Undertreatment of Tracheal Carcinoma: Multidisciplinary Audit of Epidemiologic Data

Abstract

National epidemiologic data were examined to determine the eligibility for curative therapy in tracheal carcinoma. An expert audit of primary tracheal carcinomas registered from 2000 to 2005 with the Netherlands Cancer Registry (NCR) included blinded patient data and radiographic review to assess diagnosis and resectability. Actual treatment was compared with the opinions of a multidisciplinary panel (Radboud panel) and a second reviewer. Of 101 NCR-registered primary tracheal carcinomas, the Radboud panel diagnosis was metastatic disease or local extension of adjacent tumors in 34. Seventeen cases were excluded for missing data. In 50 cases confirmed by panel and a second reviewer, actual treatment consisted of surgery in 12 (24%), radiotherapy in 29 (58%), endobronchial treatment in 6 (12%), and observation in 3 (6%). Both panel and second reviewer identified 16 additional surgical candidates, a total of 28 (56%) of 50. Treatment recommendations of panel and second reviewer disagreed in four cases (8%). One-third of NCR-registered primary tracheal carcinomas were misclassified nontracheal primary tumors involving the trachea. A majority of cases meeting audit criteria for diagnosis and surgical resection was treated with other modalities. Interreviewer disagreement was small. The audit of a national cancer registry suggests that incorrect diagnosis and undertreatment are common in rare airway tumors.Primary malignancies of the trachea are rare and challenging tumors. Surgical resection of the involved tracheal segment is the treatment of choice, and long-term diseasefree survival has been reported after tracheal resection.

Tracheal cancer – treatment results, prognostic factors and incidence of other neoplasms

“…4, 8, 10, 13, 21, 30 ACC histology was a prognostic factor correlated with better OS in our research, which is in agreement with studies in which patients with SCC and ACC were compared. 2, 7, 13, 15, 26, 27, 29, 31 According to these reports, five-year OS for SCC ranged from 7% to 46%, and for ACC from 10 to 89.4%.…”

“…3, 8 Numerous authors point out that the diagnosis of TC is often delayed due to highly uncharacteristic symptoms, such as “frog in the throat” sensation reported by Howard et al . 8, 10, 13, 18, 23 In our series, one patient had been treated with surgery and RT for thyroid carcinoma until the second histopathological examination was performed and diagnosis of TC was made. Misdiagnosis of TC as thyroid tumour was also described by other authors.…”

“…2, 4–8, 12–17, 25–27, 29 Licht et al ., in a nationwide study of TC in Denmark, and Honings et al ., in a nationwide study of TC in the Netherlands, reported that the number of patients that undergo surgery is 10% and 11.6%, respectively. 12, 27 Honings and colleagues, in their multidisciplinary audit concerning undertreatment of TC, found 32% additional surgery candidates.…”

“…13 In spite of the above, second cancers are not very often described among patients with TC and only one large study (270 patients) reported second cancers in 19.6% of TC patients. 8, 13, 15, 21–23 …”

Overview of malignant tracheal tumors

“…To summarize, primary tracheal tumors may be even more uncommon than reported in the general population, are rarely considered for surgical resection and remain associated with a poor prognosis when not resected. To surgeons experienced in their treatment, these data suggest underutilization of resection as treatment (5) and a need for better epidemiologic studies.…”