Definitive radiotherapy for inoperable adenoid cystic carcinoma of the trachea: A rare case report

Bhandari, Virendra; Ladia, Desh Deepak; Kausar, Mehlam; Varma, Amit

doi:10.4103/0970-2113.197117

Cited by 5 publications

(4 citation statements)

References 8 publications

(14 reference statements)

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“…The primary treatment for ACC is complete surgical resection, but it is often difficult to perform surgery due to the invasion of the surrounding structures such as the nerve, skull base, and brain [ 16 , 17 ]. ACC of the trachea, nasopharynx, or maxillary sinus that are unable to undergo surgery have been treated with radiotherapy [ 18 ]. The effect of definitive RT for unresectable cases has been reported from several retrospective studies, with a response rate of approximately 40% and RFS of approximately 30 months [ 19 - 21 ].…”

Section: Discussionmentioning

confidence: 99%

Role of concurrent chemoradiation on locally advanced unresectable adenoid cystic carcinoma

Keam

Ock

et al. 2021

Korean J Intern Med

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Background/Aims: Adenoid cystic carcinoma (ACC) is a rare salivary gland tumor characterized by indolence, with a high rate of local recurrence and distant metastasis. This study aimed to investigate the effect of concurrent chemoradiation (CCRT) on locally advanced unresectable ACC. Methods: We retrospectively analyzed clinical data from 10 patients with pathologically confirmed ACC of the head and neck who received CCRT with cisplatin in Seoul National University Hospital between 2013 and 2018. Results: Ten patients with unresectable disease at the time of diagnosis or with positive margins after surgical resection received CCRT with weekly cisplatin. Eight patients (80%) achieved complete remission, of which three later developed distant metastases without local relapse; one patient developed distant metastasis and local relapse. Two patient achieved partial remission without progression. Patients experienced several toxicities, including dry mouth, radiation dermatitis, nausea, and salivary gland inflammation of mostly grade 1 to 2. Only one patient showed grade 3 oral mucositis. Median relapse-free survival was 34.5 months (95% confidence interval, 22.8 months to not reached). Conclusions: CCRT with cisplatin is effective for local control of ACC with manageable toxicity and may be an effective treatment option for locally advanced unresectable ACC.

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Section: Discussionmentioning

confidence: 99%

Role of concurrent chemoradiation on locally advanced unresectable adenoid cystic carcinoma

Keam

Ock

et al. 2021

Korean J Intern Med

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“…In contrast, some studies have also indicated that TACC seems to have high radiosensitivity. Bhandari et al [ 15 ] reported a 51-year-old female with unresectable TACC, who received a dose of 54 Gy/30 fractions IMRT. At 8 mo post-radiotherapy, her CT scan showed a near complete response.…”

Section: Discussionmentioning

confidence: 99%

Rapid response to radiotherapy in unresectable tracheal adenoid cystic carcinoma: A case report

Wu¹,

Xu²

2021

WJCC

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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.

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“…The optimal dose regimen for lung metastasis of ACC remains to be determined. Previous studies suggest that 60 Gy (EQD2) is insufficient for the LC of primary pulmonary ACC (Table 3 ) [ 11 – 18 ]. In addition, the results of conventional radiotherapy for ACC of the head and neck remain inadequate, with a 5-year LC of 56% [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, in conventional radiotherapy, dose escalation also increases the risk of radiation pneumonitis. Other potential adverse events observed after short-term follow-up include grade 1 bronchial stricture and grade 3 esophagitis [ 11 , 18 ]. Grade 1 bronchial stricture was observed after intensity-modulated radiotherapy with a total dose of 54 Gy delivered in 30 fractions.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for adenoid cystic carcinoma metastatic to the lung: a case report

Kobayashi¹,

Abe

Saitoh

et al. 2021

J Med Case Reports

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Background Adenoid cystic carcinoma (ACC) is a rare malignant tumor involving mostly the head and neck region, and frequently the salivary glands. The development of lung metastasis after treatment of the primary tumor is a common occurrence in ACC. Although lung metastases show a slow rate of growth, approximately 10% of patients die from distant metastases. The radioresistance of ACC limits the efficacy of conventional radiotherapy for lung metastases, and the optimal dose remains to be determined. Stereotactic body radiotherapy (SBRT) using CyberKnife can deliver a high dose to the lung tumor, while sparing the surrounding normal lung tissues, leading to favorable local control in non-squamous cell lung cancer and metastatic lung tumors. We report a case of lung metastases from ACC treated successfully with SBRT using CyberKnife. Case presentation A 76-year-old Japanese man with ACC who was treated with carbon ion radiotherapy for a primary oropharynx tumor presented with three metastatic lesions in the lung. The tumor masses were located in the right upper, right lower, and left lower lobes of the lungs. Surgical resection was not indicated because of the presence of multiple tumors. The patient underwent SBRT at 60 Gy in 10 sequential fractions for each tumor. The biologically effective dose based on an alpha/beta ratio of 2 Gy was 240 Gy per tumor. The percentage of the total lung volume irradiated with >20 Gy was 4.9%, 3.2%, and 2.6% for each tumor. The patient developed acute radiation pneumonitis during the initial therapy, which resolved at 6 months after the CyberKnife treatment. At 21 months after the first CyberKnife treatment, three tumors showed no signs of recurrence. No late toxicity was observed. Conclusions SBRT using CyberKnife is an effective and feasible approach to the management of multiple lung metastases of ACC.

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Definitive radiotherapy for inoperable adenoid cystic carcinoma of the trachea: A rare case report

Cited by 5 publications

References 8 publications

Role of concurrent chemoradiation on locally advanced unresectable adenoid cystic carcinoma

Role of concurrent chemoradiation on locally advanced unresectable adenoid cystic carcinoma

Rapid response to radiotherapy in unresectable tracheal adenoid cystic carcinoma: A case report

Stereotactic body radiotherapy for adenoid cystic carcinoma metastatic to the lung: a case report

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