Primary tracheal tumors: treatment and results

One hundred ninety-eight patients with primary tracheal tumors were evaluated in 26 years. One hundred forty-seven tumors were excised (74%): 132 (66%) by resection and primary reconstruction, seven by laryngotracheal resection or cervicomediastinal exenteration, and eight by staged procedures. Eleven more were explored. Forty-four squamous cell carcinomas were resected, 60 adenoid cystic, and 43 assorted tumors, benign and malignant. Eighty-two patients underwent tracheal resection with primary reconstruction, and 50 had carinal resection and reconstruction. Surgical mortality for resection with primary reconstruction was 5%, with one death after tracheal and six after carinal repair. Six patients had stenosis after tracheal or carinal resection; all underwent reresection successfully. Nearly all patients with squamous or adenoid cystic carcinoma were irradiated postoperatively. Twenty of 41 survivors of resection of squamous cell carcinoma are living free of disease (some for more than 25 years), 39 of 52 with adenoid cystic carcinoma (up to nearly 19 years), and 35 of 42 with other lesions (5 lost to follow-up). Comparison of length of survival of patients with squamous cell carcinoma and adenoid cystic carcinoma who are alive without disease with those who died with carcinoma supports surgical treatment (usually followed by irradiation). Positive lymph nodes or invasive disease at resection margins appear to have an adverse effect on cure of squamous cell carcinoma; such an effect is not demonstrable with adenoid cystic carcinoma.     

Tracheal cancer in Denmark: a nationwide study.

OBJECTIVE: Most published series on tracheal cancer reflect single institution experiences. We used the nationwide Danish Cancer Registry to report on characteristics and treatment of tracheal cancers in Denmark. METHODS: One hundred and nine cases of primary tracheal cancers were extracted from the registry in the period 1978-1995. The clinical data, histological distribution and treatment modalities were analyzed. The cancers were staged in four groups (stage I-IV) according to size, location and spread. RESULTS: Seventeen cases were diagnosed at autopsy. Ninety-two cases were diagnosed in vivo and 84% of these within 3 months after the first consultation. Sixty-three percent of the cancers were squamous cell carcinomas and only 7% were adenoid cystic carcinomas. The disease was at stage I in 21%, stage II in 23%, stage III in 6% and stage IV in 50%. The majority of the patients received radiotherapy as single treatment. Only nine patients were offered surgery (six were resected and three were found inoperable). The overall survival rates for cases diagnosed in vivo were 1-year 32%, 2-year 20% and 5-year 13%. For the resected patients the 5- and 15-year survival rates were 50%. CONCLUSIONS: Tracheal cancers were rare and adenoid cystic carcinomas not as frequent as generally believed. Surgery was rarely offered. A resectability rate of only 10% is not adequately explained by selection bias and indicates a nihilistic attitude based on ignorance about surgical treatment of tracheal cancers. A more dedicated and aggressive approach with centralized workup and radical treatment is strongly recommended.     

Primary tracheal tumours: a national survey.

BACKGROUND--Primary tracheal tumours are rare, so few physicians have extensive experience of their management. No direct comparisons have been made of surgical and radiotherapy treatment. METHODS--A postal survey of cases presenting in the last 10 years in the United Kingdom was conducted. Results were expressed as cumulative survival and survival curves were compared by the log rank test. RESULTS--Three hundred and twenty one patients were recruited. Overall five year survival rates were 25% for squamous cell carcinomas, and 80% for adenoid cystic carcinoma; 62% received radiotherapy but only 10% underwent surgery. Small cell carcinoma was more common than expected with an incidence of 6%. In patients with squamous carcinoma improved survival was seen in those with tumour in the upper trachea. High dose radiotherapy was more effective than low dose only in tumours of the upper trachea and in squamous carcinoma. In adenoid cystic carcinoma no significant difference in survival rate was seen between treatment with radiotherapy and surgery. No histological diagnosis was made in 44 patients, the most common reason being fear over the safety of fibreoptic bronchoscopy; however, this group had a cumulative survival at five years of 46%. CONCLUSIONS--Survival may be somewhat better in cases with tracheal tumours than in those with bronchial tumours. Small cell carcinoma is less rare than was previously thought. Upper tracheal tumours may merit more aggressive therapy. It is important to make a histological diagnosis even if rigid bronchoscopy is necessary, and referral to specialist centres is recommended. A larger prospective study is required to compare the value of surgery and radiotherapy.     

