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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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2
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Eichhorn F, Hoffmann H, Rieken S, Herth FJF, Winter H. [Tracheal Tumours]. Zentralbl Chir 2024; 149:286-297. [PMID: 38382560 DOI: 10.1055/a-2223-1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Malignant primary tracheal tumours are rare. The most common histological subtypes are squamous cell carcinoma and adenoid cystic carcinoma. These two entities have different prognoses and growth patterns. Tracheobronchoscopy and thoracic sectional imaging are standard diagnostic tools for tumour staging and local evaluation. Complete surgical resection of the affected tracheal segment is the treatment of choice for limited disease without distant metastases. Incomplete gross tumour resection with additional irradiation is an acceptable therapeutic option for adenoid cystic carcinoma. Interventional endoscopy with tumour debulking or tracheal stenting and/or definitive mediastinal radiotherapy are treatment alternatives in either a locally advanced or palliative setting.
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MESH Headings
- Tracheal Neoplasms/surgery
- Tracheal Neoplasms/pathology
- Tracheal Neoplasms/diagnosis
- Tracheal Neoplasms/therapy
- Tracheal Neoplasms/diagnostic imaging
- Humans
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Adenoid Cystic/diagnostic imaging
- Carcinoma, Adenoid Cystic/therapy
- Carcinoma, Adenoid Cystic/diagnosis
- Bronchoscopy
- Neoplasm Staging
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/therapy
- Carcinoma, Squamous Cell/diagnostic imaging
- Trachea/surgery
- Trachea/pathology
- Trachea/diagnostic imaging
- Prognosis
- Combined Modality Therapy
- Tomography, X-Ray Computed
- Stents
- Palliative Care
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Affiliation(s)
- Florian Eichhorn
- Abteilung für Thoraxchirurgie, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
| | - Hans Hoffmann
- Sektion Thoraxchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Stefan Rieken
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universität Göttingen, Medizinische Fakultät, Göttingen, Deutschland
| | - Felix J F Herth
- Abteilung für Pneumologie und Beatmungsmedizin, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
| | - Hauke Winter
- Abteilung für Thoraxchirurgie, Thoraxklinik-Heidelberg gGmbH, Heidelberg, Deutschland
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3
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Piórek A, Płużański A, Teterycz P, Tabor S, Winiarczyk K, Knetki‐Wróblewska M, Kowalski DM, Krzakowski M. Clinicopathological characteristics of patients with primary tracheal tumors: Analysis of eighty-nine cases. Thorac Cancer 2024; 15:878-883. [PMID: 38429910 PMCID: PMC11016403 DOI: 10.1111/1759-7714.15231] [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: 11/10/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Primary tracheal tumors are very rare and the literature on this subject is limited. The most common histological type of primary tracheal tumors is squamous cell carcinoma (SCC), followed by adenoid cystic carcinoma (ACC). Limited knowledge exists regarding the behavior and outcomes of different histological types of tracheal cancers. The present study aimed to address this gap by assessing the significance of the histological type of primary tracheal tumors based on our own data and to review the literature. 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, between 2000 and 2016. The study assessed patient demographics, tumor characteristics and treatment, with a focus on SCC, ACC, and other histological types. Different histological types were compared in terms of overall survival, disease-free survival, and progression-free survival. RESULTS SCC was the most frequently diagnosed histological type (56.2%), followed by ACC (21.3%). Patients with SCC were typically older (78% over 60 years), predominantly male (66%), and associated with smoking. In contrast, the ACC had a more balanced gender distribution and did not correlate with smoking. ACC displayed a significantly better prognosis, with a median overall survival of 129.4 months, compared with 9.0 months for SCC. CONCLUSION Histological type plays a crucial role in the prognosis of primary tracheal tumors. ACC demonstrated a more favorable outcome compared with SCC.
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Affiliation(s)
- Aleksandra Piórek
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Adam Płużański
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and MelanomaMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
- Department of Computational OncologyMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Sylwia Tabor
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Kinga Winiarczyk
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Magdalena Knetki‐Wróblewska
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Dariusz M. Kowalski
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Maciej Krzakowski
- Department of Lung Cancer and Thoracic TumorsMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
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4
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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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5
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Nilssen Y, Solberg S, Brustugun OT, Møller B, Sundset A, Wahl SGF, Helland Å. Tracheal cancer: a rare and deadly but potentially curable disease that also affects younger people. Eur J Cardiothorac Surg 2023; 64:ezad244. [PMID: 37348858 PMCID: PMC10329490 DOI: 10.1093/ejcts/ezad244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/26/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES The incidence of tracheal cancer is low, few clinicians get much experience and the awareness may be low. Recent data on the treatment and outcome are limited. The aim of the present study was to present updated, national data on the incidence, characteristics, treatment and outcome for patients with tracheal cancer. METHODS All tracheal cancers registered at the Cancer Registry of Norway in 2000-2020 were extracted. The patient and tumour characteristics age, sex, stage, histology and treatment modality (surgery and radiotherapy) were examined. Overall, median and relative survival were estimated. Cox regression models were used to identify independent prognostic factors. RESULTS The 77 patients diagnosed with tracheal cancer equals a crude incidence rate and an age-standardized incidence rate of 0.075 and 0.046 per 100,000 per year respectively. The mean age was 63.8 years (range: 26-94). The numerical preponderance of men (n = 41) is not statistically significant. Eighteen patients (23.4%) were diagnosed in the localized stage. The 5-year overall survival was 31.7% [95% confidence interval (CI): 21.0-42.9], and in those treated with surgical resection or curative radiotherapy, it was 53.7% (95% CI: 26.1-75.0) and 37.8% (95% CI: 18.8-56.7), respectively. Age, histological type and treatment modality were identified as independent prognostic factors. CONCLUSIONS Despite improved survival, the prognosis for patients with tracheal cancer is still poor. Few are diagnosed in the early stage and thus most are not eligible for curative treatment, mainly surgery. An increased awareness and diagnosis in the earlier stage is crucial.
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Affiliation(s)
- Yngvar Nilssen
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Steinar Solberg
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
- Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Odd Terje Brustugun
- Section of Oncology, Vestre Viken Hospital Trust, Drammen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Arve Sundset
- Department of Pulmology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Sissel Gyrid Freim Wahl
- Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Åslaug Helland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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6
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Caramujo C, da Cruz RM, Marques RV, Jesus E. Primary adenoid cystic carcinoma of the trachea: an elusive diagnosis of chronic dyspnoea. BMJ Case Rep 2022; 15:e250227. [PMID: 35944942 PMCID: PMC9367189 DOI: 10.1136/bcr-2022-250227] [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] [Accepted: 07/28/2022] [Indexed: 11/03/2022] Open
Abstract
Primary adenoid cystic carcinoma (ACC) of the trachea is a rare entity, with a 5-year survival between 50% and 80% for resectable cases and 30% in case of unresectable disease. We report a case of a primary ACC on a woman in her 70s that presented with a drawn-out history of dyspnoea. She was diagnosed with an unresectable obstructive tumour of the trachea, which required the placement of a Y-shaped stent. The patient underwent concomitant chemoradiotherapy, with partial response, and is still in follow-up, without evidence of disease progression.
