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Piórek A, Płużański A, Knetki-Wróblewska M, Winiarczyk K, Tabor S, Teterycz P, Kowalski DM, Krzakowski M. Treatment outcomes of patients with primary tracheal tumors - analysis of a large retrospective series. BMC Cancer 2024; 24:686. [PMID: 38840114 PMCID: PMC11155021 DOI: 10.1186/s12885-024-12450-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE Primary tracheal tumors are very rare and their management is not definitely established. Due to its rarity, providing patient care in terms of optimal management poses a considerable challenge. The purpose of this study was to investigate treatment outcomes in patients with these rare tumors. METHODS We carried out a retrospective analysis of 89 patients with primary tracheal tumors treated at the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland, over sixteen years. The study assessed patient demographics, tumor characteristics and treatment. Different treatment options were compared in terms of overall survival, disease-free survival, and progression-free survival. RESULTS A total of 89 patients were included in the study. In the group presented, 45 patients underwent primary radical treatment and 44 were qualified for palliative treatment. Surgical resection was performed in 13 patients out of radically treated patients. The 5 year OS rates in the group of patients who underwent radical treatment and in the group of patients who underwent palliative treatment were 45.9% and 2.3%, respectively. In the group of patients who underwent radical surgical treatment, the 5 year OS was 76.9% compared to 35.8% in the group of patients who underwent nonsurgical treatment. CONCLUSION A multidisciplinary team should decide treatment options, including in-depth consideration of surgical treatment options.
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Affiliation(s)
- Aleksandra Piórek
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland.
| | - Adam Płużański
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Magdalena Knetki-Wróblewska
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Kinga Winiarczyk
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Sylwia Tabor
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, 02-781, Poland
- Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, 02-781, Poland
| | - Dariusz M Kowalski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic Tumors, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, Warsaw, 02-781, Poland
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Lee JH, Jang JY, Noh JM, Yang K, Pyo H. Dose-Escalated Radiotherapy for Primary Tracheobronchial Adenoid Cystic Carcinoma. Cancers (Basel) 2024; 16:2127. [PMID: 38893246 PMCID: PMC11171223 DOI: 10.3390/cancers16112127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Primary tracheobronchial adenoid cystic carcinoma (ACC) is a rare malignancy, so the optimal radiotherapy (RT) dose remains unestablished. We aimed to evaluate the effectiveness of dose-escalated RT for primary tracheobronchial ACC. We retrospectively reviewed 48 patients who had undergone definitive or postoperative RT. Patients classified into the low- and high-dose groups received RT doses <70.0 and ≥70.0 Gy in EQD2, respectively. The primary endpoint was freedom from local progression (FFLP) and overall survival (OS). Throughout the follow-up period, seven patients (14.6%) experienced local progression, while 31 (64.6%) exhibited distant metastasis, most commonly in the lungs. In total, the 5-year FFLP and OS rates were 85.7 and 84.7%, respectively. Multivariate analysis revealed that regional lymph node metastasis at diagnosis and receipt of definitive RT were associated with poorer OS. In the subgroup analysis, the definitive RT group had a 5-year FFLP rate of 33.3 and 78.2% in the low- and high-dose groups (p = 0.065), whereas 5-year OS rates were 66.7 and 79.0%, respectively (p = 0.022). Four patients (8.3%) experienced Grade 3 toxicity with tracheal or main bronchus stenosis. Dose-escalated RT with conventional fractionation may be effective in patients with tracheobronchial ACC, especially for a definitive aim.
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Affiliation(s)
- Jeong Ha Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.H.L.); (J.Y.J.); (J.M.N.)
| | - Jeong Yun Jang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.H.L.); (J.Y.J.); (J.M.N.)
- Department of Radiation Oncology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 06351, Republic of Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.H.L.); (J.Y.J.); (J.M.N.)
| | - Kyungmi Yang
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.H.L.); (J.Y.J.); (J.M.N.)
| | - Hongryull Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (J.H.L.); (J.Y.J.); (J.M.N.)
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3
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Horio Y, Kuroda H, Masago K, Matsushita H, Sasaki E, Fujiwara Y. Current diagnosis and treatment of salivary gland-type tumors of the lung. Jpn J Clin Oncol 2024; 54:229-247. [PMID: 38018262 DOI: 10.1093/jjco/hyad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
Salivary gland-type tumors of the lung are thought to originate from the submucosal exocrine glands of the large airways. Due to their rare occurrence, reports of their study are limited to small-scale or case reports. Therefore, daily clinical practices often require a search for previous reports. In the last 20 years, several genetic rearrangements have been identified, such as MYB::NF1B rearrangements in adenoid cystic carcinoma, CRTC1::MAML2 rearrangements in mucoepidermoid carcinoma, EWSR1::ATF1 rearrangements in hyalinizing clear cell carcinoma and rearrangements of the EWSR1 locus or FUS (TLS) locus in myoepithelioma and myoepithelial carcinoma. These molecular alterations have been useful in diagnosing these tumors, although they have not yet been linked to molecularly targeted therapies. The morphologic, immunophenotypic, and molecular characteristics of these tumors are similar to those of their counterparts of extrapulmonary origin, so clinical and radiologic differential diagnosis is required to distinguish between primary and metastatic disease of other primary sites. However, these molecular alterations can be useful in differentiating them from other primary lung cancer histologic types. The management of these tumors requires broad knowledge of the latest diagnostics, surgery, radiotherapy, bronchoscopic interventions, chemotherapy, immunotherapy as well as therapeutic agents in development, including molecularly targeted agents. This review provides a comprehensive overview of the current diagnosis and treatment of pulmonary salivary gland tumors, with a focus on adenoid cystic carcinoma and mucoepidermoid carcinoma, which are the two most common subtypes.