Tracheal tumors: surgical management.

In a 15-year period, 63 patients with primary tracheal tumors were seen. Twenty-eight patients with primary tumors and 8 with secondary tumors of the trachea were treated by resection with single-stage reconstruction. There were 24 cylindrical resections of trachea, 2 lateral resections of trachea, and 10 carinal reconstructions. Thirty-five additional patients with primary tracheal tumors were managed by staged reconstruction, irradiation, or no treatment. The most common primary lesion was squamous cell carcinoma and the second, adenoid cystic carcinoma. Benign primary tumors and low-grade malignant tumors obtained excellent palliation and usually cure. Surgical removal of squamous cell carcinoma and adenoid cystic carcinoma, usually with adjunctive irradiation, provided good palliation or the probability of cure. Resection of selected secondary tumors provided long-term palliation.     

Primary tracheal tumors: experience with 14 resected patients.

OBJECTIVE: Primary tracheal tumors are rare. Management includes interventional endoscopy, surgery and radiotherapy. METHODS: Between 1987 and 1996, 14 patients treated by resection and reconstruction of the trachea and bifurcation for primary tracheal tumors were retrospectively analyzed. RESULTS: The most common histological finding was adenoid cystic carcinoma (n=7), followed by a squamous cell carcinoma (n=2), a mucoepidermoid carcinoma (n=2), a carcinoid tumor (n=1) and two benign tumors (xanthogranuloma, pleomorphic adenoma). Various reconstruction techniques were used and one prosthesis was implanted. Eight of the patients required preoperative Nd-YAG laser recanalisation. Six were treated by postoperative external beam radiotherapy, in three cases combined with endoluminal brachytherapy. Two major postoperative wound-healing impairment at the anastomosis occurred. Four minor wound-healing disorders were successfully treated by interventional endoscopy. Two patients died postoperatively with mediastinitis respectively with bilateral pneumonia. A local recurrence was observed in only two cases. At the last follow-up in January 1998, nine patients were still alive. We observed five long-term survivors (>6 years) with an adenoid cystic carcinoma or mucoepidermoid carcinoma. CONCLUSIONS: Extensive segmental resection of the trachea is the treatment of choice for primary malignant and occasionally for benign tracheal tumors. Interventional endoscopy is a part of modern tracheal surgery.     

Treatment outcome of resected and nonresected primary adenoid cystic carcinoma of the lung.

BACKGROUND AND OBJECTIVE: The incidence of primary adenoid cystic carcinoma of the lung is relatively rare and the optimal treatment strategy is still unclear. METHODS: Sixteen adenoid cystic carcinoma patients were treated at our institute from 1972 to 1998 and their clinical features, treatments and survivals were reviewed. RESULTS: Half of all patients were female and the median age was 46 ranging from 30 to 64. All primary lesions were located in the central bronchial tree and 80% of the patients had some symptoms. Eleven patients underwent a resection of the tumor with/without plasty of the trachea or bronchus. Although 6 (55%) of 11 patients had a microscopic residual tumor after resection, 5 patients who received postoperative radiotherapy survived without recurrence from 3 to 17 years. Five patients received radiotherapy as their initial treatment and all tumors responded well to the treatment. The 5-year and 10-year survival rates were 91 and 76% without local recurrence in the resected group and 40 and 0% in the nonresected group, respectively. CONCLUSION: These observations suggest that surgical resection should be selected first whenever possible, and, in addition, adenoid cystic carcinoma is sensitive to radiotherapy.     

Contemporary staging and prognosis for primary tracheal malignancies: a population-based analysis.