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Affiliation(s)
- Cecília Caramujo
- Department of Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Rafael Moiteiro da Cruz
- Department of Pathology, Hospital de Santa Maria, Lisboa, Portugal
- Universidade de Lisboa Faculdade de Medicina, Lisboa, Portugal
| | - Rui Vale Marques
- Department of Radiotherapy, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Emanuel Jesus
- Department of Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
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7
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He J, Zhong Y, Suen HC, Sengupta A, Murthy RA, Stoelben E, Carretta A, Toker A, Wang C, He J, Li S. The procedure and effectiveness of release maneuvers in tracheobronchial resection and reconstruction. Transl Lung Cancer Res 2022; 11:1154-1164. [PMID: 35832456 PMCID: PMC9271432 DOI: 10.21037/tlcr-22-385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
Background Surgical resection and reconstruction are effective and radical treatments for tracheal tumors. Tension-free, well-perfused anastomosis plays a crucial role in postoperative prognosis. The use of various release maneuvers may be required to minimize anastomotic tension. However, the detailed procedures and effectiveness of them are seldomly reported. In the current study, we demonstrated the procedures and advantages of various release maneuvers during tracheal resection and reconstruction. Methods All patients who underwent tracheobronchial resection and reconstruction between January 2019 to December 2021 were included in the study. The patients underwent tracheal release maneuvers, including laryngeal suprahyoid, pericardial, hilar, and inferior pulmonary ligament releasing. The patients’ clinical features, surgical procedures, complications and postoperative outcomes were also described. Results A total of 67 patients received release maneuvers during tracheobronchial surgery. Males accounted for a greater proportion (46/67, 65.7%) of the cohort. The mean age was 44.4 years. Most lesions were located in the thoracic and cervical trachea (21/67 and 17/67, respectively), and 18 cases of carinal (9/67) and bronchial (9/67) lesions were also included. Inferior pulmonary ligament releasing was applied to most noncervical lesion patients (39/67). Two cases of thyroid carcinoma with tracheal invasion received laryngeal suprahyoid release maneuvers. Adenoid cystic carcinoma (26.9%) and squamous cell carcinoma (14.9%) were the most commonly seen malignancies. Postoperative bronchoscopy showed no anastomotic abnormalities, including ischemic change, necrosis, or dehiscence. The median postoperative hospital stay was 7 days, ranging from 4 to 38 days. In the current study, a patient with postoperative aspiration had the longest hospital stay. In addition, 3 cases of anastomotic stenosis and laryngeal edema were observed. No other maneuver-related complications or particular discomforts were reported during the 6-month follow-up. Conclusions Anastomosis is the key to successful tracheobronchial resection and reconstruction. Release maneuvers are recommended to facilitate tension-free anastomosis. In addition to simple neck flexion and paratracheal dissection, laryngeal, hilar, and pericardial releasing allow longer trachea to be resected and preservation of well-vascularized anastomosis. The release maneuvers showed acceptable effect and reliable safety without significant morbidity or mortality.
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Affiliation(s)
- Jiaxi He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Yunpeng Zhong
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Hon-Chi Suen
- Hong Kong Cardiothoracic Surgery Center, Hong Kong, China
| | - Aditya Sengupta
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raghav A Murthy
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eirch Stoelben
- Department of Thoracic Surgery, Lung Clinic Merheim, Hospital of Cologne, University of Witten-Herdecke, Cologne, Germany
| | - Angelo Carretta
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Chudong Wang
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Shuben Li
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.,National Clinical Research Center for Respiratory Disease, Guangzhou, China
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8
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Do We Need TNM for Tracheal Cancers? Analysis of a Large Retrospective Series of Tracheal Tumors. Cancers (Basel) 2022; 14:cancers14071665. [PMID: 35406437 PMCID: PMC8997166 DOI: 10.3390/cancers14071665] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary The TNM (tumor, node, metastases) staging system established by the Union for International Cancer Control/American Joint Committee on Cancer is commonly used to select a treatment method for patients with cancers, guide adjuvant therapy after surgery, and predict the prognosis. It is an essential tool for working with cancer patients in everyday medical practice. Currently, the eighth edition of the TNM staging system is used. Primary tracheal tumors are uncommon neoplasms. Probably due to their rarity, neither an AJCC staging system nor other, widely accepted staging system exists for primary tracheal cancers. Only a few studies stated their proposed guidelines for the staging of tracheal neoplasms. The absence of a universally adopted staging system makes it difficult for clinicians to assess tracheal cancers properly. This makes it challenging to conduct analyses and compare the results of published works. A standard classification system would help assess and qualify patients for treatment and, perhaps, establish uniform indications for adjuvant treatment. All this could contribute to an increase in the proportion of patients qualified for radical surgery, which is the preferred treatment method. Abstract Due to the low incidence of primary tracheal neoplasms, there is no uniform system for staging of this disease. Our retrospective analysis based on registry data included 89 patients diagnosed with primary tracheal cancer at the National Research Institute of Oncology in Warsaw, Poland, between January 2000 and December 2016. We analyzed demographic, clinical, pathological, therapeutic, and survival data. The staging—for the purpose of our analysis—was performed retrospectively on the basis of imaging results. Tumor (T) category was defined as a disease confined to the trachea or lesion derived from the trachea and spreading to adjacent structures and organs. Node (N) and metastases (M) categories were divided into absence/presence of metastasis in regional lymph nodes and the absence/presence of distant metastasis. Survival analysis was performed depending on the clinical presentation of these features. There was a significant difference in overall survival depending on the T, N, M categories in the entire group. In the group of patients undergoing radical treatment, the T and N categories had a statistically significant impact on overall survival. In the group of patients treated with palliative aim, only the T category had an impact on overall survival. Multivariate analysis showed statistical significance for the T category in patients undergoing radical and those receiving palliative treatment. The assessment of the anatomical extent of lesions may help decide about treatment options and prognosis.
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9
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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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10
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Primary tracheal microcystic reticular schwannoma - Case report of a rare neurogenic tumor treated by segmental tracheal resection. Int J Surg Case Rep 2021; 79:251-254. [PMID: 33485177 PMCID: PMC7820791 DOI: 10.1016/j.ijscr.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/06/2021] [Accepted: 01/09/2021] [Indexed: 02/05/2023] Open
Abstract
Knowledge about tracheal tumors is important to avoid misdiagnosis. Awareness of the option of tracheal resection is necessary to avoid suboptimal treatment recommendations. Microcystic reticular schwannoma is a rare variant of a neurogenic tumor and may occur in the trachea. Complete resection should be considered even without clear preoperative tumor histology. Tracheal segmental resection is a safe procedure and treatment of choice for resectable, intra-/transmural tumors causing tracheal obstruction.
Introduction and importance Diagnosis and treatment of rare diseases are challenging because experience and evidence are limited. Primary tracheal tumors have a low prevalence but awareness of these is important to avoid misdiagnoses. We present a first case of a tracheal microcystic reticular schwannoma in which diagnosis and treatment recommendations were revised several times resulting in months of anxious uncertainty for the patient before complete resection and extensive histopathologic examination were performed. Case presentation A 65-year old woman complained about coughing and cervical pain. Tomographies revealed a tumor of the dorsolateral trachea. After repeated biopsies pathologists and tumorboards in different hospitals could not agree on diagnosis or treatment recommendation, so the impatient patient opted for a complete resection for definite treatment. Clinical discussion Neoplasms of the posterior mediastinum are mainly neurogenic. In rare cases they may originate in the trachea and can be difficult to differentiate from other tumor entities if only biopsies are available. Although the preoperative diagnosis was unclear, tracheal resection was performed successfully. The differential diagnoses of soft tissue sarcoma or myoepithelioma were discarded and a benign, microcystic, reticular schwannoma was confirmed by international reference pathologists. Conclusion Microcystic, reticular schwannoma is a rare variant and may occur in the trachea. Diagnosis of such rare neoplasms can be difficult, resulting in delayed or suboptimal treatment. Often biopsies are not sufficient to reach a definite diagnosis. But even without preoperative histology, tracheal resection is a safe and feasible option for definitive treatment with very low recurrence rates.