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Affiliation(s)
- Yoshitsugu Horio
- Department of Outpatient Services, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
- Department of Thoracic Surgery, Teikyo University Hospital, Mizonokuchi, Kanagawa-prefecture, Japan
| | - Katsuhiro Masago
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hirokazu Matsushita
- Division of Translational Oncoimmunology, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Eiichi Sasaki
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka Fujiwara
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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4
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Desai N, Zambetti BR, Wong DL, Schachter AE, Judge NP, Valaulikar GS, Ng T. Outcomes and predictors of survival for tracheal cancer. J Surg Oncol 2023; 128:1251-1258. [PMID: 37732718 DOI: 10.1002/jso.27447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Primary tracheal cancer is uncommon, with poor survival. While surgical resection is the mainstay of therapy, the role of chemotherapy and radiation is poorly defined. We aimed to study the impact of treatment modalities on survival. METHODS Patients with primary tracheal cancer were identified from the National Cancer Database over 12 years, 2004-2015. Patient characteristics, tumor characteristics, treatment modalities, and survival were recorded. Factors associated with survival were assessed using Cox Regression. RESULTS Of the 1726 patients identified, 59% were male, 83% White race, 62% had a comorbidity index of zero, median age 64 years, median tumor size 2.7 cm, and median survival was 28.5 months (89 months for patients undergoing surgical resection). Cox Regression for all patients found adenoid cystic carcinoma (ACC) (p < 0.001), radiation (p < 0.001), and surgical resection (p < 0.001) to be associated with improved survival, while increasing age (p < 0.001) decreased survival. For patients receiving resection, ACC (p < 0.001) was associated with improved survival, while increasing age (p < 0.001) and positive margins (p = 0.002) were associated with worse survival. For R0 resections, ACC (p < 0.001) was associated with improved survival, while increasing age (p < 0.001) decreased survival, with chemotherapy and radiation having no impact. For R1/2 resections, ACC (p < 0.001) and radiation (p < 0.001) were associated with improved survival, while increasing age (p < 0.001) decreased survival, with chemotherapy having no impact on survival. CONCLUSIONS Primary tracheal cancer is highly lethal, with surgical resection leading to the best chance of survival. For patients undergoing resection, radiation provided survival benefits for R1/2 but not R0, while chemotherapy did not impact survival regardless of margin status.
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Affiliation(s)
- Nidhi Desai
- Division of Thoracic Surgery and Department of Surgery, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA
| | - Benjamin R Zambetti
- Division of Thoracic Surgery and Department of Surgery, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA
| | - Denise L Wong
- Division of Thoracic Surgery and Department of Surgery, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA
| | - Aubrey E Schachter
- Division of Thoracic Surgery and Department of Surgery, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA
| | - Nathan P Judge
- Division of Thoracic Surgery and Department of Surgery, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA
| | - Ganpat S Valaulikar
- Division of Thoracic Surgery and Department of Surgery, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA
| | - Thomas Ng
- Division of Thoracic Surgery and Department of Surgery, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee, USA
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Buchalet C, Durdux C. Role of radiotherapy in the management of rare solid thoracic tumors of the adults. Cancer Radiother 2023; 27:614-621. [PMID: 37558606 DOI: 10.1016/j.canrad.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 08/11/2023]
Abstract
Thoracic tumors include more than one hundred histopathological subtypes. Rare thoracic malignancies can be defined as representing less than 1% of all thoracic tumors. The European Rare Cancer Surveillance Project (RARECARE) identified rarity as an incidence less than 6 for 100,000 people, with significant difference of prevalence between them. Modalities of treatment for these pathologies include surgery, radiotherapy, and systemic therapies. In this article, we aim to discuss role and techniques of radiotherapy in management of rare solid thoracic tumors in adults, focusing on different anatomical locations such as lung parenchyma, mediastinum, vessels, chest wall and pleural cavity.
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Affiliation(s)
- C Buchalet
- Département d'oncologie radiothérapie, Institut du Cancer de Montpellier, 208, avenue des Apothicaires, 34000 Montpellier, France.
| | - C Durdux
- Département d'oncologie radiothérapie, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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Liu B, Stevens J, Beverungen G, Halpern MT. Applying computer text mining algorithms for oversampling tumor mutation status in medical records for the NCI Patterns of Care studies. Int J Med Inform 2023; 177:105157. [PMID: 37480595 DOI: 10.1016/j.ijmedinf.2023.105157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/29/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUNDS The National Cancer Institute (NCI) conducts Patterns of Care (POC) studies for selected cancer sites under a Congressional Mandate. These studies aim to collect treatment information beyond what is typically collected by the NCI's Surveillance, Epidemiology, and End Results (SEER) Program. The 2019 POC study focused on non-small cell lung cancer (NSCLC) and melanoma cancer sites. For the NSCLC cases, one of the primary sampling objectives was to oversample patients who tested positive for EGFR/ALK mutations, but initial information on mutation test results was unavailable prior to selecting the study sample. METHODS To address this, text mining algorithms were developed to screen all eligible NSCLC cases from the SEER database. These algorithms were designed to identify the mutation test status, allowing for stratified sampling based on SEER registry, sex, race/ethnicity, and tumor mutation test results. RESULTS The final NSCLC sample included 2,434 patients aged 20+ with advanced stage (IIIB-IVB) NSCLC diagnosed in 2017 and 2018. Among this sample, 692 cases (13.2%) tested positive for EGFR/ALK mutations. An evaluation of the text mining algorithms performance, based on cases where both algorithm results and known EGFR/ALK status from medical chart abstraction were available, showed good results: sensitivity of 77.6%, specificity of 90.8%, and an overall accuracy 84.8%. CONCLUSIONS The adaption of text mining algorithm proved effective in oversample patients with uncommon conditions in studies where electronic medical records are accessible. The 2019 POC study provides valuable data for researchers to evaluate cancer therapy details and patient characteristics, particularly among those with EGFR/ALK test positive cases.
