Treatment of primary tracheal carcinoma - The role of external and endoluminal radiotherapy

Background and Purpose: In a retrospective study the role of radiation ther apy for the treatment of primary tracheal carcinoma was investigated. Patients and Methods: Between 1984 and 1997, 25 patients with primary trach eal carcinoma were treated with external beam radiotherapy (17 squamous-cel l carcinoma [SCC], 8 adenoid cystic carcinoma [ACC], median dose SCC 60 Gy, ACC 55 Gy). An additional brachytherapy boost was carried out in 10/25 pat ients (median dose SCC 18 Gy, ACC 15 Gy). Ten patients underwent operative treatment. Results: The median survival (Kaplan-Meier) for patients with SCC was 33 mo nths (ACC 94.2). The 1-, 2- and 5-year survival rates (Kaplan-Meier) for pa tients with SCC were 64.7% (ACC 85.7%), 64.7% (ACC 85.7%), and 26% (ACC 85. 7%) . Patients with ACC and patients with a complete remission after treatm ent had a significantly better survival probability (log rank test, p < 0.0 5). An excellent or good relief of clinical symptoms was achieved in 88% of the patients with SCC (ACC 88%). Eleven patients were locally controlled a t last follow-up (SCC: 5/17; BCC: 6/8). Grade 1 to 2 toxicity (RTOG/EORTC) occurred in 12% (SCC: 2/17, ACC: 1/8) and Grade 3 to 4 toxicity in 8% (SCC: 0/17, ACC: 2/8) of the patients. Persistent or progressive local disease c aused complications in 5 patients (fatal hemorrhage n = 2, esophagotracheal fistula n = 2, tracheal necrosis n = 1). Conclusion: Radiation therapy is an effective treatment for primary trachea l neoplasms. Surgery followed by adjuvant radiotherapy and primary radiothe rapy in inoperable cases represent potentially curative treatment options. Prospective multicenter studies are needed to determine the optimal radioth erapeutic approach.