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11
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Criner GJ, Eberhardt R, Fernandez-Bussy S, Gompelmann D, Maldonado F, Patel N, Shah PL, Slebos DJ, Valipour A, Wahidi MM, Weir M, Herth FJ. Interventional Bronchoscopy. Am J Respir Crit Care Med 2020; 202:29-50. [PMID: 32023078 DOI: 10.1164/rccm.201907-1292so] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
For over 150 years, bronchoscopy, especially flexible bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions, and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and therapeutic treatments besides aspiration of airway secretions, however, has been limited. Challenges to the wider use of flexible bronchoscopy have included difficulty in navigating to the lung periphery, the avoidance of vasculature structures when performing diagnostic biopsies, and the ability to biopsy a lesion under direct visualization. The last 10-15 years have seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to lung lesions, and the ability to visualize lesions during biopsy. Moreover, multiple new techniques have either become recently available or are currently being investigated to treat a broad range of airway and lung parenchymal diseases, such as asthma, emphysema, and chronic bronchitis, or to alleviate recurrent exacerbations. New bronchoscopic therapies are also being investigated to not only diagnose, but possibly treat, malignant peripheral lung nodules. As a result, flexible bronchoscopy is now able to provide a new and expanding armamentarium of diagnostic and therapeutic tools to treat patients with a variety of lung diseases. This State-of-the-Art review succinctly reviews these techniques and provides clinicians an organized approach to their role in the diagnosis and treatment of a range of lung diseases.
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Affiliation(s)
- Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ralf Eberhardt
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | | | - Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Fabien Maldonado
- Department of Medicine and Department of Thoracic Surgery, Vanderbilt University, Nashville, Tennessee
| | - Neal Patel
- Division of Pulmonary Medicine, Mayo Clinic, Jacksonville, Florida
| | - Pallav L Shah
- Respiratory Medicine at the Royal Brompton Hospital and National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Krankenhaus Nord, Vienna, Austria; and
| | - Momen M Wahidi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mark Weir
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Felix J Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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12
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Hao ZR, Yao ZH, Zhao JQ, Li DZ, Wan YY, Kang YM, Lin DJ. Clinical efficacy of treatment for primary tracheal tumors by flexible bronchoscopy: Airway stenosis recanalization and quality of life. Exp Ther Med 2020; 20:2099-2105. [PMID: 32782522 PMCID: PMC7401314 DOI: 10.3892/etm.2020.8900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 01/06/2020] [Indexed: 01/09/2023] Open
Abstract
The aim of the present study was to evaluate the effectiveness of interventional treatment of primary tracheal tumors through flexible bronchoscopy. The clinical data of 38 patients with primary tracheal tumours who underwent flexible bronchoscopy intervention therapy between January 2011 and January 2017 were retrospectively analyzed. The average time interval from onset of symptoms to the appearance of actual clinical manifestations in the 38 patients ranged from 0 to 60 months, with an average of 8.1±11.6 months and a median of 4.2 months. The rate of misdiagnosis at the first visit was 36.8% (14/38). After interventional treatment, the overall efficiency (complete + partial response) of airway stenosis recanalization in the 38 patients was 89.5%. In 3 patients with benign tumors, the anhelation score was reduced following treatment (1.00±0.77 vs. 3.13±1.21 at the pre-treatment stage; P<0.001). The overall survival rates of the 35 patients at 1, 3 and 5 years were 69.3, 48.7 and 20.3%, respectively. Therefore, flexible bronchoscopic intervention may effectively smoothen the airways of patients and relieve the symptoms of anhelation. Combining radiotherapy and chemotherapy may improve patient prognosis and safety.
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Affiliation(s)
- Ze-Rui Hao
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China.,Department of Respiratory Medicine, The Second People's Hospital of Liaocheng Affiliated to Taishan Medical College, Linqing, Shandong 252601, P.R. China
| | - Zhou-Hong Yao
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Jing-Quan Zhao
- Department of Respiratory Medicine, Beijing Tsinghua Changgung Hospital, Beijing 102218, P.R. China
| | - De-Zhi Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yun-Yan Wan
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Yan-Meng Kang
- Department of Respiratory Medicine, Qianfo Mountain Hospital, School of Medicine, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Dian-Jie Lin
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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13
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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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14
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Challenging tracheal resection anastomosis: Case series. Auris Nasus Larynx 2020; 47:616-623. [PMID: 32035696 DOI: 10.1016/j.anl.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/21/2019] [Accepted: 01/21/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study was conducted to review our experience in Otorhinolaryngology Department, Mansoura University Hospitals, Egypt, in the last 2 years in the management of high-risk patients who underwent cricotracheal resection due to different pathologies. METHODS This case series included nine patients with severe, grade III or IV subglottic / cervical tracheal stenosis. These patients were considered high risk patients due to unusual pathology / etiology of stenosis or associated surgical field morbidity. Four patients had recurrent stenosis after previous unsuccessful cricotracheal resection, three patients had subglottic stenosis due to external neck trauma which compromised the surgical field. One patient had upper tracheal neoplasm, and in 1 patient there was upper tracheal stenosis associated with tracheo-esophageal fistula. RESULTS Successful decannulation was achieved in all patients (n = 9) without any reported major intraoperative or postoperative compilations. CONCLUSION Cases of subglottic / upper tracheal stenosis due to uncommon pathologies like neoplastic lesions, external neck trauma compromising the surgical field and revision cricotracheal resection, can be successfully managed by cricotracheal resection. However, a highly skilled team, well familiar with these surgeries, is mandatory to achieve an optimum outcome.
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15
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Fast cyclical-decellularized trachea as a natural 3D scaffold for organ engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 105:110142. [DOI: 10.1016/j.msec.2019.110142] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 08/15/2019] [Accepted: 08/26/2019] [Indexed: 12/16/2022]
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16
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Rabiou S, Alami B, Efared B, Lakranbi M, Harmouchi H, El-Amrani R, Serraj M, El-Bouazzaoui A, Ouadnouni Y, Kanja N, Smahi M. How thoracic surgeon manage tracheal tumors in African country? (Case series). Ann Med Surg (Lond) 2019; 44:13-19. [PMID: 31289669 PMCID: PMC6593208 DOI: 10.1016/j.amsu.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/05/2019] [Accepted: 06/08/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Tracheal tumors are a rare pathological entity whose diagnosis is usually delayed by clinical latency. Surgery, which consists of a tracheal resection-anastomosis with or without reconstructive reconstruction, remains the treatment that ensures the best long-term survival. Methods This is a retrospective study about 8 patients admitted in the department of thoracic surgery of Hassan II's university hospital of Fes for tracheal tumors management during 7 years time (December 2010 to December 2017). Results There were 6 men and 2 women with an average age of 44.4 years ranged from 17 to 65 years, 4 were smokers. Dyspnea was the main trigger sign. Seven (7) have undergone bronchial fibroscopy diagnostic with a finding of budding process in 5 patients, the middle of the trachea is often concerned in 3 patients, obstructing the lumen of the trachea in almost all patients. The treatment in all patients was surgical with an intubation via the operative field, 4 trachea resection-anastomosis, 4 plasty (Lateral resection with V plasty, Kergin's plasty, Mattey's tracheobronchial anastomosis and widened V-resection to the carina). The most common histological type in our series was Adenoid Cystic Carcinoma in 2 of our patients. For the other patients we have found squamous cell carcinoma (1 case), adenocarcinoma (1 case), atypical carcinoid tumor (1 case), low grade mucoepidermoid carcinoma (1 case), an adenoma pleomorph (1 case) and endotracheal goiter (1 case). The operative follow-up was simple in 7 of our patients, all of whom underwent post-operative fibroscopy within an average of 9 days. Two cases of post-operative recurrent palsy had been observed, all of which had progressed well under treatment. We have noted 2 deaths, including one at day 4 post-operative, and the other died from complications of post-radiation tracheal stenosis. Back to 32 months' average follow-up, we have enregistered a case of a distant relapse by cervical lymph node metastasis in one patient, 5 years after surgery. Conclusion Primary tumors of the trachea remain of reserved prognosis with 5-year survival of 57% of all histological types combined. Computed tomodensitometry and tracheobronchial fibroscopy remain the means of reference exploration in the diagnosis and assessment of surgical resectability.