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Affiliation(s)
- Benmei Liu
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, MD, USA.
| | | | | | - Michael T Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Rockville, MD, USA
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7
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Zheng Z, Du Z, Fang Z, Shi Y, Chen X, Jin M, Liu K. Survival benefit of radiotherapy and nomogram for patients with primary tracheal malignant tumors: a propensity score-matched SEER database analysis. J Cancer Res Clin Oncol 2023; 149:9919-9926. [PMID: 37249645 PMCID: PMC10423124 DOI: 10.1007/s00432-023-04896-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/20/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE The purpose of this study was to conduct a matched-pair analysis to assess the impact of radiotherapy (RT) on patients with malignant tracheal tumors using the surveillance, epidemiology, and end results database. Additionally, a predictive nomogram was developed for patients with malignant tracheal tumors. METHODS Propensity score matching (PSM) was used to minimize bias between the RT and no-RT groups. We utilized both univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for patients and subgroups. We developed a novel nomogram and evaluated its results using the C-index. RESULTS A total of 648 patients between 1975 and 2019 were included, and 160 patients in RT were 1:1 propensity score-matched with no-RT. The independent prognostic factors for patients with tracheal malignant tumors were surgery, marital status, disease extension, pathology, and age. The independent risk factors for patients without surgery included RT and disease extension. The C-index confirmed that the nomogram accurately predicted the prognosis of patients with tracheal malignant tumors. CONCLUSIONS Our findings suggest that RT may provide a survival benefit for tracheal cancer patients who did not undergo surgery. The nomogram can be a useful tool for predicting prognosis in patients with tracheal malignant tumors.
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Affiliation(s)
- Zhen Zheng
- Department of Radiation Oncology and Chemotherapy, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Zhennan Du
- Department of Respiratory Medicine, Ningbo Yinzhou No. 2 Hospital, Ningbo, 315000, China
| | - Zhongjie Fang
- Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Yunbin Shi
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Xue Chen
- Department of Radiation Oncology and Chemotherapy, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Ming Jin
- Department of Radiation Oncology and Chemotherapy, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China
| | - Kaitai Liu
- Department of Radiation Oncology and Chemotherapy, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315000, China.
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Marchioni A, Tonelli R, Samarelli AV, Cappiello GF, Andreani A, Tabbì L, Livrieri F, Bosi A, Nori O, Mattioli F, Bruzzi G, Marchioni D, Clini E. Molecular Biology and Therapeutic Targets of Primitive Tracheal Tumors: Focus on Tumors Derived by Salivary Glands and Squamous Cell Carcinoma. Int J Mol Sci 2023; 24:11370. [PMID: 37511133 PMCID: PMC10379311 DOI: 10.3390/ijms241411370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Primary tracheal tumors are rare, constituting approximately 0.1-0.4% of malignant diseases. Squamous cell carcinoma (SCC) and adenoid cystic carcinoma (ACC) account for about two-thirds of these tumors. Despite most primary tracheal cancers being eligible for surgery and/or radiotherapy, unresectable, recurrent and metastatic tumors may require systemic treatments. Unfortunately, the poor response to available chemotherapy as well as the lack of other real therapeutic alternatives affects the quality of life and outcome of patients suffering from more advanced disease. In this condition, target therapy against driver mutations could constitute an alternative to chemotherapy, and may help in disease control. The past two decades have seen extraordinary progress in developing novel target treatment options, shifting the treatment paradigm for several cancers such as lung cancer. The improvement of knowledge regarding the genetic and biological alterations, of major primary tracheal tumors, has opened up new treatment perspectives, suggesting the possible role of biological targeted therapies for the treatment of these rare tumors. The purpose of this review is to outline the state of knowledge regarding the molecular biology, and the preliminary data on target treatments of the main primary tracheal tumors, focusing on salivary-gland-derived cancers and squamous cell carcinoma.
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Affiliation(s)
- Alessandro Marchioni
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41121 Modena, Italy
| | - Anna Valeria Samarelli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, 41121 Modena, Italy
| | - Gaia Francesca Cappiello
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Alessandro Andreani
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Luca Tabbì
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Francesco Livrieri
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Annamaria Bosi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | - Ottavia Nori
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
| | | | - Giulia Bruzzi
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
- Otolaryngology Unit, University Hospital of Modena, 41121 Modena, Italy
| | - Daniele Marchioni
- Otolaryngology Unit, University Hospital of Modena, 41121 Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences, University of Modena Reggio Emilia, University Hospital of Modena, 41121 Modena, Italy
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Ping C, Liang J, Liu ZY, He J, Zhou JY, Cheng H, Yuan GD. The impact of surgery and age on mortality with primary trachea malignant tumors: a retrospective study based on propensity-score matching analysis. J Cardiothorac Surg 2023; 18:224. [PMID: 37430368 DOI: 10.1186/s13019-023-02340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/03/2023] [Indexed: 07/12/2023] Open
Abstract
PURPOSE This study aimed to explore the survival significance of surgery and age on the prognosis of patients with primary trachea malignancies. METHODS The entire cohort of 637 patients with primary malignant trachea tumors was used to perform the main analyses. The data of those patients were from a public database. Overall survival (OS) curves were drawn by the Kaplan-Meier method and compared by the Log-rank test. The univariable and multivariable Cox regression analyses calculated the hazard ratio (HR) and 95% confidence interval (CI) for overall mortality. The propensity-score matching analysis was used to reduce the selection bias. RESULTS Age, surgery, histological type, N classification, M classification, marital status, and tumor grading were identified as independent prognostic factors after eliminating confounding factors. The results of the Kaplan-Meier method revealed that patients with age < 65 had a survival advantage over those with age ≥ 65 (HR = 1.908, 95% CI 1.549-2.348, P < 0.001). The 5-year OS rates were 28% and 8% in the group with age < 65 and age ≥ 65, respectively (P < 0.001). Cases with surgery had better survival over patients without surgery (HR = 0.372, 95% CI 0.265-0.522, P < 0.001). Compared with patients who did not undergo operations, patients with surgery had a higher median survival time (20 vs. 174 months). For patients with surgery, young age was considered a survival-promoting factor (HR 2.484; 95% CI 1.238-4.983, P = 0.010). CONCLUSION We suggested that age and surgery were the independent prognostic factors in patients with primary malignant trachea tumors. Besides, age serves as an essential indicator for evaluating the prognosis of postoperative patients.
