BACKGROUND Adenoid cystic carcinoma(ACC)occurs mainly in the head and neck.Tracheal ACC(TACC)is uncommon.Primary resection is recommended as the main treatment of choice,and radiotherapy is considered for residual dis...BACKGROUND Adenoid cystic carcinoma(ACC)occurs mainly in the head and neck.Tracheal ACC(TACC)is uncommon.Primary resection is recommended as the main treatment of choice,and radiotherapy is considered for residual disease in the postoperative setting.Definitive radiotherapy is an alternative approach to cure unresectable TACC.As the status of radiosensitivity in TACC is uncertain,the evidence for radiotherapy in unresectable TACC is not well established,especially in terms of the optimal dosage and its response evaluation.Herein,we report a case of locally advanced TACC.CASE SUMMARY A 49-year-old woman was diagnosed with TACC,which included a range of lesions arising in the upper trachea extending caudally 2 cm to 7 cm of the glottis.She was treated with definitive radiotherapy,given the low likelihood of complete resection of the disease.Due to the indolent growth and the propensity for infiltration along the airways,the scheduled radiation dose of 76 Gy in 38 fractions with 6-MV X-ray delivered by intensity-modulated radiotherapy was conducted to the primary tumor volume.After irradiation of 40 Gy,the patient’s dyspnea on exertion was dramatically relieved and bronchoscopy revealed that the previous large polypoid intra-luminal mass was significantly eliminated,with near-complete response.The patient completed two phases of scheduled radiotherapy,and acute reactions to treatment included subjective chest tightness and grade 2 esophagitis,managed medically.After 5 years of treatment,the patient is alive without recurrent disease,and there were no serious late radiation esophagus and lung damage,with only slight dysphagia without perforation and fistula.CONCLUSION Taken together,TACC is uncommon and the treatment of unresectable TACC is challenging.This case indicated that patients with unresectable TACC who rapidly respond to radiation may benefit from primary radical radiotherapy.Radiotherapy may be considered an effective alternative treatment modality.展开更多
Background: The correlation between computed tomography (CT)-based tracheal size and spirometry values is unknown in patients with tracheal stenosis by thoracic malignancy, which is often treated by tracheal stenting....Background: The correlation between computed tomography (CT)-based tracheal size and spirometry values is unknown in patients with tracheal stenosis by thoracic malignancy, which is often treated by tracheal stenting. Objectives: To evaluate the correlation between the tracheal cross-sectional area (CSA) and spirometric values before and after tracheal stenting, and to confirm that greater improvement in tracheal CSA leads to a larger improvement in spirometry values. Methods: A total of 32 patients with malignant tracheal stenosis underwent tracheal stenting. Before (n = 32) and after (n = 27) treatment, patients underwent chest CT, measuring mean and minimum tracheal CSA values, and spirometry. The correlation between tracheal CSA and each spirometric value was evaluated using Spearman rank correlation analysis. Differences in the pre- and posttreatment tracheal CSA and spirometric values were evaluated using the Wilcoxon matched-pairs test. Results: Significant improvement in the minimum tracheal CSA and in spirometric values was observed after stenting (P P P Conclusions: The tracheal size measured on chest CT correlates with patients’ spirometric values, particularly at the prestenting examination, in patients with malignant tracheal stenosis. The increase in the minimum tracheal CSA after stenting on CT is a predictor for improved spirometric values, which is first demonstrated by this study.展开更多
基金Supported by National Natural Science Foundation of China,No.81573024。
文摘BACKGROUND Adenoid cystic carcinoma(ACC)occurs mainly in the head and neck.Tracheal ACC(TACC)is uncommon.Primary resection is recommended as the main treatment of choice,and radiotherapy is considered for residual disease in the postoperative setting.Definitive radiotherapy is an alternative approach to cure unresectable TACC.As the status of radiosensitivity in TACC is uncertain,the evidence for radiotherapy in unresectable TACC is not well established,especially in terms of the optimal dosage and its response evaluation.Herein,we report a case of locally advanced TACC.CASE SUMMARY A 49-year-old woman was diagnosed with TACC,which included a range of lesions arising in the upper trachea extending caudally 2 cm to 7 cm of the glottis.She was treated with definitive radiotherapy,given the low likelihood of complete resection of the disease.Due to the indolent growth and the propensity for infiltration along the airways,the scheduled radiation dose of 76 Gy in 38 fractions with 6-MV X-ray delivered by intensity-modulated radiotherapy was conducted to the primary tumor volume.After irradiation of 40 Gy,the patient’s dyspnea on exertion was dramatically relieved and bronchoscopy revealed that the previous large polypoid intra-luminal mass was significantly eliminated,with near-complete response.The patient completed two phases of scheduled radiotherapy,and acute reactions to treatment included subjective chest tightness and grade 2 esophagitis,managed medically.After 5 years of treatment,the patient is alive without recurrent disease,and there were no serious late radiation esophagus and lung damage,with only slight dysphagia without perforation and fistula.CONCLUSION Taken together,TACC is uncommon and the treatment of unresectable TACC is challenging.This case indicated that patients with unresectable TACC who rapidly respond to radiation may benefit from primary radical radiotherapy.Radiotherapy may be considered an effective alternative treatment modality.
文摘Background: The correlation between computed tomography (CT)-based tracheal size and spirometry values is unknown in patients with tracheal stenosis by thoracic malignancy, which is often treated by tracheal stenting. Objectives: To evaluate the correlation between the tracheal cross-sectional area (CSA) and spirometric values before and after tracheal stenting, and to confirm that greater improvement in tracheal CSA leads to a larger improvement in spirometry values. Methods: A total of 32 patients with malignant tracheal stenosis underwent tracheal stenting. Before (n = 32) and after (n = 27) treatment, patients underwent chest CT, measuring mean and minimum tracheal CSA values, and spirometry. The correlation between tracheal CSA and each spirometric value was evaluated using Spearman rank correlation analysis. Differences in the pre- and posttreatment tracheal CSA and spirometric values were evaluated using the Wilcoxon matched-pairs test. Results: Significant improvement in the minimum tracheal CSA and in spirometric values was observed after stenting (P P P Conclusions: The tracheal size measured on chest CT correlates with patients’ spirometric values, particularly at the prestenting examination, in patients with malignant tracheal stenosis. The increase in the minimum tracheal CSA after stenting on CT is a predictor for improved spirometric values, which is first demonstrated by this study.