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Affiliation(s)
- Sani Rabiou
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Université de Niamey, Niger
| | - Badredine Alami
- Department of Radiology, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | | | - Marwane Lakranbi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | | | - Rim El-Amrani
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
| | - Mounia Serraj
- Department of Pneumology, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Université de Niamey, Niger
| | - Abderrahim El-Bouazzaoui
- Department of Anaesthesiology and Resuscitation A4, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Nabil Kanja
- Department of Anaesthesiology and Resuscitation A4, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Mohamed Smahi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
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Oliveira CM, Colaiácovo R, Araki O, Domene AFC, Mamede Filho DO, Saieg MA, Rossini LGB. The role of endoscopic ultrasound in the staging of tracheal neoplasm: a brief review. ACTA ACUST UNITED AC 2019; 65:589-591. [PMID: 31166431 DOI: 10.1590/1806-9282.65.5.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 11/21/2022]
Abstract
Our case report shows the complexity of dealing with tracheal tumors, highlighting the importance of the method used for staging. In this report, endoscopic ultrasound (EUS) was crucial to identify the involvement of the esophageal muscular propria in a tracheal tumor and change the surgical planning of the case. Staging this kind of tumor represents a challenge for physicians. There is no evidence in the literature on which methods represent the gold standard for T staging.
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Affiliation(s)
- Cristiane Mota Oliveira
- EUS fellowship, French-Brazilian Center of Endoscopy (CFBEUS), Santa Casa of São Paulo, Brasil
| | - Rogerio Colaiácovo
- Assistant physician, French-Brazilian Center of Endoscopy (CFBEUS), Santa Casa of São Paulo, Brasil
| | - Osvaldo Araki
- Assistant physician, French-Brazilian Center of Endoscopy (CFBEUS), Santa Casa of São Paulo, Brasil
| | | | | | - Mauro Ajaj Saieg
- Associate Professor, Patology departament, Santa Casa Medical School, Brasil
| | - Lucio Giovanni Battista Rossini
- Head physician, French-Brazilian Center of Endoscopy (CFBEUS), Santa Casa of São Paulo, Brasil. Manager of the Endoscopy Service of the Sírio-Libanês Hospital, São Paulo, Brasil. Endoscopist at Samaritano Hospital, São Paulo, Brasil. Case report conducted at the French-Brazilian Center of Endoscopy (CFBEUS) and Endoscopy department of the Santa Casa of São Paulo, Brasil
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18
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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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Bedayat A, Yang E, Ghandili S, Galera P, Chalian H, Ansari-Gilani K, Guo HH. Tracheobronchial Tumors: Radiologic-Pathologic Correlation of Tumors and Mimics. Curr Probl Diagn Radiol 2019; 49:275-284. [PMID: 31076268 PMCID: PMC7115773 DOI: 10.1067/j.cpradiol.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/19/2019] [Accepted: 04/02/2019] [Indexed: 12/26/2022]
Abstract
Tracheobronchial masses encompass a broad spectrum of entities, ranging from benign and malignant neoplasms to infectious and inflammatory processes. This article reviews the cross-sectional findings of tracheal tumors and tumor-like entities, correlates imaging findings with histologic pathology, and discusses pearls and pitfalls in accurately diagnosing and classifying tracheal tumors and mimics.
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Affiliation(s)
- Arash Bedayat
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of diagnostic Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Radiology, Stanford University Medical center, Stanford, CA.
| | - Eric Yang
- Department of Pathology, Stanford University Medical center, Stanford, CA; Department of diagnostic Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Radiology, Stanford University Medical center, Stanford, CA
| | - Saeed Ghandili
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA; Department of diagnostic Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Radiology, Stanford University Medical center, Stanford, CA
| | - Pallavi Galera
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA, USA; Department of diagnostic Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Radiology, Stanford University Medical center, Stanford, CA
| | - Hamid Chalian
- Department of Radiology, Duke University, Durham, NC, USA; Department of diagnostic Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Radiology, Stanford University Medical center, Stanford, CA
| | - Kianoush Ansari-Gilani
- Department of diagnostic Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Heiwei Henry Guo
- Department of Radiology, Duke University, Durham, NC, USA; Department of diagnostic Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH; Department of Radiology, Stanford University Medical center, Stanford, CA
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20
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Chowdhary RL, Chufal KS, Pahuja AK, Bhushan M, Singh R, Ahmad I. Image-guided volumetric modulated arc therapy (IG-VMAT) for unresectable ACC of the trachea: a feasible curative option. BMJ Case Rep 2019; 12:12/3/e227128. [PMID: 30902839 DOI: 10.1136/bcr-2018-227128] [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
A middle-aged man presented with progressively worsening breathlessness and non-productive cough for the last 3 months. On examination, his breathing was stridulous and air entry was decreased bilaterally. He underwent emergency fibre-optic bronchoscopy, which revealed a tracheal growth causing luminal narrowing, and after tumour debulking, he improved symptomatically. Histopathological evaluation of the specimen revealed an adenoid cystic carcinoma of the trachea, and systemic evaluation revealed metastatic dissemination. Systemic molecular-targeted therapy was initiated (gefitinib and later imatinib mesylate) and continued for 5 years, in view of stable disease on periodic follow-up. He subsequently presented with breathlessness again, which was managed with an emergency tracheostomy. In view of stable systemic disease and local progression only, he received definitive radiotherapy with image-guided volumetric modulated arc therapy, which resulted in a complete radiological response. The patient has been disease-free for the last 9 months.
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Affiliation(s)
- Rahul Lal Chowdhary
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Kundan Singh Chufal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Anjali Kakria Pahuja
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Manindra Bhushan
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Rajpal Singh
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Irfan Ahmad
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
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Issoufou I, Belliraj L, Harmouchi H, Ammor FZ, Lakranbi M, Ouadnouni Y, Smahi M. [Surgery of primary tracheal tumours of the salivary gland type]. Rev Mal Respir 2019; 36:547-552. [PMID: 30691699 DOI: 10.1016/j.rmr.2019.01.001] [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: 04/21/2018] [Accepted: 09/05/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Primary tumours of the trachea are very rare and may develop from the tracheal salivary glands. CASE REPORTS We describe four patients operated on in our service between 2010 and 2017 of whom two had an adenocystic carcinoma, one a mucoepidermoid carcinoma and one a pleomorphic adenoma of the trachea. All were treated by resection and tracheal anastomosis with clear margins in three cases. The malignant cases received adjuvant treatment consisting of radiotherapy in one case and radiochemotherapy in the second. Immediate postoperative recovery was uncomplicated in all patients. One death followed the developement of post irradiation tracheal stenosis two years after surgery in a patient with an adenocystic carcinoma where the resection margins were invaded by tumour. CONCLUSIONS Resection and anastomosis of the trachea remains the best therapeutic option with a better prognosis when the resection is complete.
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Affiliation(s)
- I Issoufou
- Service de chirurgie thoracique, CHU Hassan II, BP. 1893, Km 2.200, route de Sidi Harazem, 30000 Fès, Maroc.