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Affiliation(s)
- Chen Ping
- Department of Thoracic Surgery, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu Province, 215128, P. R. China
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P. R. China
| | - Jia Liang
- Department of Internal Medicine, Zhabei central hospital, Shanghai, 200070, P. R. China
| | - Zhi-Yuan Liu
- School of Medicine, School of Life Science and Technology, Shanghai Tenth People's Hospital of Tongji University, Tongji University, Shanghai, 200072, P. R. China
| | - Jiang He
- Department of Thoracic Surgery, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu Province, 215128, P. R. China
| | - Ji-Yao Zhou
- Department of Thoracic Surgery, Suzhou Wuzhong People's Hospital, Suzhou, Jiangsu Province, 215128, P. R. China
| | - Hao Cheng
- School of Medicine, School of Life Science and Technology, Shanghai Tenth People's Hospital of Tongji University, Tongji University, Shanghai, 200072, P. R. China.
| | - Guang-Da Yuan
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P. R. China.
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Zhao Y, He G, Zhai Y, Zhou Z, Bi N, Mao Y, Zhang Y, Xiao Z, Gao S, Lv J, Xue Q, Feng Q. Adenoid Cystic Carcinoma of Lobar Bronchial Origin: 20-Year Experience at a Single Institution. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11590-5. [PMID: 35355128 DOI: 10.1245/s10434-022-11590-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/08/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pulmonary adenoid cystic carcinoma (ACC) is a rare type of lung malignancy. The prevalence of ACC of lobar bronchial origin is lower than that of other lung malignancies, and studies investigating it are lacking. This study aimed to evaluate survival of patients with ACC of the lobar bronchus after surgical resection and to explore its prognostic factors. METHODS Between January 2000 and December 2019, 35 patients at the National Cancer Center/Cancer Hospital with a diagnosis of ACC of the lobar bronchus were included in the retrospective analysis. RESULTS During a median follow-up period of 61 months (range, 10-194 months), the analysis showed a 5-year overall survival (OS) rate of 81.4%, a 5-year locoregional recurrence-free survival rate of 84.0%, and 5-year disease-free survival rate of 60.1%. The univariate analysis exclusively identified the surgical margin as a predictor of OS, and survival was significantly longer for the patients with negative surgical margins than for those with positive surgical margins (R0 vs. R1: 94.4% vs. 66.0%; p = 0.014). Adjuvant radiotherapy was administered to most of the patients with positive surgical margins, which might have contributed to prolonged OS (R0 vs. R1+RT: 94.4% vs. 66.7%, p = 0.173; R0 vs. R1+no RT: 94.4% vs. 62.5%, p = 0.007). CONCLUSIONS For ACC of lobar bronchial origin, complete resection is the radical treatment, and the OS rate was significantly higher for the R0 patients than for the R1 patients. Adjuvant radiotherapy for patients with R1 may prolong survival.
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Affiliation(s)
- Ying Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guosheng He
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Zhang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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11
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Zeng R, Wang H, Cai X, Guo X, Ping Y, Yang Q. Radiotherapy for Primary Tracheal Carcinoma: Experience at a Single Institution. Technol Cancer Res Treat 2021; 20:15330338211034273. [PMID: 34372715 PMCID: PMC8361538 DOI: 10.1177/15330338211034273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There is limited understanding of tracheal carcinoma (TC) because of its rarity. We examined the efficacy of radiotherapy (RT) for patients with primary TC. Methods: We analyzed the records of 32 patients with primary TC who received RT at our center between November 1996 and December 2016. Results: Thirteen patients received adjuvant RT and 18 received definitive RT. Eight patients achieved complete remission (CR) after definitive RT. Among all patients, the 5-year overall survival (OS) rate was 46.9% and the locoregional progression free survival (LRPFS) rate was 68.1%. Univariate analysis indicated the 5-year OS was better in those with adenoid cystic adenocarcinoma than squamous cell carcinoma (P = 0.001); the 5-year LRPFS was better in patients who received surgical resection than those who did not (92.9% vs 46.4%, P = 0.013) and in patients who received postoperative RT than in those who received definitive RT (91.7% vs 50.1%, P = 0.038). A sub-group univariate analysis indicated the 5-year PFS was better for those who received at least 68 Gy of radiation (44.4% vs 13.0%, P = 0.044). Patients who achieved CR had a better 5-year PFS than those who did not (57.1% vs 10%, P = 0.006). No patients had a toxicity of grade 3 or more. Conclusions: Adjuvant and definitive RT are safe and effective treatments for TC. Patients who received dosages of 68 Gy or more and who had complete tumor regression following definitive RT seemed to have better long-term survival.