OBJECTIVE: Determine staging characteristics and survival outcomes for primary malignancies of the trachea. Design Cross-sectional analysis of national cancer database. METHODS: Cases of primary tracheal malignancy were extracted from the Surveillance, Epidemiology, and End Results database for the time period 1988-2000. T-stage, N-stage, and overall stage of presentation were determined. Mean, median, and 5-year survival statistics were computed using Kaplan-Meier survival analysis for each tumor histology and for the overall cohort according to stage. RESULTS: Ninety-two cases with adequate histologic information were identified. Mean age at presentation was 59.3 years with an equal sex distribution. Squamous cell carcinoma was the most common tumor type (41 cases) followed by adenoid cystic carcinoma (19 cases). Forty-nine cases (53%) presented with stage 3 or stage 4 disease. Squamous cell carcinoma exhibited poorer survival (mean survival, 44.0 month, 5-year survival, 34%) than adenoid cystic carcinoma (mean survival, 115 month, 5-year survival, 78%). Five-year unadjusted survival rates according to overall stage were 52.8%, 70.0%, 75.0%, 15.1%, respectively. CONCLUSIONS: Primary tracheal malignancies often present with advanced stage. Patients with squamous cell carcinoma of the trachea have poorer prognoses when compared with adenoid cystic carcinoma and other tumor types. Staging tracheal cancer with a TNM-based system helps predict survival. EBM rating: C.     

Surgical treatment of tracheal and carinal tumors

Tracheal tumors are rare. The two most common histologic types (occurring in about equal numbers) are adenoid cystic carcinoma and squamous cell carcinoma. Current approaches for tracheal mobilization allow safe resection of up to 50% of the tracheal length and primary anastomosis in the vast majority of patients.     

Clinicopathological investigation of 20 cases of primary tracheal cancer.

OBJECTIVE: Primary tracheal cancer is considered to be relatively rare. Its epidemiology, therapeutic strategy and prognosis are not well understood. METHODS: We retrospectively investigated the clinicopathological aspects of 20 patients with primary tracheal cancer. RESULTS: Patients included 11 men and nine women with a mean age of 57.3 years. There were 12 squamous cell carcinomas and eight adenoid cystic carcinomas. Four patients received only palliative therapy. Sixteen patients underwent surgical treatment such as segmental tracheal, laryngotracheal, or carinal resection. One patient with squamous cell carcinoma died of postoperative mediastinitis. Although resected specimens from five patients had tumor positive margins, only one of those patients died after local recurrence and only three patients had postoperative treatment. The 5-year survival rate for patients who underwent surgery was 72.3%. CONCLUSIONS: Surgical treatment is the first choice therapeutic modality for primary tracheal cancer in consideration of its prognosis. While performing the operation, safety of the anastomosis should take precedence over completeness of resection.     

Incidence and Treatment of Tracheal Cancer: A Nationwide Study in The Netherlands

Background The aim of this study was to assess the incidence, characteristics, treatment, and survival of patients with tracheal malignancies in the Netherlands. Methods All cases of tracheal cancer entered into the database of the Netherlands Cancer Registry in the period 1989–2002 were selected. Data on histological type, age at time of diagnosis, treatment, and survival were analyzed retrospectively. Results The annual incidence was 0.142 per 100,000 inhabitants (308 cases, of which 15 were found incidentally at autopsy). Of these, 72% were men. In 52.9%, the histological type was squamous cell carcinoma and in only 7.1% adenoid cystic carcinoma (ACC). Mean age at time of diagnosis was 64.3 years. Of the 293 patients diagnosed while alive, 34 patients underwent surgical resection (11.6%), 156 patients received radiotherapy (53.2%), and 103 patients neither (35.4%). Median survival of all 293 patients was 10 months (mean 28 months) with 1-year, 5-year, and 10-year survival rates of 43%, 15%, and 6%, respectively. The prognosis of patients with ACC was significantly better. The 5-year survival rate in patients who underwent surgical resection was 51%, and the 10-year survival rate in these patients was 33%. Conclusion The prognosis of patients with a tracheal malignancy is usually poor. Surgical treatment, however, can lead to good survival rates; still, this is currently only used in selected patients, even though it would seem to be possible in more cases in view of the technical advances in the field of tracheal surgery. Centralizing the care and treatment of tracheal cancers and implementing a more assertive attitude towards this disease could make surgery accessible to a larger number of patients. Data from the literature show that this would lead to better survival in patients with a tracheal malignancy.     