| | - L Belliraj
- Service de chirurgie thoracique, CHU Hassan II, BP. 1893, Km 2.200, route de Sidi Harazem, 30000 Fès, Maroc
| | - H Harmouchi
- Service de chirurgie thoracique, CHU Hassan II, BP. 1893, Km 2.200, route de Sidi Harazem, 30000 Fès, Maroc
| | - F Z Ammor
- Service de chirurgie thoracique, CHU Hassan II, BP. 1893, Km 2.200, route de Sidi Harazem, 30000 Fès, Maroc
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, BP. 1893, Km 2.200, route de Sidi Harazem, 30000 Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, BP. 1893, Km 2.200, route de Sidi Harazem, 30000 Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, BP. 1893, Km 2.200, route de Sidi Harazem, 30000 Fès, Maroc; Faculté de médecine et de pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
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22
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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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Jin Z, Chen Z, Wu K, Shen Y, Guo S. Investigation of Migration-Preventing Tracheal Stent with High Dose of 5-Fluorouracil or Paclitaxel for Local Drug Delivery. ACS APPLIED BIO MATERIALS 2018; 1:1328-1336. [PMID: 34996236 DOI: 10.1021/acsabm.8b00290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Stent migration is one of the common reasons for the failure of tracheal stent. An antitumor drug/tracheal stent combination can promptly relieve dyspnea caused by tracheal stenosis and locally treat malignant occupying lesion or tumor. To prevent stent migration for more effective treatment, we prepared a migration-preventing nitinol tracheal stent (TS) with a high dose of 5-fluorouracil or paclitaxel (5-FU/TS or PTX/TS) by stent surface coating with a bilayered film, which is composed of a drug-loaded layer containing Carbopol 974P as mucoadhesive matrix and a blank Carbopol 974P layer. The resulting stent had a similar mechanical performance with the nitinol tracheal stent itself. The bilayered film containing 30% PTX (PTX30) could keep adhesion to porcine mucosa for 221.7 ± 11.4 min in PBS at a stirring speed of 150 rpm, and the corresponding PTX30/TS was difficult to be moved in the porcine tracheal lumen with a pulling force less than 0.7 N, indicating its good migration-preventing ability. The migration-preventing ability of the 5-FU/TS or PTX/TS was related to the compositions of bilayered films. The 5-FU release from the 5-FU/TS was dominated by a relaxation mechanism, while the PTX release was mainly controlled by a diffusion mechanism. Moreover, the 5-FU permeation from the 5-FU loaded film through the porcine tracheal mucosa was determined by the 5-FU dissolution, and PTX permeation was limited by the trans-mucosa process. After the deployment of PTX30/TS, inflammatory responses were observed in the rabbit tracheas and gradually alleviated during the follow-up period.
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Affiliation(s)
- Zhu Jin
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Zhaoyang Chen
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Keqin Wu
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Yuanyuan Shen
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Shengrong Guo
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
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24
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Miura A, Mori T, Yoshida A, Watanabe Y, Sunami K, Watanabe S, Kohno T, Tsuta K. Primary adenocarcinoma of the trachea revealing a mucinous bronchial gland cell origin. Pathol Res Pract 2018; 214:796-799. [DOI: 10.1016/j.prp.2018.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/28/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
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25
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Raices M, Dietrich A, Castro RS, Smith D. Tracheal Leiomyosarcoma: Urgent Bronchoscopic Treatment of an Acute Ventilatory Failure. Arch Bronconeumol 2018; 54:589-590. [PMID: 29576198 DOI: 10.1016/j.arbres.2018.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/31/2018] [Accepted: 02/18/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Micaela Raices
- Department of Thoracic Surgery Service and Pulmonary Transplantation, Hospital Italiano, Buenos Aires, Argentina.
| | - Agustín Dietrich
- Department of Thoracic Surgery Service and Pulmonary Transplantation, Hospital Italiano, Buenos Aires, Argentina
| | - Rodrigo S Castro
- Department of Thoracic Surgery Service and Pulmonary Transplantation, Hospital Italiano, Buenos Aires, Argentina
| | - David Smith
- Department of Thoracic Surgery Service and Pulmonary Transplantation, Hospital Italiano, Buenos Aires, Argentina
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26
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Levy A, Omeiri A, Fadel E, Le Péchoux C. Radiotherapy for Tracheal–Bronchial Cystic Adenoid Carcinomas. Clin Oncol (R Coll Radiol) 2018; 30:39-46. [DOI: 10.1016/j.clon.2017.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022]
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27
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Je HU, Song SY, Kim DK, Kim YH, Jeong SY, Back GM, Choi W, Kim SS, Park SI, Choi EK. A 10-year clinical outcome of radiotherapy as an adjuvant or definitive treatment for primary tracheal adenoid cystic carcinoma. Radiat Oncol 2017; 12:196. [PMID: 29202770 PMCID: PMC5716005 DOI: 10.1186/s13014-017-0933-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/15/2017] [Indexed: 12/26/2022] Open
Abstract
Background To evaluate the role of radiotherapy (RT) as an adjuvant or definitive treatment in primary tracheal adenoid cystic carcinoma (ACC) for local tumor control and survival. Methods A retrospective chart review was performed in 22 patients treated with adjuvant or definitive RT for primary tracheal ACC at a single center between November 1994 and December 2008. Results Thirteen and 9 patients received adjuvant and definitive RT, respectively. Microscopic residual disease after surgery was pathologically reported in 11 patients. The median RT dose was 59.4 Gy for adjuvant and 74.4 Gy for definitive RT. The overall response rate for definitive RT was 77.8%. Six patients in the definitive RT group exhibited local progression (LP), whereas 14 patients in both groups exhibited distant metastasis. The most common recurrence site in cases of treatment failure was the lung parenchyma. The median follow-up duration was 123 months, and the 10-year overall survival (OS) rate was 54.2%. Although LP was the most common cause of death (4 patients), two-thirds of the patients treated with definitive RT lived for >5 years. The 5-year and 10-year LP-free survival (LPFS) rates in the definitive RT group were 66.7 and 26.7%, respectively. Patients with higher RT dose by brachytherapy boost had good 5-year OS, 83.3%, and showed no local progression till 5-years. Most of the RT-induced side-effects were mild and tolerable, but 2 patients died of tracheal stenosis without any tumor recurrence. Conclusions Adjuvant RT may be suitable for controlling microscopic residual disease, whereas definitive RT may yield appropriate long-term survival in >50% patients with unresectable tracheal ACC. Dose escalation should be considered to warrant long-term survival in definitive RT.
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Affiliation(s)
- Hyoung Uk Je
- Department of Radiation Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Dong Kwan Kim
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yong-Hee Kim
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong-Yun Jeong
- Asan institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Geum Mun Back
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.,Department of Medical Health Science, Kangwon National University Graduate School, Chuncheon, South Korea
| | - Wonsik Choi
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Su Ssan Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seung-Il Park
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun Kyung Choi
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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28
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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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29
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Al Khatib S, Asha W, Khzouz O, Barakat F, Khader J. Advanced Tracheal Adenoid Cystic Carcinoma with Thyroid Invasion Mimicking Thyroid Cancer Treated with Definitive Radiation: Case Report and Review of the Literature. Case Rep Oncol 2017; 10:706-712. [PMID: 28878654 PMCID: PMC5582503 DOI: 10.1159/000479225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022] Open
Abstract
A 54-year-old female patient, a breast cancer survivor and a case of unresectable adenoid cystic carcinoma of the trachea, with thyroid invasion, presented with suprasternal neck swelling mimicking thyroid primary. A literature search was undertaken to highlight this rare presentation. There have been few reports in the literature describing tracheal adenoid cystic carcinoma involving the thyroid.