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Affiliation(s)
- Ruifang Zeng
- Department of Radiation Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China.,Ruifang Zeng and Hanyu Wang contribute equally to this work
| | - Hanyu Wang
- Department of Radiation Oncology, State Key Laboratory of Oncology in Southern China, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, China.,Ruifang Zeng and Hanyu Wang contribute equally to this work
| | - Xiaohui Cai
- Department of Radiation Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoqiong Guo
- Department of Radiation Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Yanan Ping
- Department of Radiation Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiuyuan Yang
- Department of Radiation Oncology, Cancer Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
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12
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National Utilization of Surgery and Outcomes for Primary Tracheal Cancer in the United States. Ann Thorac Surg 2020; 110:1012-1022. [PMID: 32335015 DOI: 10.1016/j.athoracsur.2020.03.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/04/2020] [Accepted: 03/23/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Tracheal cancer (TC) is a rare disease, and surgical treatment requires a high level of expertise. We sought to determine the treatment patterns and surgical outcomes of TC in the United States. METHODS The National Cancer Database was queried for all cases of primary invasive TC without distant metastatic disease between 2004 and 2015. Primary surgical treatment and outcomes were analyzed. Factors associated with utilization of surgery and overall survival were tested using regression analysis. RESULTS Of 1379 identified TC patients, 338 patients (25%) were treated surgically. Among resected patients, most had adenoid cystic (48%) or squamous cell (28%) carcinoma. Median length of hospital stay after resection was 7 days (interquartile range, 3-8), and 30-day mortality was 1.4%. Most nonsurgically managed patients underwent radiation (63%). Factors associated with surgical resection were younger age, higher education level, tumor size, and adenoid cystic histology. On multivariate analysis patients were also more likely to undergo surgery if they traveled a farther distance for treatment (>45 km; odds ratio, 1.53; 95% confidence interval, 1.09-2.13) or were treated at academic centers (odds ratio, 1.68; 95% confidence interval, 1.25-2.26). Five-year overall survival was 71% after resection, 39% after surgical debulking, and 31% without surgery (P < .001). CONCLUSIONS National surgical outcomes for resection of TC demonstrate low perioperative mortality and excellent long-term prognosis. However, few nonmetastatic TC patients underwent surgery, indicating disparities in access to optimal surgical care and variability in practice patterns at a national level.
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13
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Demography, patterns of care and survival outcomes in patients with malignant tumors of trachea: A systematic review and individual patient data analysis of 733 patients. Lung Cancer 2019; 132:87-93. [DOI: 10.1016/j.lungcan.2019.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/19/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022]
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14
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Yusuf M, Gaskins J, Trawick E, Tennant P, Bumpous J, van Berkel V, Fox M, Dunlap N. Effects of adjuvant radiation therapy on survival for patients with resected primary tracheal carcinoma: an analysis of the National Cancer Database. Jpn J Clin Oncol 2019; 49:628-638. [DOI: 10.1093/jjco/hyz047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective(s)
To identify predictors for receiving adjuvant radiation therapy (RT) and investigate the impact of adjuvant RT on survival for patients with resected primary tracheal carcinoma (PTC).
Methods
The National Cancer database was queried for patients with PTC diagnosed from 2004 to 2014 undergoing resection. Patients who died within 30 days of resection were excluded to minimize immortal time bias. Kaplan–Meier methods, Cox regression modeling and propensity score weighted (PSW) log-rank tests were considered to assess the relationship between adjuvant RT and overall survival (OS). Logistic regression was performed to identify predictors associated with receiving adjuvant RT.
Results
A total of 549 patients were identified with 300 patients (55%) receiving adjuvant RT. Squamous cell carcinoma (SCC) was the most common histology with 234 patients (43%). Adenoid cystic carcinoma (ACC) was second most frequent with 180 patients (33%). Adjuvant RT was not associated with OS by multivariable Cox analysis or PSW log-rank test (P values > 0.05). Patients with positive surgical margins (odds ratio (OR) 1.80, confidence interval (CI) 1.06–3.07) were more likely to receive adjuvant RT than those with negative surgical margins. Patients with ACC (OR 6.53, CI 3.57–11.95) were more likely to receive adjuvant RT compared with SCC.
Conclusions
Adjuvant RT was not significantly associated with OS for patients with resected PTC in this analysis. Surgical margin status and tumor histology were associated with receiving adjuvant RT. Further investigations including prospective registry studies capturing radiation technique and treatment volumes are needed to better define which patients with resected PTC may benefit from adjuvant RT.
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Affiliation(s)
- Mehran Yusuf
- Department of Radiation Oncology, University of Louisville Hospital, Louisville KY, USA
| | - Jeremy Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville KY, USA
| | - Emma Trawick
- Department of Medicine, New York University School of Medicine, New York NY, USA
| | - Paul Tennant
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville KY, USA
| | - Jeffrey Bumpous
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville Hospital, Louisville KY, USA
| | - Victor van Berkel
- Department of Cardiovascular and Thoracic Surgery, University of Louisville Hospital, Louisville KY, USA
| | - Matthew Fox
- Department of Cardiovascular and Thoracic Surgery, University of Louisville Hospital, Louisville KY, USA
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville Hospital, Louisville KY, USA
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15
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Hararah MK, Stokes WA, Oweida A, Patil T, Amini A, Goddard J, Bowles DW, Karam SD. Epidemiology and treatment trends for primary tracheal squamous cell carcinoma. Laryngoscope 2019; 130:405-412. [PMID: 30977524 DOI: 10.1002/lary.27994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/25/2019] [Accepted: 03/20/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Management of tracheal squamous cell carcinoma (TSCC) has been complicated by the lack of prognostic data and staging. We describe the epidemiology of TSCC and current treatment approaches. METHODS Five hundred thirty-two adult patients with primary TSCC from 2004 to 2012 in the National Cancer Database were identified. Demographic, clinical factors, and 5-year overall survival were analyzed. Staging was classified as localized, regional extension, and distant spread. Treatment modality was defined as "no treatment (NT)," "limited surgery (LS)," "curative surgery (CS)," "LS with any adjuvant therapy (AT) (LS+AT)," "CS with AT (CS+AT)," "radiation therapy (RT)," or "chemoradiation (CRT)." RESULTS Overall survival was 25%. Majority of cases were males, white, and occurred in sixth/seventh decades. Twenty-six percent of cases received CRT, 20% underwent LS+AT or CS+AT, 20% underwent LS or CS only, and 17% underwent RT alone. On multivariate analysis, CS (HR 0.42, 95% CI: 0.26-0.69), CS+AT (HR 0.44, 95% CI: 0.36-0.77), CRT (HR 0.48, 95% CI: 0.35-0.67), and RT (HR, 0.66 95% CI: 0.46-0.94) were associated with decreased likelihood of death compared to NT. Elderly patients and those with poor performance status had worse outcomes even on multivariate analysis. CONCLUSIONS TSCC is increasingly treated with surgery and systemic therapy in addition to RT, with improved survival outcomes. CS, CS+AT, CRT, or RT provided improved survival advantage in patients with variable levels of improvement based on the extent of the disease. Prospective trials would help differentiate survival advantages between treatment modalities. Patients' goals of care, comorbidities, and age should be considered when deciding appropriate treatment recommendations. LEVEL OF EVIDENCE NA Laryngoscope, 130:405-412, 2020.