Management of tracheal tumors

Since 1962, 110 primary tracheal tumors have been seen including 43 squamous cell carcinomas, 38 adenoid cystic, and 29 varied. Sixty-nine patients underwent resection of their primary tumors; an additional 33 patients with secondary tumors involving the trachea also underwent resection. Seventy-three of these 102 patients underwent primary reanastomosis. In 17, laryngotracheal resection was required; staged resections were done for the rest. Survival data indicate that benign tumors are cured by resection with reconstruction and that patients with squamous cell carcinoma, adenoid cystic carcinoma, and other types of malignant lesions obtained either long-term palliation or cure if surgical resection was possible. In patients with selected types of secondary tumors, resection and reconstruction provide prolonged palliation.     

Surgical management of hard palate malignancies.

OBJECTIVE: A variety of surgical procedures can be used to treat malignancies of the hard palate and inferior maxilla. This study was designed to evaluate the efficacy of alveolectomy, palatectomy, and infrastructure maxillectomy in the treatment of cancers in these areas.Methods And Material: A retrospective review of 50 patients who underwent alveolectomy, palatectomy, or infrastructure maxillectomy from 1971 to 1997 was performed. The pathology of these lesions included squamous cell carcinoma (25), adenoid cystic carcinoma (11), adenocarcinoma (6), and others (8). RESULTS: The 5-year survival rate by Kaplan-Meier analysis for all lesions was 85%. The 5-year survival rate for squamous cell carcinoma was 76%, and that for adenoid cystic carcinoma was 90%. The 10-year survival rate for adenoid cystic carcinoma was 75%. There was minimal morbidity associated with these procedures. DISCUSSION: Alveolectomy, palatectomy, and infrastructure maxillectomy are the procedures of choice for lesions in the region of the hard palate. The differences between these surgical techniques are presented, and indications, contraindications, and results for each technique are discussed.     

Management and surgical resection for tracheobronchial tumors institutional experience with 12 patients

We reviewed the records of 12 patients with primary tracheobronchial tumors and various clinical characteristics treated at our institution to investigate our overall management experience with disease. Over a 21-year period, we treated 1405 cases of primary pulmonary neoplasms, of which 12 (0.9%) patients had primary tracheobronchial tumors with eight different histological types, including three adenoid cystic carcinomas, two bronchial carcinoids, two papillomas, one squamous cell carcinoma, one mucous gland adenoma, one inflammatory pseudotumor, one schwannoma, and one mucoepidermoid carcinoma. Eleven of the patients had symptoms of airway obstruction and/or secondary infection or bleeding. A complete resection was performed in ten, which included a sleeve lobectomy in seven, sleeve pneumonectomy in one, tracheal resection in one, and left main stem resection without lung resection in one. Median survival following complete resection was 91 months. When possible, a complete resection provides the best potential benefits and symptomatic relief for patients with tracheo-endobronchial tumors. Further, various options related to tracheobronchoplasty including conservative resection can be applied for surgical intervention.     