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Affiliation(s)
- Sondos Al Khatib
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Wafa Asha
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Omar Khzouz
- Department of Diagnostic Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Farid Barakat
- Department of Pathology, King Hussein Cancer Center, Amman, Jordan
| | - Jamal Khader
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
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30
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He J, Shen J, Huang J, Dai C, Liang W, Ye M, Kong M, Chen B, Zhu C, He J. Prognosis of primary tracheal tumor: A population-based analysis. J Surg Oncol 2017; 115:1004-1010. [PMID: 28407313 DOI: 10.1002/jso.24611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Jiaxi He
- Department of Thoracic Surgery; the First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease; Guangzhou China
- National Clinical Research Center for Respiratory Disease; Guangzhou China
| | - Jianfei Shen
- Zhejiang Taizhou Hospital; Linhai Zhejiang China
| | - Jun Huang
- Department of Thoracic Surgery; the First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease; Guangzhou China
- National Clinical Research Center for Respiratory Disease; Guangzhou China
| | - Chenyang Dai
- Shanghai Pulmonary Hospital; Tongji University School of Medicine; Shanghai China
| | - Wenhua Liang
- Department of Thoracic Surgery; the First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease; Guangzhou China
- National Clinical Research Center for Respiratory Disease; Guangzhou China
| | - Minhua Ye
- Zhejiang Taizhou Hospital; Linhai Zhejiang China
| | - Min Kong
- Zhejiang Taizhou Hospital; Linhai Zhejiang China
| | - Baofu Chen
- Zhejiang Taizhou Hospital; Linhai Zhejiang China
| | - Chengchu Zhu
- Zhejiang Taizhou Hospital; Linhai Zhejiang China
| | - Jianxing He
- Department of Thoracic Surgery; the First Affiliated Hospital of Guangzhou Medical University; Guangzhou China
- Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease; Guangzhou China
- National Clinical Research Center for Respiratory Disease; Guangzhou China
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31
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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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Bhattacharyya N. Contemporary Staging and Prognosis for Primary Tracheal Malignancies: A Population-Based Analysis. Otolaryngol Head Neck Surg 2016; 131:639-42. [PMID: 15523440 DOI: 10.1016/j.otohns.2004.05.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otology and Laryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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33
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Li S, Liu J, He J, Dong Q, Liang L, Yin W, Pan H, He J. Video-assisted thoracoscopic surgery resection and reconstruction of thoracic trachea in the management of a tracheal neoplasm. J Thorac Dis 2016; 8:600-7. [PMID: 27076958 PMCID: PMC4805830 DOI: 10.21037/jtd.2016.01.60] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/18/2016] [Indexed: 11/06/2022]
Abstract
Intratracheal tumor is a rare tumor, accounting for only 2% of upper respiratory tract neoplasms. Its symptoms are similar to those of head and neck cancers, including coughing up blood, sore throat, and airway obstruction. The diagnosis of this disease is often based on the findings of fibrobronchoscopy or computed tomography (CT). Surgery remains the treatment of choice for tracheal tumor. In patients with benign neoplasms or if the tumors have limited involvement, fibrobronchoscopic resection of the tumor can be performed. For malignant tumors, however, radical resection is required. In the past, open incision is used during the surgery for tumors located in thoracic trachea. Along with advances in video-assisted thoracoscopic surgery (VATS) minimally invasive techniques and devices, VATS resection and reconstruction of the trachea can achieve the radical resection of the tumor and meanwhile dramatically reduce the injury to the patients. In this article we describe the application of VATS resection and reconstruction of trachea in the management of a tracheal neoplasm.
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34
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Burke G, McCaughan B, Glanville A. Metachronous tracheal squamous cell carcinoma treated with Nd: YAG laser. Respirol Case Rep 2015; 3:22-4. [PMID: 25802745 PMCID: PMC4364794 DOI: 10.1002/rcr2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/15/2014] [Accepted: 11/18/2014] [Indexed: 12/19/2022] Open
Abstract
Tracheal squamous cell carcinoma detected early in a high-risk patient has been treated twice with local neodymium-yttrium aluminium garnet laser therapy with good result so far. Ongoing bronchoscopic monitoring continues.
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Affiliation(s)
- Greg Burke
- Department of Medicine, Shoalhaven District Hospital Nowra, New South Wales, Australia
| | - Brian McCaughan
- Sydney Cardiothoracic Surgeons, RPA Medical Centre Newtown, New South Wales, Australia
| | - Allan Glanville
- Department of Respiratory Medicine, St Vincent's Hospital Sydney, New South Wales, Australia
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35
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Laryngeal preservation in managing advanced tracheal adenoid cystic carcinoma. Case Rep Otolaryngol 2015; 2015:404586. [PMID: 25878915 PMCID: PMC4387972 DOI: 10.1155/2015/404586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 03/12/2015] [Accepted: 03/15/2015] [Indexed: 11/17/2022] Open
Abstract
A 37-year-old male athlete was diagnosed with primary tracheal adenoid cystic carcinoma following investigation for dyspnea, wheeze, and eventual stridor. Preoperative bronchoscopy revealed a highly vascular tumor 4 cm distal to the cricoid with no gross disease extending to the carina. Imaging revealed circumferential tracheal irregularity immediately inferior to the cricoid, with no definite cricoid invasion. Locoregional extension of disease was noted invading the thyroid and abutment of the carotid approximately 180°. Intraoperative findings identified tracheal mucosal disease extending distal to the carina and proximally at the cricothyroid joints where bilateral functional recurrent nerves were preserved. A decision made to preserve the larynx given the inability to fully resect distal tracheal disease. A 5 cm sleeve resection of the trachea was made with a cricotracheal anastomosis following suprahyoidal muscle release and laryngeal drop-down. The patient was treated with adjuvant radiotherapy including platinum based chemotherapy in an effort to maximise local control. PET scanning three months after therapy revealed no FDG uptake locally or distally.
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36
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Abdennadher M, Rivera C, Gibault L, Fabre E, Pricopi C, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M. [Mucoepidermoid tracheo-bronchial tumors in adulthood. A series of 22 cases]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:27-36. [PMID: 25687822 DOI: 10.1016/j.pneumo.2014.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Mucoepidermoid tumours (TME) are rare tumours arising from the submucosal glands of the tracheobronchial tree. The majority of these tumours develop in a benign fashion but some of them are malignant. The latter can be easily mistaken for adenosquamous carcinomas. PATIENTS AND METHOD We have reviewed 22 patients suffering from TME observed over a period of 25 years. Two arose from the trachea and 20 from the cartilaginous bronchi; 12 of these tumours had macroscopic and histological criteria of low-grade malignancy, 4 had macroscopic and 6 macroscopic and microscopic criteria of high grade malignancy. RESULTS Prognosis of the latter was very poor and no survival observed after 6 years follow-up, a behavior similar to that observed in non-small cell lung carcinomas and adenosquamous carcinomas. CONCLUSION The best treatment of these orphan tumours remains surgery.
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Affiliation(s)
- M Abdennadher
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - C Rivera
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - L Gibault
- Service d'anatomie pathologique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - E Fabre
- Service d'oncologie, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Arame
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - C Foucault
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - A Dujon
- Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, 76230 Bois Guillaume, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France.
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Nunn AC, Nouraei SAR, George PJ, Sandhu GS, Nouraei SAR. Not always asthma: clinical and legal consequences of delayed diagnosis of laryngotracheal stenosis. Case Rep Otolaryngol 2014; 2014:325048. [PMID: 25580336 PMCID: PMC4281394 DOI: 10.1155/2014/325048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/02/2014] [Indexed: 11/24/2022] Open
Abstract
Laryngotracheal stenosis (LTS) is a rare condition that occurs most commonly as a result of instrumentation of the airway but may also occur as a result of inflammatory conditions or idiopathically. Here, we present the case of a patient who developed LTS as a complication of granulomatosis with polyangiitis (GPA), which was misdiagnosed as asthma for 6 years. After an admission with respiratory symptoms that worsened to the extent that she required intubation, a previously well 14-year-old girl was diagnosed with GPA. Following immunosuppressive therapy, she made a good recovery and was discharged after 22 days. Over subsequent years, she developed dyspnoea and "wheeze" and a diagnosis of asthma was made. When she became pregnant, she was admitted to hospital with worsening respiratory symptoms, whereupon her "wheeze" was correctly identified as "stridor," and subsequent investigations revealed a significant subglottic stenosis. The delay in diagnosis precluded the use of minimally invasive therapies, with the result that intermittent laser resection and open laryngotracheal reconstructive surgery were the only available treatment options. There were numerous points at which the correct diagnosis might have been made, either by proper interpretation of flow-volume loops or by calculation of the Empey or Expiratory Disproportion Indices from spirometry data.