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Affiliation(s)
- Mohammad K Hararah
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, U.S.A
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, U.S.A
| | - Ayman Oweida
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, U.S.A
| | - Tejas Patil
- Department of Medical Oncology, University of Colorado School of Medicine, Aurora, U.S.A
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California, U.S.A
| | - Julie Goddard
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, U.S.A
| | - Daniel W Bowles
- Department of Medical Oncology, University of Colorado School of Medicine, Aurora, U.S.A.,Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado, U.S.A
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, U.S.A
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16
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Wen J, Liu D, Xu X, Chen D, Chen Y, Sun L, Chen J, Fan M. Nomograms for predicting survival outcomes in patients with primary tracheal tumors: a large population-based analysis. Cancer Manag Res 2018; 10:6843-6856. [PMID: 30588090 PMCID: PMC6294060 DOI: 10.2147/cmar.s186546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The aim of this study was to develop and validate reliable nomograms to predict individual overall survival (OS) and cancer-specific survival (CSS) for patients with primary tracheal tumors and further estimate the role of postoperative radiotherapy (PORT) for these entities. Patients and methods A total of 405 eligible patients diagnosed between 1988 and 2015 were selected from the Surveillance, Epidemiology, and End Results database. All of them were randomly divided into training (n=303) and validation (n=102) sets. For the purpose of establishing nomograms, the Akaike information criterion was employed to select significant prognostic factors in multivariate Cox regression models. Both internal and external validations of the nomograms were evaluated by Harrell’s concordance index (C-index) and calibration plots. Propensity score matching (PSM) method was performed to reduce the influence of selection bias between the PORT group and the non-PORT group. Results Two nomograms shared common variables including age at diagnosis, histology, N and M stages, tumor size, and treatment types, while gender was only incorporated in the CSS nomogram. The C-indices of OS and CSS nomograms were 0.817 and 0.813, displaying considerable predictive accuracy. The calibration curves indicated consistency between the nomograms and the actual observations. When the nomograms were applied to the validation set, the results remained reconcilable. Moreover, the nomograms showed superiority over the Bhattacharyya’s staging system with regard to the C-indices. After PSM, PORT was not associated with significantly better OS or CSS. Only squamous cell carcinoma (SCC) patients in the PORT group had improved OS compared to non-PORT group. Conclusion The first two nomograms for predicting survival in patients with primary tracheal tumors were proposed in the present study. PORT seems to improve the prognosis of SCC patients, which needs further exploration.
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Affiliation(s)
- Junmiao Wen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Di Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Xinyan Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, People's Republic of China
| | - Yongbing Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou 215000, People's Republic of China
| | - Liang Sun
- School of Radiation Medicine and Protection, Medical College of Soochow University, Suzhou 215123, People's Republic of China
| | - Jiayan Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
| | - Min Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China,
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18
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Yegya-Raman N, Jhawar SR, Jabbour SK, Hussain S, Kim S. Radiation Therapy for Tracheobronchial Metastases from Head and Neck Squamous Cell Carcinoma. Cureus 2018; 10:e3151. [PMID: 30345207 PMCID: PMC6191010 DOI: 10.7759/cureus.3151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Tracheobronchial metastases from head and neck squamous cell carcinoma (HNSCC) represent a rare occurrence, with few reported cases in the literature. Here, we present two patients with HNSCC who developed tracheobronchial metastases at different time points in their disease course. Patient 1 presented with a localized tonsillar primary, underwent tonsillectomy and post-operative radiation therapy to the tumor bed and bilateral neck, and experienced multiple subsequent metastases in different locations throughout the tracheobronchial tree. Each time, she received surgery and/or chemoradiation therapy to the metastatic lesion(s). Patient 2 presented with a supraglottic primary metastatic to the carina and both mainstem bronchi, and, based on patient 1’s recurrence pattern and a suspicion for direct tumor extension, was treated upfront with definitive chemoradiation from the supraglottis down through much of the tracheobronchial tree. A year out from treatment, patient 2 has achieved excellent locoregional control with few treatment-related toxicities but unfortunately has developed new liver metastases not seen on pre-treatment imaging. This case highlights the difficulty in ascertaining the extent of metastatic spread for HNSCC patients with isolated tracheobronchial metastases and describes our approach to delivering curative-intent radiation therapy.
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Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Sachin R Jhawar
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Sabiha Hussain
- Division of Pulmonary and Critical Care Medicine, Robert Wood Johnson University Hospital, New Brunswick, USA
| | - Sung Kim
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
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19
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Abstract
Malignant airway tumors present particular challenges for surgeons, namely: to distinguish symptoms from those of the more frequent benign airway diseases; to separate metastatic disease from the uncommon primary tumors; and to consider curative resection in appropriate candidates. Here, we present a critical review of tracheal malignant obstruction, focusing on the evaluation of a patient with malignant airway tumor, patient selection for resection and the predictors of long-term survival. The new development in primary tracheal tumors is an old story, that of making physicians aware that resection rates in epidemiologic studies remain low, mainly because opportunities for resection are missed.