原发性气管癌44例临床分析

比较原发性气管癌手术与非手术治疗的疗效，探讨影响本病预后的因素。回顾性分析经组织学证实的４４例原发性气管癌病人的临床与随访资料。手术切除１８例；非手术治疗２６例（放疗采用钴６０或高能Ｘ线，靶区剂量为６０～７０Ｇｙ；化疗采用ＣＯＭＦ或ＡＭＦＰ方案４～６个疗程）。结果采用ＫａｐｌａｎＭｅｉｅｒ法计算其１、３、５年生存率，手术切除者分别为８３．３％、６６．７％和３３．３％，非手术治疗者分别为７３．１％、４２．３％和１５．４％。ｌｏｇｒａｎｋ检验显示无统计学意义，Ｐ＞０．０５。气管上段腺样囊性癌预后相对较好，治疗后５年内约有７７．３％病人死于肿瘤末控、复发或转移。结论：原发性气管癌手术与非手术者的预后似乎无明显差异，影响本病预后的因素主要为其发病部位和病理类型     

Pulmonary Resection for Metastatic Head and Neck Cancer

BACKGROUND: Pulmonary metastasectomy has become the standard therapy for various metastatic malignancies to the lungs; however, little data have been available about lung metastasectomy for head and neck cancers. To confirm a role for resection of pulmonary metastases for such tumors, we reviewed our institutional experience. METHODS: Between 1991 and 2007, 20 patients with pulmonary metastases from head and neck cancers underwent complete pulmonary resection. All patients had obtained or had obtainable locoregional control of their primary head and neck cancers. Various perioperative variables were investigated retrospectively to analyze the prognostic factors for overall survival and disease-free survival after metastasectomy. RESULTS: Of the 20 patients, 10 (50%) had squamous cell carcinoma, 7 (35%) had adenoid cystic carcinoma, and 3 had miscellaneous carcinomas. The median disease-free interval from the time of treatment of the head and neck primary cancers to the development of pulmonary metastases was 27 months. Overall survival rate after metastasectomy was 59.4% at 5 years and 47.5% at 10 years, respectively. Disease-free survival rate was 25.0% at 5 years after pulmonary resection. A disease-free interval equal to or longer than 12 months was a significantly favorable prognostic factor for both overall survival and disease-free survival (p = 0.02 and 0.01, respectively). Patients with squamous cell carcinoma and male sex showed a worse overall survival (p = 0.04 and 0.03, respectively). CONCLUSION: The current practice of pulmonary metastasectomy for head and neck cancers in our institution was well justified. A disease-free interval equal to or longer than 12 months, nonsquamous cell carcinoma, and female sex might be relevant to a better prognosis.     

氩等离子体凝固术治疗气管腺样囊性癌19例效果分析

目的评价经支气管镜氩等离子体凝固术(argon plasma coagulation, APC)在气管支气管腺样囊性癌治疗中的临床应用价值。 方法回顾性分析2000年1月至2017年12月解放军总医院呼吸科收治的原发性气管支气管腺样囊性癌患者19例,其中12例气管腺样囊性癌、7例支气管腺样囊性癌,均行经支气管镜氩等离子体凝固术治疗。 结果19例患者进行了6～132个月(平均58.11个月)的随访,定期行胸部CT和支气管镜检查,治疗后近期有效率为100%,咳嗽、胸闷、气短等症状明显改善。其中完全有效10例(53%)、部分有效5例(26%)、轻度有效4例(21%)。19例患者气促指数,治疗前(3.5± 0.5)级、治疗后(1.5±0.6)级,差异有统计学意义(t＝6.2,P<0.05)。无严重并发症。 结论APC对于气道腔内病变的治疗安全有效,可有效切除肿瘤,保证气道通畅,迅速改善临床症状,为气管支气管腺样囊性癌提供一种新的治疗选择。     

