A case of adenoid cystic carcinoma of trachea: treatment complications and radiotherapy role

Abstract

Purpose: Adenoid cystic carcinoma (ACC) of trachea is a relatively rare malignant neoplasm, for which there is a lack of prospective clinical trials investigating treatment effectiveness. Most of the authors prefer surgical resection followed by post-operative radiation therapy in case of incomplete excision. There are no available prospective data on post-relapse treatment.

Case presentation: The current paper presents a case of tracheal ACC in a young woman, treated solely with surgical resection without radiotherapy due to postoperative neurological complications requiring additional diagnostics, management, and treatment. As a complication itself, spinal cord dysfunction after tracheal surgery is extremely rare, in which radical radiotherapy and brachytherapy were successfully administered after disease recurrence.

Conclusions: Lack of post-operative radiotherapy resulting from neurological complications could be a reason for ACC recurrence in our patient. Administration of radiotherapy after incomplete resection of recurrent disease may lead to long-term locoregional control.

Keywords: adenoid cystic carcinoma; radiotherapy; spinal cord dysfunction; tracheal tumors.

Fig. 1

Radiotherapy plan presented in computed tomography scans of the treated region with 3D reconstruction. Isodoses levels are presented in the dose color wash method from dose 1,300 cGy (blue) to 6,580 cGy (red)

Fig. 2

Dose-volume histograms for the patient’s treatment plan from Figure 1

Fig. 3

The figures present images from video-bronchoscopy. A) White light video-bronchoscopy revealing a residual tumor located on main carina; B) Under autofluorescence imaging of video-bronchoscopy, the tumor showed reddish brown area with defined margin on normal mucosa appearing in green color

Fig. 4

A-C) Images of Fritz adjustable intralumenal applicator in different shots; D) Fluoroscopy with visible Fritz applicator