Rapid response to radiotherapy in unresectable tracheal adenoid cystic carcinoma: A case report

Abstract

BACKGROUND Adenoid cystic carcinoma (ACC) occurs mainly in the head and neck. Tracheal ACC (TACC) is uncommon. Primary resection is recommended as the main treatment of choice, and radiotherapy is considered for residual disease in the postoperative setting. Definitive radiotherapy is an alternative approach to cure unresectable TACC. As the status of radiosensitivity in TACC is uncertain, the evidence for radiotherapy in unresectable TACC is not well established, especially in terms of the optimal dosage and its response evaluation. Herein, we report a case of locally advanced TACC. CASE SUMMARY A 49-year-old woman was diagnosed with TACC, which included a range of lesions arising in the upper trachea extending caudally 2 cm to 7 cm of the glottis. She was treated with definitive radiotherapy, given the low likelihood of complete resection of the disease. Due to the indolent growth and the propensity for infiltration along the airways, the scheduled radiation dose of 76 Gy in 38 fractions with 6-MV X-ray delivered by intensity-modulated radiotherapy was conducted to the primary tumor volume. After irradiation of 40 Gy, the patient’s dyspnea on exertion was dramatically relieved and bronchoscopy revealed that the previous large polypoid intra-luminal mass was significantly eliminated, with near-complete response. The patient completed two phases of scheduled radiotherapy, and acute reactions to treatment included subjective chest tightness and grade 2 esophagitis, managed medically. After 5 years of treatment, the patient is alive without recurrent disease, and there were no serious late radiation esophagus and lung damage, with only slight dysphagia without perforation and fistula. CONCLUSION Taken together, TACC is uncommon and the treatment of unresectable TACC is challenging. This case indicated that patients with unresectable TACC who rapidly respond to radiation may benefit from primary radical radiotherapy. Radiotherapy may be considered an effective alternative treatment modality.

Role of radiation alone versus concurrent chemoradiotherapy in surgically ineligible patients with tracheobronchial squamous cell carcinoma

“…Similarly, in our study, disease extent was identi ed to be the primary reason for inoperability, with only 26.4% of the patients being eligible for surgery. Therefore, while RT has been considered a crucial curative treatment option for patients with unresectable tumors, its outcomes remain controversial and are often limited to small case series [11][12][13]. Our current study revealed a tendency towards improved PFS and OS when concurrent chemotherapy was administered alongside RT, indicating that CCRT may be an effective treatment option for patients who are not eligible for surgery.…”

Preliminary results in tracheal replacement using stented aortic matrices for primary extensive tracheal cancer

“…Previous studies showed that surgery was correlated to a significantly better survival than nonsurgical treatment, 3 , 9 , 10 demonstrated by an overall 5-year and 10-year survival rates, in case of resected tracheobronchial ACC, of 52% to 88.7% for R0 resections and 29% to 43.2% for R1 resections. In unresectable patients, the overall 5-year and 10-year survival rates were 33% and 10%, respectively.…”

“…Adjuvant radiotherapy is currently used when positive margins (R1 or R2, grossly positive margins) are found at histologic examination. 10 , 12 , 13 , 14 Patients with grossly positive airway margins had significantly worse survival than patients with grossly negative resection margins. 11 , 12 In 1996, Regnard and colleagues 15 published a multi-institutional French study in which complete or incomplete resection for ACC was associated with a 5-year survival of 82% (36 patients) and 63% (26 patients), respectively.…”

“…The most common contraindication to tracheal cancer surgery is the extent of airway involvement, and even in the event of possible resection, the surgical margins are frequently affected by residual tumor. 3 , 9 , 10 Our technique addresses these patients considered “unresectable,” offering a tracheal substitute, without the need for immunosuppressive therapy. In our series, the length of airway resection ranges from 50 to 120 mm, with resection of carina in 6 cases and of the lung in 2 cases requiring 1 lobectomy and 1 bilobectomy.…”

Clinical use of 18F-FDG PET/CT in the differential diagnosis of patients with primary and secondary adenoid cystic carcinoma of the lung: a retrospective cohort study

“…Regarding advanced inoperable ACCL, palliative chemotherapy and radiotherapy should be considered as an alternative therapy (23,33,34). Wu et al reported a case with unresectable tracheal ACC who responded rapidly to radiotherapy (35). Moreover, only a few case reports have indicated that ACCL patients may be candidates for target therapy (36).…”