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

View Article: PubMed Central - PubMed

ABSTRACT

Background: Tracheal cancers (TC) are rare and treatment results that are reported are typically not satisfactory. The purpose of this research was assessment of the results of treatment of TC patients, identification of potential additional surgery candidates, evaluation of prognostic factors, and assessment of the occurrence of other malignancies.

Patients and methods: The Regional Cancer Database and the Hospital Database were searched for patients with tracheal neoplasms. Fifty-eight of 418 patients identified initially, met the inclusion criteria (primary TC with confirmed histology and complete treatment records). Standard statistical tests were used.

Results: Squamous cell carcinoma (SCC; 63.8%) and adenoid cystic carcinoma (ACC; 15.5%) were the most commonly diagnosed histological types of TC. Radiotherapy was delivered in 48 cases, surgery or endoscopic resection in 20, and chemotherapy in 14. TC was diagnosed as a second cancer in 10 patients, in 1 patient it occurred prior to the lung cancer, and in 1 was diagnosed simultaneously. During the median follow-up of 12.7 months, 85.5% of the patients died because of the disease. Local recurrence occurred in 17% cases. In univariate analysis, patients with ACC had statistically better five-year overall survival (77.8%) than those diagnosed with SCC (8.4%, p = 0.0001). Radiotherapy, performance status and haemoptysis were factors significantly influencing overall survival (OS) in the multivariate analysis. Among patients who were not treated surgically, 15–26% were found to constitute additional surgery candidates, depending on the selection criteria.

Conclusions: The diagnostic workup should be focused on the identification of TC patients suitable for invasive treatment and radiotherapy. Respiratory system cancer survivors can be considered a risk group for tracheal cancer. Radiotherapy constitutes an important part of the treatment of patients with TC.

No MeSH data available.


Overall survival in the irradiated (RT) and non-RT group.
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j_raon-2016-0046_fig_004: Overall survival in the irradiated (RT) and non-RT group.

Mentions: Radiotherapy as a sole or main treatment method was described by a number researchers.8, 11, 18, 19, 30–31, 33–34, 36 Only four studies present the outcome of at least 50 patients.8, 28, 31, 34 The median total doses usually ranged from 40 to 60 Gy2. In our series, the doses delivered ranged from 14 to 82.6 Gy2 and the median total dose delivered in radical radiotherapy was 66.0 Gy2. In some reports, an additional brachytherapy boost of 6 to 30 Gy was added to escalate the dose delivered to the tumour.19, 28, 34, 37, 38 In our series, three patients had a brachytherapy boost and the BT total dose ranged from 12.5 to 16 Gy2. In the studies cited above, five-year OS for patients treated only with radiotherapy ranged from 8 to 30.4%.19, 28, 31, 33, 34 Mornex et al. reported that the total dose over 56 (up to 70 Gy in their series) correlated with better outcomes - 12% for the higher TD compared to 5% for the lower.28 Hetnał et al. reported that patients with ACC histology treated with radiotherapy had better outcomes than SCC patients, and five-year OS were 80% and 9% for ACC and SCC, respectively.34 In our series, radiotherapy was a part of the treatment in 48 patients, and those patients who received RT had better overall survival in spite of large heterogeneity of the group (both radical and palliative treatments included), various fractionation schemes used, and no uniform target volume definition throughout the analysed period of time (Figure 4).


Tracheal cancer – treatment results, prognostic factors and incidence of other neoplasms
Overall survival in the irradiated (RT) and non-RT group.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5120581&req=5

j_raon-2016-0046_fig_004: Overall survival in the irradiated (RT) and non-RT group.
Mentions: Radiotherapy as a sole or main treatment method was described by a number researchers.8, 11, 18, 19, 30–31, 33–34, 36 Only four studies present the outcome of at least 50 patients.8, 28, 31, 34 The median total doses usually ranged from 40 to 60 Gy2. In our series, the doses delivered ranged from 14 to 82.6 Gy2 and the median total dose delivered in radical radiotherapy was 66.0 Gy2. In some reports, an additional brachytherapy boost of 6 to 30 Gy was added to escalate the dose delivered to the tumour.19, 28, 34, 37, 38 In our series, three patients had a brachytherapy boost and the BT total dose ranged from 12.5 to 16 Gy2. In the studies cited above, five-year OS for patients treated only with radiotherapy ranged from 8 to 30.4%.19, 28, 31, 33, 34 Mornex et al. reported that the total dose over 56 (up to 70 Gy in their series) correlated with better outcomes - 12% for the higher TD compared to 5% for the lower.28 Hetnał et al. reported that patients with ACC histology treated with radiotherapy had better outcomes than SCC patients, and five-year OS were 80% and 9% for ACC and SCC, respectively.34 In our series, radiotherapy was a part of the treatment in 48 patients, and those patients who received RT had better overall survival in spite of large heterogeneity of the group (both radical and palliative treatments included), various fractionation schemes used, and no uniform target volume definition throughout the analysed period of time (Figure 4).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Tracheal cancers (TC) are rare and treatment results that are reported are typically not satisfactory. The purpose of this research was assessment of the results of treatment of TC patients, identification of potential additional surgery candidates, evaluation of prognostic factors, and assessment of the occurrence of other malignancies.

Patients and methods: The Regional Cancer Database and the Hospital Database were searched for patients with tracheal neoplasms. Fifty-eight of 418 patients identified initially, met the inclusion criteria (primary TC with confirmed histology and complete treatment records). Standard statistical tests were used.

Results: Squamous cell carcinoma (SCC; 63.8%) and adenoid cystic carcinoma (ACC; 15.5%) were the most commonly diagnosed histological types of TC. Radiotherapy was delivered in 48 cases, surgery or endoscopic resection in 20, and chemotherapy in 14. TC was diagnosed as a second cancer in 10 patients, in 1 patient it occurred prior to the lung cancer, and in 1 was diagnosed simultaneously. During the median follow-up of 12.7 months, 85.5% of the patients died because of the disease. Local recurrence occurred in 17% cases. In univariate analysis, patients with ACC had statistically better five-year overall survival (77.8%) than those diagnosed with SCC (8.4%, p = 0.0001). Radiotherapy, performance status and haemoptysis were factors significantly influencing overall survival (OS) in the multivariate analysis. Among patients who were not treated surgically, 15–26% were found to constitute additional surgery candidates, depending on the selection criteria.

Conclusions: The diagnostic workup should be focused on the identification of TC patients suitable for invasive treatment and radiotherapy. Respiratory system cancer survivors can be considered a risk group for tracheal cancer. Radiotherapy constitutes an important part of the treatment of patients with TC.

No MeSH data available.