PRIMARY TRACHEAL TUMORS - A NATIONAL SURVEY

Background-Primary tracheal tumours are rare, so few physicians have e xtensive experience of their management. No direct comparisons have be en made of surgical and radiotherapy treatment. Methods-A postal surve y of cases presenting in the last 10 years in the United Kingdom was c onducted. Results were expressed as cumulative survival and survival c urves were compared by the log rank test. Results-Three hundred and tw enty one patients were recruited. Overall five year survival rates wer e 25% for squamous cell carcinomas, and 80% for adenoid cystic carcino ma; 62% received radio-therapy but only 10% underwent surgery. Small c ell carcinoma was more common than expected with an incidence of 6%. I n patients with squamous carcinoma improved survival was seen in those with tumour in the upper trachea. High dose radiotherapy was more eff ective than low dose only in tumours of the upper trachea and in squam ous carcinoma. In adenoid cystic carcinoma no significant difference i n survival rate was seen between treatment with radiotherapy and surge ry. 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%.Conclusion s-Survival may be somewhat better in cases with tracheal tumours than in those with bronchial tumours. Small cell carcinoma is less rare tha n was previously thought. Upper tracheal tumours may merit more aggres sive therapy. It is important to make a histological diagnosis even if rigid bronchoscopy is necessary, and referral to specialist centres i s recommended. A larger prospective study is required to compare the v alue of surgery and radio therapy.