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Affiliation(s)
- Maria Lucia L Madariaga
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Henning A Gaissert
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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20
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Li Y, Wei R, Song S. Diagnostic and Prognostic Value of Serum Thymidine Kinase 1 in Cancer Patients. Indian J Hematol Blood Transfus 2018; 34:168-170. [DOI: 10.1007/s12288-017-0812-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 04/03/2017] [Indexed: 10/19/2022] Open
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21
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Survival trends in patients with tracheal carcinoma from 1973 to 2011. Am J Otolaryngol 2017; 38:673-677. [PMID: 28927948 DOI: 10.1016/j.amjoto.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/21/2017] [Accepted: 08/23/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE The prognosis for primary tracheal cancer is dismal. We investigated whether there has been improvement in survival in tracheal cancer patients and how treatment modality affected overall and cancer-specific survival. MATERIALS AND METHODS Using the Surveillance, Epidemiology, and End Results database, 1144 patients with tracheal cancer were identified between 1973 and 2011. Patients were stratified by age group, gender, race, tumor histology, and treatment modality. Radical surgery and survival rates based upon these stratifications were determined. Longitudinal analyses of survival and the percentage of patients undergoing surgery and radiation were conducted. RESULTS In the final cohort, 327 tracheal cancer patients (34%) underwent radical surgery. Patients of younger age, female gender, and who presented with non-squamous cell tumors were statistically more likely to undergo surgery. Over time, utilization of radiation has declined while use of radical surgery has increased. Concomitantly, 5-year survival has increased from approximately 25% in 1973 to 30% by 2006. Those who did not have surgery were 2.50 times more likely to die of tracheal cancer (95% Confidence Interval 2.00-3.11, p<0.001) than those who did have surgery. Additionally, patients who underwent radical surgery alone (without adjuvant radiation therapy) were 50% or 19% less likely to die of tracheal cancer than those who underwent no treatment or combination therapy, respectively (both p<0.001). CONCLUSIONS Survival in patients with tracheal cancer is improving over time. The utilization of radical surgery is increasing and confers the highest survival advantage to patients who are candidates.
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22
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Yathiraj PH, Ail S, Singh A, Mamidipudi V. Unresectable squamous cell carcinoma of upper trachea with long-term survival after concurrent chemoradiotherapy. BMJ Case Rep 2017; 2017:bcr-2017-221284. [PMID: 28801512 DOI: 10.1136/bcr-2017-221284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Upper tracheal malignancies are rare, and long-term survival is even rarer, especially among the unresectable malignancies. A 66-year-old chronic smoker was diagnosed as a locally advanced, non-metastatic squamous cell carcinoma of the upper trachea. Being unresectable, he was treated with six cycles of concurrent weekly cisplatin and three-dimensional conformal radiotherapy to a dose of 60 Gy in 30 fractions over 6 weeks. Follow-up imaging at 6 and 12 months revealed no disease. Our patient is presently 36 months post-treatment and is disease free without tracheal necrosis, fistula or radiation pneumonitis but developed hypothyroidism and is presently euthyroid. Concurrent chemoradiotherapy appears safe up to 3 years at least without any necrosis and is effective in controlling local disease. Meticulous planning obviates the need for higher technology like motion management techniques or intensity-modulated radiotherapy.
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Affiliation(s)
- Prahlad H Yathiraj
- Department of Radiotherapy and Oncology, Manipal University, Kasturba Medical College, Manipal, Karnataka, India
| | - Sandeep Ail
- Department of Radiotherapy and Oncology, Manipal University, Kasturba Medical College, Manipal, Karnataka, India
| | - Anshul Singh
- Department of Radiotherapy and Oncology, Manipal University, Kasturba Medical College, Manipal, Karnataka, India
| | - Vidyasagar Mamidipudi
- Department of Radiotherapy and Oncology, Manipal University, Kasturba Medical College, Manipal, Karnataka, India
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Doggett S, Chino S, Lempert T, Federhart J. Percutaneous CT-fluoroscopic-guided radioisotope seed placement for the management of adenoid cystic carcinoma of the trachea. Brachytherapy 2016; 16:639-645. [PMID: 28039009 DOI: 10.1016/j.brachy.2016.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE Tracheal and paratracheal malignancies present challenges in radiotherapeutic management due to their proximity to sensitive structures, central location, and because of the potential for catastrophic radiation induced fistula. The use of external beam radiation therapy and intraluminal brachytherapy has a limited number of reports in the literature. We have searched for a technique for treating tracheal and paratracheal malignancies allowing application of a high dose of radiation while minimizing dose to normal tissues. Our group has considerable experience in the use of percutaneous CT-guided radioisotope seed implants for intrathoracic malignancies. We have previously reported our technique for percutaneous CT-fluoroscopic-guided radioisotope seed implants in the management of thoracic malignancies. We have now treated several tracheal and paratracheal malignancies with our technique and report our results here. This is to our knowledge the first report of treatment of tracheal malignancy with CT-guided permanent seed implant. METHODS AND MATERIALS Three patients with tracheal adenoid cystic carcinoma were implanted with 103Pd under CT-fluoroscopic guidance utilizing percutaneous approach. RESULTS All patients tolerated the procedure well, and at 9-month average followup, all show disease regression, symptom improvement, and no sign of toxicity. CONCLUSIONS We believe this to be the first published series on CT-directed permanent seed brachytherapy for tracheal malignancies. Review of PubMed literature to 1990 discloses no prior writings on the use of permanent seed implantation for tracheal cancers. Tracheal malignancies provide a vexing radiation therapy challenge to stay within the therapeutic window. CT-directed permanent seed brachytherapy allows a high dose to be delivered to the tumor with a rapid falloff to the surrounding tissues. Short-term results from seed implant are excellent. Our 3 patients responded well in the short term to permanent seed brachytherapy with no chronic side effects and with reduction or relief of cough and pain. CT-fluoro-guided permanent seed implantation is an effective and low morbidity treatment for tracheal malignancies. Long-term followup is needed to further elucidate durability of response and toxicity.
