Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9535-9541
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9535
Rapid response to radiotherapy in unresectable tracheal adenoid cystic carcinoma: A case report
Qiang Wu, Feng Xu
Qiang Wu, Feng Xu, Lung Cancer Center and Institute, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wu Q and Xu F conducted data curation and project management; Wu Q reviewed and analyzed data; Xu F designed the concept and methodology and supervised the entire study; Wu Q and Xu F wrote the manuscript and all authors read and approved the final manuscript; all authors contributed to the article and approved the submitted version.
Supported by National Natural Science Foundation of China, No.81573024.
Informed consent statement: The patient provided written informed consent to participate in this study. Written informed consent was obtained for the publication of any potentially identifiable images or data included in this article.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Xu, MD, Professor, Lung Cancer Center and Institute, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. fengxuster@163.com
Received: January 21, 2021
Peer-review started: January 21, 2021
First decision: February 11, 2021
Revised: February 24, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 6, 2021
Abstract
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.

Keywords: Adenoid cystic carcinoma, Tracheal cancer, Radiotherapy, Tracheal adenoid cystic carcinoma, Case report

Core Tip: Tracheal adenoid cystic carcinoma (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 who rapidly responded to radiotherapy.