Clinical Characteristics and Prognosis of Primary Tracheal Cancer: A Single Institution Experience
Background Primary tracheal cancers (PTCs) are rare and current evidence-based understanding is limited to retrospective reports and national databases. We present single institutional study of a historical cohort of PTC from Canadian provincial cancer registry database.
Materials and Methods: After institutional research ethics board approval, all PTC patients diagnosed from 1980 to 2014 were identified through the Canadian provincial cancer registry. Demographic and tumor related factors were evaluated using descriptive statistics. Survival rates were estimated using the Kaplan-Meier method and cox hazard regression analyses were performed to identify predictors of disease-free survival (DFS) and overall survival (OS).
Results: A total of 30 patients were included in the study. At presentation, 10 patients (33%) had only local disease, 14 patients (47%) had locoregional disease and the remaining 4 patients (13%) had distant metastasis. The majority of patients underwent primary radiation treatment. The overall survival rate was 30% at 2 years and 16% at 5 years. Patients receiving radical-intent therapy had better 2-year DFS and OS compared to patients managed with palliative radiotherapy and best supportive care (46%, 17% and 0%) (p=<0.001) and (50%, 23% and 0%) (p=<0.001), respectively. Radiotherapy resulted in a better 2-year OS and DFS (32% versus 14%) (p=<0.03) and (32% versus 0%) (p=<0.001), respectively.
Conclusion: PTC is an uncommon neoplasm making the study of the disease technically and logistically challenging. Radical radiotherapy alone is curative option in inoperable PTC. Intent of treatment and radiotherapy were associated with superior survival outcomes.
Morency G, Chalaoui J, Samson L, Sylvestre J. Malignant neoplasms of the trachea. Can Assoc Radiol J. 1989;40(4):198-200.
Webb BD, Walsh GL, Roberts DB, Sturgis EM. Primary tracheal malignant neoplasms: the University of Texas MD Anderson Cancer Center experience. J Am Coll Surg. 2006;202(2):237-46.
Shah H, Garbe L, Nussbaum E, Dumon JF, Chiodera PL, Cavaliere S. Benign tumors of the tracheobronchial tree. Endoscopic characteristics and role of laser resection. Chest. 1995;107(6):1744-51.
Wilson RW, Kirejczyk W. Pathological and radiological correlation of endobronchial neoplasms: Part I, Benign tumors. Ann Diagn Pathol. 1997;1(1):31-46.
Yang KY, Chen YM, Huang MH, Perng RP. Revisit of primary malignant neoplasms of the trachea: clinical characteristics and survival analysis. Jpn J Clin Oncol. 1997;27(5):305-9.
Li W, Ellerbroek NA, Libshitz HI. Primary malignant tumors of the trachea. A radiologic and clinical study. Cancer. 1990;66(5):894-9.
Nuwal P DR, Singhal AK. Primary adenoid cystic carcinoma of trachea presenting as midline neck swelling and mimicking thyroid tumor: a case report and review of literature. Lung India. 2010;27:167–169.
Bhattacharyya N. Contemporary staging and prognosis for primary tracheal malignancies: a population-based analysis. Otolaryngol Head Neck Surg. 2004;131(5):639-42.
Park CM, Goo JM, Lee HJ, Kim MA, Lee CH, Kang MJ. Tumors in the tracheobronchial tree: CT and FDG PET features. Radiographics. 2009;29(1):55-71.
Gaissert HA, Grillo HC, Shadmehr MB, Wright CD, Gokhale M, Wain JC, et al. Long-term survival after resection of primary adenoid cystic and squamous cell carcinoma of the trachea and carina. Ann Thorac Surg. 2004;78(6):1889-96; discussion 96-7.
Schneider P, Schirren J, Muley T, Vogt-Moykopf I. Primary tracheal tumors: experience with 14 resected patients. Eur J Cardiothorac Surg. 2001;20(1):12-8.
Fonkalsrud EW, Sumida S. Tracheal replacement with autologous esophagus for tracheal stricture. Arch Surg. 1971;102(2):139-42.
Grillo HC. Primary tracheal tumours. Thorax. 1993;48(7):681-2.
Gilbert RW, Neligan PC. Microsurgical laryngotracheal reconstruction. Clin Plast Surg. 2005;32(3):293-301, v.
Puri T, Gunabushanam G, Malik M, Kukreja M, Julka PK, Rath GK. Long-term clinical remission following radiotherapy in tracheal adenocarcinoma: review of the published work. Australas Radiol. 2007;51(5):485-8.
Harms W, Latz D, Becker H, Gagel B, Herth F, Wannenmacher M. Treatment of primary tracheal carcinoma. The role of external and endoluminal radiotherapy. Strahlenther Onkol. 2000;176(1):22-7.
Thotathil ZS, Agarwal JP, Shrivastava SK, Dinshaw KA. Primary malignant tumors of the trachea - the Tata Memorial Hospital experience. Med Princ Pract. 2004;13(2):69-73.
Honings J, van Dijck JA, Verhagen AF, van der Heijden HF, Marres HA. Incidence and treatment of tracheal cancer: a nationwide study in the Netherlands. Ann Surg Oncol. 2007;14(2):968-76.
Yamazaki K KY, Hirasawa M, et al. A study on low grade malignant tumours arisen in the trachea and the bronchus. Kyobu Geka. 1997;50:939–941.