Pulmonary Metastasectomy for Head and Neck Cancers

Background: Distant metastases from carcinomas that arise from the head and neck region are infrequent. The most common site is the lung. To evaluate the results of resection of pulmonary metastases for head and neck cancers, we reviewed our own cases of these metastases.Methods: Between November 1966 and March 1995, 83 patients with pulmonary metastases from head and neck cancers underwent 94 thoracic operations. All patients had obtained or had obtainable locoregional control of their primary head and neck cancers. Kaplan-Meier and Cox regression models were used to analyze the prognostic factors for survival after metastasectomy.Results: Median age was 53 years (range, 17–77). Fifty-nine were male and 24 were female. Forty-one patients had squamous cell cancers, and 36 had glandular tumors that consisted mostly of thyroid and adenoid cystic carcinomas. The median disease-free interval from the time of treatment of the head and neck primary cancers to the development of pulmonary metastases was 27 months. Sixty-eight (82%) patients had complete resection. Overall operative mortality rate was 2%. Overall actuarial survival rate after metastasectomy was 50% at 5 years. Patients with glandular tumors had a 5-year survival rate of 64% compared with 34% for patients with squamous cell cancers. When the patients with glandular tumors were analyzed according to their histology, patients with adenoid cystic carcinomas had an 84% 5-year survival, but none remained disease-free. Patients with thyroid cancers fared similarly whether they were treated medically or surgically. On multivariate analysis, the adverse prognostic factors for patients with squamous cell cancers were incomplete resection, age greater than 50 years, and disease-free interval less than or equal to 2 years.Conclusions: Approximately 30% of patients with pulmonary metastases from squamous cell cancers of the head and neck who underwent complete resection of all their metastases can expect to achieve long-term survival. The role of pulmonary resection for patients with glandular tumors is unclear.Presented in part at the 51st Annual Symposium Meeting of the Society of Surgical Oncology, San Diego, March 26–29, 1998.     

Management outcomes following lateral temporal bone resection for ear and temporal bone malignancies

OBJECTIVE: To evaluate clinical outcomes following lateral temporal bone resection (LTBR) for management of malignancies involving the ear or temporal bone. SUBJECTS AND METHODS: A retrospective medical record review was performed on patients receiving LTBR for management of malignancies involving the ear or temporal bone between 1990 and 2007. RESULTS: In this group of 35 patients, the mean age was 62.7 years, with tumor histopathologies including squamous cell carcinoma (SCC, 20), basal cell carcinoma (BCC, 7), adenoid cystic carcinoma (ACC, 7), and adenocarcinoma (1). The 5-year overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were 77%, 79%, and 52%, respectively. Complete resection resulted in improved OS, DSS, and DFS (P < 0.004 for each) and reduced local recurrence (P < 0.001). CONCLUSIONS: In patients with carcinomas of the ear and temporal bone, upfront excision including LTBR is an effective management when combined with postoperative radiation therapy. Complete removal of all disease may improve survival and decrease recurrence.     

Malignant tumor of the trachea in children: diagnostic pitfalls and surgical management

Primary tracheal malignant neoplasms are very rare. Histologically, squamous cell and adenoid cystic carcinomas are the most common types of malignant primary tracheal tumors when all age groups are studied. In the past 5 years, we treated 2 children with tracheal mucoepidermoid carcinoma. Herein we report both cases and review the literature on the subject with particular emphasis on diagnosis and surgical management.     

Reconstruction of the trachea after resection for neoplasm

Sixty-three patients with primary tracheal tumors were seen in a 15-year period. The most common lesion was squamous-cell carcinoma, the next most common lesion was adenoid cystic carcinoma, and the remaining lesions were a variety of malignant and benign lesions. There were 3 carcinoid tumors in the group. Twenty-four cylindrical resections of the trachea, 2 lateral resections of the trachea, and 10 carinal reconstructions were performed. The balance of the patients seen in this period of time were not amenable to single-stage reconstruction and were managed by staged procedures, by irradiation, or by no treatment at all. Twenty-eight of the patients in the group with resections had primary tumors and 8 had secondary tumors. Secondary tumors included carcinoma of the thyroid, carcinoma of the esophagus, and recurrent carcinoid tumor in the left main bronchus. Although the numbers in any group are small and the period of follow-up not very long, indications are that surgical removal of squamous-cell carcinoma and adenoid cystic carcinoma of the trachea, usually with adjunctive irradiation, provides good palliation or the possibility of cure. Resection of benign primary tumors and low-grade malignant tumors resulted in excellent palliation and usually cure. Resection of selected secondary tumors did not offer much prospect for cure but did provide long-term palliation.