoptic bronchoscopy with piecemeal resection of his tracheal lesions, which mildly improved his symptoms. Next, he underwent bronchoscopy with Nd:YAG laser (1064nm) laser ablation. He was then entirely weaned off supplemental oxygen. For the following three months, he experienced a decreased symptomatic burden. A repeat laser ablation was planned, but due to interval changes in the patient’s airway anatomy, it was deemed unsafe. Consequently, the patient’s tracheal pemphigoid fully recurred. This case demonstrates the promise laser ablation holds for patients with tracheal cicatricial pemphigoid.

Distribution Characteristics of Juvenile-Onset Recurrent Respiratory Papillomatosis at First-Time Surgery.

The lesion distribution of juvenile-onset recurrent respiratory papillomatosis (JORRP) during first-time surgery has been rarely reported. The purpose of this study was to describe the anatomical distribution of papilloma across 25 Derkay sites during initial surgery and to assess the impact of the lesion distribution on disease severity. Surgical videos and medical records of 106 patients with JORRP (27 aggressive and 79 nonaggressive cases) were retrospectively reviewed. Lesion locations were recorded using Derkay anatomical sites. Logistic regression was used to analyze the effect of the lesion distribution on disease severity. Among the 106 patients, the true vocal cords (90.6% left, 84.0% right) were the most frequently involved site, followed by the false vocal cords (39.6% left, 35.8% right) and the anterior commissure (26.4%). Two patients (1.9%) had tracheal involvement. Patients with false vocal cord involvement (odds ratio [OR] = 3.425, 95% confidence interval [CI] [1.285, 9.132], P = .014) and a younger age at diagnosis (OR = .698, 95% CI [.539, .905], P = .007) were more likely to require more than 4 procedures in the year following first-time surgery. Lesions were most common on the true vocal cords. False vocal cord involvement and a younger age at diagnosis were risk factors for disease severity.

Endobronchial Tuberculosis: Diagnosis and Treatment Approach

Endobronchial tuberculosis (EBTB) is defined as tuberculosis (TB)infection of the tracheobronchial tract. Tracheal and bronchial involvement from TB infection was first reported by Morten in 1698. Endobronchial tuberculosis is a form of TB that is difficult to diagnose because the lesions are frequently undetectable by sputum examination and chest X-ray alone. Endobronchial tuberculosis is present in 10-40% of active TB patients and more than 90% of cases are accompanied by bronchial stenosis of various degrees. The main goal of therapy in active EBTB is to eradicate Mycobacterium tuberculosis in the tracheobronchial tract and further prevent stenosis. Complications of EBTB apart from airway stenosis are atelectasis, haemoptysis and shortness of breath accompanied by wheezing even after administration of anti-tuberculosis drugs (ATD).

STRIDOR IN A PATIENT WITH PULMONARY TB: CHASING A TRACHEAL RODENT

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: TB is an airborne infectious disease caused by Mycobacterium tuberculosis with the respiratory system being the most commonly involved. The involvement of airways is much less common than the lung parenchyma CASE PRESENTATION: A 38-year-old female patient with a past medical history of asthma and recently diagnosed with active pulmonary tuberculosis 6 months prior, on treatment with pyrazinamide, isoniazid, and rifampicin presented with c/o noisy breathing for 3 months. Was initially treated with bronchodilator and steroids with marginal improvement. Radiological evaluation revealed multiple cavitary lung nodules with tracheal stenosis as well right bronchus intermedius stenosis. Bronchoscopy revealed a stenotic segment measuring 2.5 cm, in the proximal trachea with residual airway which was not amenable to be passed through by bronchoscope. The stenotic lesion was biopsied and sequentially dilated to permit further advancement of the scope. There were no other stenotic segments. Several areas most notably at the distal main trachea and right main stem had what appeared to be caseating material coming through the wall of the airway with significant inflammation. Microbiological examination of bronchial washings and tissue samples did not reveal acid-fast bacilli. And this was not unexpected as the patient has already been on antituberculous treatment. Differentials of the tracheal stenosis including wegners, and other connective tissue disorders were ruled out after extensive serological testing DISCUSSION: During the pre-antibiotic era tracheobronchial tuberculosis was reported in 10-20% of all patients with pulmonary tuberculosis. The development of effective antitubercular drugs paralleled the decline in the incidence of tuberculosis in general and that of the trachea and bronchus. The pathophysiological mechanism of tracheal involvement includes implantation of organisms from infected sputum, extension to the peribronchial region by lymphatic drainage from parenchymal infection, direct extension from adjacent parenchymal infection, lymph node erosion, or hematogeneous spread. The disease progress in stages from simple erythema and edema with lymphocytic infiltration of the submucosa followed by tubercle formation. The end result is trachea bronchial narrowing secondary to fibrosis ensuing from extensive mucosal and submucosal tissue destruction. The common CT findings in the acute stage are smooth or irregular wall thickening causing. The role of steroids in the treatment is controversial with variable reports of efficacy during the early granulomatous phase. The mainstay of treatment remains to be antituberculous chemotherapy. Airway patency can be achieved by serial staged bronchoscopic-guided dilatation or stent insertion. CONCLUSIONS: A high index of suspicion will aid in early diagnosis and possible prevention of debilitating airway narrowing in tracheobronchial Tuberculosis. REFERENCE #1: Lee JH, Park SS, Lee DH, et al. EndobronchialTuberculosis: Clinical and Bronchoscopic Features in 121Cases. Chest 1992;102:990-4. REFERENCE #2: Jung SS, Park HS, Kim JO, et al. Incidence and clinicalpredictors of endobronchial tuberculosis in patients withpulmonary tuberculosis. Respirology 2015;20:488-95. REFERENCE #3: Kashyap S, Solanki A. Challenges in EndobronchialTuberculosis: From Diagnosis to Management. Pulm Med2014;2014:594806. DISCLOSURES: No relevant relationships by Muhammad Ahsan, source=Web Response No relevant relationships by Nadish Garg, source=Web Response No relevant relationships by Killol Patel, source=Web Response No relevant relationships by ARCHANA SREEKANTAN NAIR, source=Web Response