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Affiliation(s)
- Adam C. Nunn
- Department of Trauma & Orthopaedics, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, UK
| | - S. Ali R. Nouraei
- The Neutral Corner Ltd, Clavering House, Clavering Place, Newcastle upon Tyne, NE1 3NG, UK
| | - P. Jeremy George
- Department of Respiratory Medicine, University College Hospital, Euston Road, London NW1 2BU, UK
| | - Guri S. Sandhu
- Department of Ear, Nose, and Throat Surgery, Chelsea and Westminster Hospital, Fulham Road, London SW10 9NH, UK
| | - S. A. Reza Nouraei
- Department of Ear, Nose, and Throat Surgery, The Royal Free Hospital, Pond Street, London NW3 2QG, UK
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38
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Borik W, Pricopi C, Hernigou A, Fabre E, Laccourreye O, Hidden G, Le Pimpec Barthes F, Riquet M. [Squamous cell carcinoma of the trachea: imaging lymph node mapping]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:329-334. [PMID: 25457221 DOI: 10.1016/j.pneumo.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/17/2014] [Indexed: 06/04/2023]
Abstract
The anatomy of the trachea lymphatics is poorly understood and the only researches date back to more than one century. Tracheal tumors are very rare, miscellaneous and variously lymphophilic. The cancers of the trachea have no TNM and their lymph node metastases are little studied despite their poor prognosis. We observed 2 cases of squamous cell carcinoma, one in the cervical and the other in the intrathoracic trachea. TDM-3D reformats demonstrated metastatic lymph nodes of the right para-tracheal lymph node chain (2R and 4R) in both patients and in the cervical lymph nodes (right recurrent nerve lymph node chain) in the patient with cervical tumor. Right location of the mediastinal metastases may be explained by the anatomy of the lymph node chain drainage of the lung segments, the right para-tracheal chain being the only one to regularly possess lymph nodes at that level. The right recurrent nerve lymph node metastases of the cervical tumor are explained by common lymph drainage of the cervical trachea towards larynx lymph centres. Besides lymph node metastases, cancers prognosis may also depends on its location in the trachea. Thus, the tracheal tumors are complex and constitute quite as many orphan tumors. Multicentric studies are mandatory to better understand their behavior. Means provided by new imaging techniques might permit establishing a veritable TNM lymph node mapping of these tumors.
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Affiliation(s)
- W Borik
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - C Pricopi
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - A Hernigou
- Service de radiologie, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - E Fabre
- Service d'oncologie médicale, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - O Laccourreye
- Service d'ORL, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - G Hidden
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - F Le Pimpec Barthes
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France
| | - M Riquet
- Service de chirurgie thoracique, hôpital européen Georges-Pompidou, université Paris Descartes, 20-40, rue Leblanc, 75015 Paris, France.
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Abstract
Malignant involvement of the trachea predominantly results from direct spread of neighboring tumors to the tracheal wall. Primary tracheal malignancies show a low incidence of approximately 0.1 in every 100,000 persons per year, squamous cell carcinomas and adenoid cystic carcinomas accounting for about two-thirds of adult primary tracheal tumors. The etiology of squamous cell carcinoma and its premalignant lesions is strongly associated with tobacco smoking. Patients with tracheal malignancies show an unfavorable prognosis, with reported 5- and 10-year survival rates of 5% to 15% and 6% to 7%, respectively, for all types of tracheal carcinoma.
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Affiliation(s)
- Klaus Junker
- Institute of Pathology, Bremen Central Hospital, St. Juergen-Strasse 1, Bremen 28177, Germany.
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40
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Kim D, Hwang YI, Choi S, Park C, Lee N, Kim EA. A case of tracheal adenoid cystic carcinoma in a worker exposed to rubber fumes. Ann Occup Environ Med 2013; 25:22. [PMID: 24472110 PMCID: PMC3923329 DOI: 10.1186/2052-4374-25-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 10/04/2013] [Indexed: 12/01/2022] Open
Abstract
Background Primary tracheal tumors occur infrequently, accounting for less than 0.1% of all tumors. Adenoid cystic carcinoma (ACC) is the second most common type of malignancy of the trachea after squamous cell carcinoma (SCC). Little has been reported on the risk factors for tracheal ACC. The purpose of this study is to describe a case of tracheal ACC in a patient who had been exposed to rubber fumes, and to review the relationship between tracheal ACC and rubber fumes. Case report A 48-year-old man who had been experiencing aggravation of dyspnea for several months was diagnosed as having ACC of the trachea on the basis of a pathologic examination of a biopsy specimen obtained via laser microscopy-guided resection. The patient had been exposed to rubber fumes for 10 years at a tire manufacturing factory where he worked until ACC was diagnosed. His job involved preheating and changing rubber molds during the curing process. Conclusion ACC of both the trachea and the salivary glands show very similar patterns with regard to histopathology and epidemiology and are therefore assumed to have a common etiology. Rubber manufacturing is an occupational risk factor for the development of salivary gland tumors. Further, rubber fumes have been reported to be mutagenic. The exposure level to rubber fumes during the curing process at the patient’s workplace was estimated to be close to or higher than British Occupational Exposure Limits. Therefore, tracheal ACC in this case might have been influenced by occupational exposure to rubber fumes.
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Affiliation(s)
| | | | | | | | | | - Eun-A Kim
- Occupational Safety and Health Research Institute, KOSHA, Incheon, Korea.
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41
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Nouraei SAR, Nouraei SM, Patel A, Murphy K, Giussani DA, Koury EF, Brown JM, George PJ, Cummins AC, Sandhu GS. Diagnosis of laryngotracheal stenosis from routine pulmonary physiology using the expiratory disproportion index. Laryngoscope 2013; 123:3099-104. [PMID: 23686716 DOI: 10.1002/lary.24192] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/HYPOTHESIS The study's objective was to determine the utility of expiratory disproportion index (EDI), the ratio of forced expiratory volume in 1 second (FEV1) to peak expiratory flow rate (PEFR) (EDI = FEV1[L] /PEFR[L/s] × 100), in differentiating between laryngotracheal stenosis (LTS) and other respiratory diagnoses. LTS is an uncommon complication of mechanical ventilation or vasculitis or a manifestation of airway compression or malignancy. It frequently masquerades as asthma and evades timely diagnosis, causing prolonged morbidity and airway-related mortality. STUDY DESIGN Observational study. METHODS We compared spirometry results of 9,357 healthy subjects and nonstenosis pulmonary patients with 217 cases of LTS. Bootstrap analysis, receiver-operating characteristic (ROC) statistics, and Pearson correlation were used to assess the diagnostic utility of the EDI and its correlation with stenosis severity. RESULTS Mean EDI values were 36 ± 7 in nonstenosis cases, 76 ± 17 in benign stenoses, and 69 ± 23 in tracheal cancer (P < .0001). A significant correlation existed between anatomic stenosis severity and EDI (P < .0001; R = 0.61). Area under the ROC curve was 0.98, and at a threshold of >50, EDI had a sensitivity of 95.9% and a specificity of 94.2% in differentiating between stenosis and nonstenosis cases. CONCLUSIONS EDI can reliably diagnose LTS using routine lung function data. Its simplicity and clinical utility, first recognized by Duncan Empey, are underpinned by a unique physiology whereby PEFR, being determined by total tracheobronchial tree resistance, falls disproportionately compared with FEV1 , which is determined within small intrathoracic airways. EDI provides valuable information about the presence and extent of LTS particularly in nonspecialist clinical settings and its routine inclusion within standard lung function reports could prevent the prolonged morbidity and mortality that currently result from missed and delayed diagnoses.
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Affiliation(s)
- S A Reza Nouraei
- National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London
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42
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Nouraei SM, Middleton SE, Reza Nouraei SA, Virk JS, George PJ, Hayward M, Sandhu GS. Management and prognosis of primary tracheal cancer: A national analysis. Laryngoscope 2013; 124:145-50. [DOI: 10.1002/lary.24123] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/05/2013] [Accepted: 03/05/2013] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | - Jagdeep S. Virk
- National Centre for Airway ReconstructionCharing Cross Hospital
| | - P. Jeremy George
- Department of Respiratory MedicineUniversity College HospitalLondon
| | - Martin Hayward
- Department of Cardiothoracic SurgeryUniversity College HospitalLondon
| | - Guri S. Sandhu
- National Centre for Airway ReconstructionCharing Cross Hospital
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43
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Small-cell cancer presenting as a tracheal polyp: a case report and review of the literature. J Bronchology Interv Pulmonol 2013. [PMID: 23207357 DOI: 10.1097/lbr.0b013e31824dd182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary tracheal tumors are rare. Malignant tracheal polyps constitute the majority, with very few case reports of small-cell cancer in the literature. Staging of these tumors follows the lung cancer TNM staging system, with little evidence-based guidance for their management. We report a case of small-cell cancer presenting as a tracheal polyp and review the related literature.