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Affiliation(s)
- Stephen Doggett
- Radiation Oncology, Mission Regional Medical Center, Mission Viejo, CA.
| | - Shigeru Chino
- Thoracic Surgery, Mission Regional Medical Center, Mission Viejo, CA
| | - Todd Lempert
- Interventional Radiology, Mission Regional Medical Center, Mission Viejo, CA
| | - Jay Federhart
- Interventional Radiology, Mission Regional Medical Center, Mission Viejo, CA
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24
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Napieralska A, Miszczyk L, Blamek S. Tracheal cancer - treatment results, prognostic factors and incidence of other neoplasms. Radiol Oncol 2016; 50:409-417. [PMID: 27904449 PMCID: PMC5120581 DOI: 10.1515/raon-2016-0046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 06/16/2016] [Indexed: 12/15/2022] Open
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.
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Affiliation(s)
- Aleksandra Napieralska
- Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Leszek Miszczyk
- Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Sławomir Blamek
- Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
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Gurria JP, De Acosta DM, Hafezi N, Yousif EB, AlAmeer E, Anderson RC. Spindle cell sarcomatoid carcinoma of the trachea: first case report of surgical resection. J Cardiothorac Surg 2016; 11:128. [PMID: 27495807 PMCID: PMC4974669 DOI: 10.1186/s13019-016-0524-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary malignant tracheal tumors are rare, accounting for approximately 0.2 % of respiratory tract tumors yearly, with squamous cell carcinomas and adenoid cystic carcinomas accounting for two-thirds of these cases. Sarcomatoid carcinomas are a group of poorly differentiated non-small cell lung carcinomas containing a component of sarcoma or sarcoma-like (spindle and/or giant cell) differentiation, categorized into five morphologic subgroups. Spindle cell sarcomatoid carcinoma is a rare variant of sarcomatoid carcinomas, consisting of only spindle-shaped tumor cells. Only one other case has been reported as a primary tracheal tumor. CASE PRESENTATION We present a 75-year-old male, having progressive dyspnea and cough, with a spindle cell sarcomatoid carcinoma tumor visualized on chest computed tomography scan and confirmed with biopsy. CONCLUSIONS Due to its low incidence, knowledge of treatment methods, prognostic factors, and etiology is limited thus approaches to eradication have widely varied. We are reporting the second published case of spindle cell sarcomatoid carcinoma of the trachea and the first reported successful outcome of definitive treatment with tracheal resection.
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Affiliation(s)
- Juan P Gurria
- Department of Surgery, University of Illinois College of Medicine at Peoria, 624 N.E. Glen Oak Avenue, Ste. 2680, Peoria, IL, 61603-3135, USA.
| | - David M De Acosta
- Department of Surgery, University of Illinois College of Medicine at Peoria, 624 N.E. Glen Oak Avenue, Ste. 2680, Peoria, IL, 61603-3135, USA
| | - Niloufar Hafezi
- Department of Surgery, University of Illinois College of Medicine at Peoria, 624 N.E. Glen Oak Avenue, Ste. 2680, Peoria, IL, 61603-3135, USA
| | - Eman B Yousif
- Department of Surgery, University of Illinois College of Medicine at Peoria, 624 N.E. Glen Oak Avenue, Ste. 2680, Peoria, IL, 61603-3135, USA
| | - Ehab AlAmeer
- Department of Surgery, University of Illinois College of Medicine at Peoria, 624 N.E. Glen Oak Avenue, Ste. 2680, Peoria, IL, 61603-3135, USA
| | - Richard C Anderson
- Department of Surgery, University of Illinois College of Medicine at Peoria, 624 N.E. Glen Oak Avenue, Ste. 2680, Peoria, IL, 61603-3135, USA
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Case report of tracheobronchial squamous cell carcinoma treated with radiation therapy and concurrent chemotherapy. Adv Radiat Oncol 2016; 1:127-131. [PMID: 28740880 PMCID: PMC5506744 DOI: 10.1016/j.adro.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 03/10/2016] [Accepted: 03/18/2016] [Indexed: 12/17/2022] Open
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Abstract
PURPOSE OF REVIEW This article reviews the current literature for the purpose of developing a practical approach for the diagnosis and management of primary tracheal tumors. RECENT FINDINGS Because of nonspecific symptoms, tracheal tumors remain a diagnostic challenge. Currently available management strategies are not being optimally utilized due to lack of physician awareness and knowledge. The use of newer diagnostic modalities has increased diagnostic accuracy resulting in earlier detection in recent years. This review describes currently available diagnostic modalities along with relatively newer ones such as virtual bronchoscopy, anatomic Optical Coherence Tomography, spectroscopic techniques, and endobronchial ultrasonography. We will review and discuss management strategies including surgical options, adjuvant therapies, and interventional pulmonary techniques including their role in palliation. SUMMARY Early detection along with improved surgical and interventional pulmonology techniques has led to a decline in the death rates from tracheal cancer in recent years. However, further studies are required to define the role of chemotherapeutic agents, combination therapies, and novel techniques such as tracheal transplantation, in the management of primary tracheal tumors. More robust evidence-based studies are needed to provide evidence for clinical practice guidelines for the treatment of primary tracheal tumors.
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Yang H, Yao F, Tantai J, Zhao Y, Tan Q, Zhao H. Resected Tracheal Adenoid Cystic Carcinoma: Improvements in Outcome at a Single Institution. Ann Thorac Surg 2016; 101:294-300. [DOI: 10.1016/j.athoracsur.2015.06.073] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 12/17/2022]
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Abstract
A patient identified with tracheal cancer benefits most from evaluation by an experienced center and an extensive effort to assess the possibility of a complete surgical resection as the most efficient treatment option for cure. Localized, nonoperable disease may still be controlled by combined modality using chemotherapy and concurrent radiation.
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