Combined surgery and radiotherapy as curative treatment for tracheal adenoid cystic carcinoma: a case report

Abstract

Background Adenoid cystic carcinoma of the trachea is a rare tumor, characterized by slow growth and low rate of local and distant metastasis. When achievable, complete surgical resection represents the optimal treatment approach, with the highest results in terms of overall survival. Radiation therapy is a reasonable alternative in cases of inoperable disease. Case presentation We report a case of an 82-year-old white man affected by primary adenoid cystic carcinoma of the trachea, treated with debulking surgery and radiotherapy on the residual disease. A three-dimensional conformal radiation therapy was conducted. The total dose amounted to 70 Gy, administered in 35 fractions of 2 Gy. The medium doses given to the esophagus and lungs were 23 Gy and 4.2 Gy respectively. The maximum dose delivered to the spinal cord was 31 Gy with satisfactory results in terms of local control of the disease. Conclusion A combined approach of surgical resection followed by radiotherapy on the residual disease provided an excellent result in terms of disease control, quality of life, and overall survival in a patient with locally advanced tracheal adenoid cystic carcinoma.

Syncope due to tracheal adenoid cystic carcinoma

“…The preferred primary treatment is surgical resection with clear margins and tracheal reconstruction when possible . The surgical technique for resection and reconstruction depends on the location within the trachea and the extent of tumour with or without positive lymph nodes .…”

“…If the tracheal tumour is non‐resectable, radiotherapy is the modality of choice . The 5‐year survival rate of resectable tracheal ACC has been reported to be up to 52%, with a 10‐year survival rate of 29%.…”

“…Three histological growth patterns have been described: tubular, solid, and cribriform. There is no association with smoking, and the distribution between genders is equal .…”

“…Tracheal tumours comprise a small proportion of respiratory tract neoplasms, accounting for only about 2% of airway malignancies . Squamous cell carcinoma is the most common malignant tracheal tumour, followed by adenoid cystic carcinoma (ACC) and other rare tumours such as mucoepidermoid carcinoma, lymphoma, sarcoma, and melanoma . ACC arises from glandular secretory cells, which are common in salivary glands.…”

“…ACC is therefore most often found in the head and neck region but can also arise in the trachea, originating from submucosal seromucous glands . Symptoms are usually attributable to the intraluminal component of the tumour causing an obstruction of the airway, potentially leading to stridor, dyspnoea, wheezing, haemoptysis, and cough . ACC is a slow‐growing malignant tumour with a deceptively bland histological appearance belying its high propensity for local recurrence.…”