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Hobai IA, Chhangani SV, Alfille PH. Anesthesia for tracheal resection and reconstruction. Anesthesiol Clin 2013; 30:709-30. [PMID: 23089505 DOI: 10.1016/j.anclin.2012.08.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tracheal resection and reconstruction (TRR) is the treatment of choice for most patients with tracheal stenosis or tracheal tumors. Anesthesia for TRR offers distinct challenges, especially for the less experienced practitioner. This article explores the preoperative assessment, strategies for induction and emergence from anesthesia, the essential coordination between the surgical and anesthesia teams during airway excision and anastomosis, and postoperative care. The most common complications are reviewed. Targeted readership is practitioners with less extensive experience in managing airway surgery cases. As such, the article focuses first on the most common proximal tracheal resection. Final sections discuss specific considerations for more complicated cases.
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Affiliation(s)
- Ion A Hobai
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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45
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Regenerative Therapies-Trachea. Regen Med 2013. [DOI: 10.1007/978-94-007-5690-8_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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46
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Stevic R, Milenkovic B, Stojsic J, Pesut D, Ercegovac M, Jovanovic D. Clinical and Radiological Manifestations of Primary Tracheobronchial Tumours: A Single Centre Experience. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n5p205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Tracheobronchial tumours usually cause an airway obstruction and secondary pulmonary infections. Although rare, they are an important differential diagnosis as they may mimic other conditions and diseases. This paper aims to analyse clinical, radiological and histological characteristics of the patients with tracheobronchial tumours diagnosed for a period of 7 years. Materials and Methods: In this retrospective, observational study, we carefully reviewed 65 patients who were diagnosed with tracheal and endobronchial tumours, and performed statistical analysis on the results. Results: Among these 65 patients (36 men and 29 women) with a mean age of 48.8 years (range, 15 to 75), 50 had malignant tumours while 15 had benign ones. The most common symptoms were cough, chest pain and haemoptysis. Cough was a more frequent symptom in patients with benign tumours (P <0.0014). Only 2 patients were asymptomatic. Tumours were predominantly localised in the large airways (46 in large bronchi and 2 in trachea). The most common radiological manifestation of malignant tumours was tumour mass (46%) followed by atelectasis. One third benign tumour caused atelectasis, while tumour mass and consolidation were found in 3 patients each. Computerised tomography revealed endoluminal tumour mass in 29.2% of the cases, which was more frequently found in benign than malignant tumours (47% vs 24%, respectively). On bronchoscopy, tumours were visible in 73% and 70% benign and malignant cases respectively. Conclusion: Tracheobronchial tumours should be ruled as a possible diagnosis in patients with cough, haemoptysis, dyspnoea and chest pain. The imaging techniques and histological examination of the tissue would subsequently lead to correct diagnosis and proper treatment can be administered.
Key words: Bronchus, Computerised tomography, Trachea, Tumour, X-ray
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Affiliation(s)
- Ruza Stevic
- Faculty of Medicine, University of Belgrade, Serbia
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47
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Siesling S, van der Zwan JM, Izarzugaza I, Jaal J, Treasure T, Foschi R, Ricardi U, Groen H, Tavilla A, Ardanaz E. Rare thoracic cancers, including peritoneum mesothelioma. Eur J Cancer 2012; 48:949-60. [PMID: 22406029 DOI: 10.1016/j.ejca.2012.02.047] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/31/2012] [Accepted: 02/13/2012] [Indexed: 01/11/2023]
Abstract
Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) and followed-up to 31st December 2003. Over 17,688 cases of rare thoracic cancers were selected based on the list of the RACECARE project. Mesothelioma was the most common tumour (19 per million per year) followed by epithelial tumours of the trachea and thymus (1.3 and 1.7, respectively). The age standardised incidence rates of epithelial tumours of the trachea was double in Eastern and Southern Europe versus the other European regions: 2 per million per year. Epithelial tumours of the thymus had the lowest incidence in Northern and Eastern Europe and UK and Ireland(1) and somewhat higher incidence in Central and Southern Europe.(2) Highest incidence in mesothelioma was seen in UK and Ireland(23) and lowest in Eastern Europe.(4) Patients with tumours of the thymus had the best prognosis (1-year survival 85%, 66% at 5 years). Five year survival was lowest for the mesothelioma 5% compared to 14% of patients with tumours of the trachea. Mesothelioma was the most prevalent rare cancer (12,000 cases), followed by thymus (7000) and trachea (1400). Cancer Registry (CR) data play an important role in revealing the burden of rare thoracic cancers and monitoring the effect of regulations on asbestos use and smoking related policies.
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Affiliation(s)
- Sabine Siesling
- Department of Registry and Research, Comprehensive Cancer Centre The Netherlands, PO Box 330, 9700 AH Groningen, The Netherlands.
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48
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Tsujikawa S, Okutani R, Oda Y. Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy. J Anesth 2011; 26:269-72. [DOI: 10.1007/s00540-011-1289-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/08/2011] [Indexed: 12/01/2022]
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49
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Hoerbelt R, Padberg W. [Primary tracheal tumors of the neck and mediastinum : resection and reconstruction procedures]. Chirurg 2011; 82:125-33. [PMID: 21253678 DOI: 10.1007/s00104-010-1974-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary tumors of the trachea account for less than 0.1% of all tumors. They are malignant in more than 90% of cases with squamous cell carcinoma and adenoidcystic carcinoma accounting for 2/3 of all tracheal tumors. Since they are often misdiagnosed as asthma or chronic lung disease, diagnosis can be delayed for years. Once the diagnosis has been established, surgical resection being the only curative treatment should be considered first. Modern techniques for tracheal surgery such as laryngotracheal, tracheal or carinal resection and different tracheal mobilisation maneuvers such as laryngeal and hilar release allow for resection of more than 50% of the trachea and anastomosis without excessive tension. Results in patients with complete tumor resection are good with 5-year and 10-year survival between 39% and 79% and between 18% and 51%, respectively. However, careful patient evaluation, preservation of tracheal blood supply and accepting the limits of resectability are mandatory to avoid major complications that accompany tracheal resections in more than 20% of cases depending on the type of resection.
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MESH Headings
- Airway Obstruction/diagnosis
- Airway Obstruction/mortality
- Airway Obstruction/pathology
- Airway Obstruction/surgery
- Anastomosis, Surgical/methods
- Carcinoma, Adenoid Cystic/diagnosis
- Carcinoma, Adenoid Cystic/mortality
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Cervicoplasty/methods
- Follow-Up Studies
- Humans
- Lymph Node Excision/methods
- Lymphatic Metastasis/pathology
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/mortality
- Mediastinal Neoplasms/pathology
- Mediastinal Neoplasms/surgery
- Microsurgery/methods
- Neoplasm Invasiveness
- Neoplasm Staging
- Postoperative Complications/etiology
- Postoperative Complications/mortality
- Postoperative Complications/surgery
- Risk Factors
- Survival Rate
- Tomography, X-Ray Computed
- Trachea/blood supply
- Trachea/innervation
- Trachea/pathology
- Trachea/surgery
- Tracheal Neoplasms/diagnosis
- Tracheal Neoplasms/mortality
- Tracheal Neoplasms/pathology
- Tracheal Neoplasms/surgery
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Affiliation(s)
- R Hoerbelt
- Klinik für Allgemein-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Giessen und Marburg, Standort Giessen, Deutschland.
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50
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Primary major airway tumors; management and results. Eur J Cardiothorac Surg 2011; 39:749-54. [DOI: 10.1016/j.ejcts.2010.08.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/11/2010] [Accepted: 08/19/2010] [Indexed: 11/21/2022] Open
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