Outcomes of Tracheal Resections in Well-Differentiated Thyroid Cancer-A case series and meta-analysis.

Tracheal invasion in thyroid cancer is a well-known form of advanced disease. There is an ongoing controversy over outcomes of tracheal shaving in this situation. The aim of this study was to compare the results of tracheal shaving to radical resections in patients with low-volume tracheal involvement. An institutional case series and a meta-analysis was conducted. All studies that included patients diagnosed with well-differentiated thyroid cancer (WDTC) and tracheal invasion were analyzed. Patients with low-volume tracheal invasion (according to the Shin classification) were extracted from the various studies and subsequently included in this study. The outcomes of tracheal shaving and radical resection were consolidated and compared. All recurrences and mortality over 10years of follow-up were calculated using the Kaplan-Meier method. Institutional case series included 22 patients diagnosed with WDTC and tracheal invasion that underwent resection. There was one case of recurrence (4.5%) during the follow-up period and no mortality. The meta-analysis yielded a total of 284 patients from six studies who met the inclusion criteria. The 10-year overall survival was 82.4% for the shave group and 80.8% for the resection group. The combined Kaplan-Meier curves revealed no statistically significant difference between the two techniques (hazard ratio [HR] = 0.86, P = .768). The combined 10-year local control rate of the shave group was 90.2%. The outcomes of tracheal shaving in low-volume invasion are similar to more aggressive forms of tracheal resections. Shave resection is oncologically safe in carefully selected WDTC patients demonstrating minimal tracheal invasion.

Patient-reported outcomes (PROs) from a phase II trial of pembrolizumab for HPV-associated papilloma patients with laryngeal, tracheal and/or pulmonary involvement.

6080 Background: Recurrent respiratory papillomatosis (RRP) is caused by human papillomavirus (HPV) types 6 & 11. RRP proliferates in the respiratory tract impacting breathing, swallowing, and voice and carries a 1-4% risk of malignant transformation.There is no curative therapy for RRP. Given the tolerized host immune response against HPV, the safety and efficacy of pembrolizumab (pembro) as an alternative treatment for this patient population was evaluated in a phase II clinical trial. Patient reported outcomes (PROs) were assessed during the trial to capture the patient perspective of pembro as an alternative to surgery or in office procedures, both standard of care (SOC). Methods: RRP patients who had previously undergone >3 procedures in any year, or with known tracheal or pulmonary involvement prior to study entry were treated with pembro 200mg every 3 weeks. The primary endpoint of the trial was best ‘overall response rate’ (ORR) measured by an endoscopic-based disease burden score (lower score reflects better ‘response’) and/or RECIST 1.1, secondary endpoint included PROs. Twenty-one patients were required to assess the primary endpoint. Most of the QoL surveys used Likert scale to assess PROs (‘never, sometimes, often, most of the time, always’). The percentage reporting ’never’ having an issue with symptom or activity at baseline, 6 months, and at time of ORR (nadir disease burden score) is reported here. Results: Twenty-one patients were accrued. Median age (range) was 45 (19-68), 57% (12/21) were male and 67% (14/21) were white. Questionnaire completion rates were 100% at baseline, 90% at 6 months, and 85% at ORR. Improvement in: social interactions (less difficulty with: physical intimacy [38%,56%,65% reporting ‘never’ at baseline, 6 months, and at ORR respectively]), discussing disease diagnosis [19%,21%,39%]); personal feelings (less depression [14%,32%,33%], less anxiety [5%,16%,22%], less embarrassment [19%,37%,50%]), and work-related absences (less frequently fabricating reasons for work absence due to disease-related treatment [57%,78%,56%] and less utilization of family vacation or FMLA for disease treatment [29%,53%,56%]) were reported. At ORR, 72% (13/18) patients reported that IV infusion was not emotionally burdensome and 78% (14/18) reported it as the preferred treatment relative to their perceived experience with SOC surgery or in office procedures. Conclusions: PRO results show consistent benefit in key aspects of the patient experience with pembro over procedure based SOC further supporting its overall clinical benefit in patients with HPV-associated RRP. Clinical trial information: NCT02632344.