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Background Tracheobronchial adenoid cystic carcinoma (TACC) is an uncommon gland-type tumor. While prior studies have addressed its clinical features and prognosis, evidence from larger cohorts remains scarce. Methods TACC patients treated at Dongzhimen Hospital (DZM) and Emergency General Hospital (EG) between 2010 and 2023 were enrolled. Survival curves were plotted using the Kaplan–Meier method before and after propensity score matching (PSM). The key variables were screened by LASSO regression, and predictive and interaction analysis was done by multifactor Cox regression and accelerated failure time (AFT) models. Overall survival (OS) was the study endpoint. Results The median age of 169 TACC patients (EG 144, DZM 25) was 47.8 ± 13.2 years, 50.9% were female, and 79.9% of patients had not undergone surgery. The median follow-up was 67.5 months (interquartile range [IQR] 42.2–105.8). Survival at 5, 10, and 15 years was 68.0%, 32.4%, and 17.1%, respectively. The median survival time was 88 months. Multifactorial Cox regression analysis found initial tumor extension (ITE) (HR: 1.28, 95% CI 1.12–1.47; P  = 0.000), surgery (HR: 0.36, 95% CI 0.20–0.64; P  = 0.000), and photodynamic therapy (PDT) (HR: 0.46, 95% CI 0.22–0.97; P  = 0.042) to be independent prognostic factors; this was re-affirmed by AFT model. Survival was extended by surgery combined with PDT, but the interaction was nonsignificant. Conclusion This study identified ITE as the independent prognostic factor. Surgery is the key to the prognosis, and PDT and its combination with surgery may enhance patient survival.

Background Primary adenoid cystic carcinomas (ACCs) of the trachea are rare tumors of the central bronchial system. In patients presenting with unresectable tumors, severe comorbidities, or incomplete surgical resection, definitive radiotherapy is currently the recommended treatment. Irradiation with carbon ions (C 12 ) has shown promising local control (LC) and survival rates in cases of ACCs of the head and neck. No data on the therapeutic efficacy of C12 radiotherapy in treating tracheal ACC has been published. Methods All patients with histologically confirmed ACC of the trachea treated with surgery and/or radiation treatment at Heidelberg University Hospital between 1991 and 2017 were included in this analysis. Patient and treatment characteristics, short- and long-term toxicity after radiotherapy, overall survival (OS), freedom from local progression (FFLP), and freedom from distant progression (FFDP) were prospectively acquired and retrospectively analyzed. Results Thirty-eight patients (23 women and 15 men) with a median age of 51 were treated by surgery ( n  = 20) and/or radiotherapy with either C 12 ( n  = 7) or photons ( n  = 24). Of these patients, 61% presented with locally advanced (stage 4) ACC. The median follow-up for all patients was 74.5 months. The 5-year OS for all patients was 95% (10-year: 81%). The 5-year FFLP and FFDP were 96% (10-year: 83%) and 69% (10-year: 53%), respectively. In patients who underwent surgery alone, the 5-year OS was 100% (10-year: 80%). The 5-year FFLP and FFDP were 100% (10-year: 100%) and 80% (10-year: 60%), respectively. In patients who underwent radiotherapy alone, the 5-year OS was 100% (10-year: 83%). The 5-year FFLP and FFDP were 88% (10-year: 44%) and 67% (10-year: 34%), respectively. In patients who received multi-modal treatment including surgery and adjuvant radiotherapy, the 5-year OS was 84% (10-year: 84%). The 5-year FFLP was 100% (10-year: 100%) and the 5-year FFDP was 65% (10-year, 65%). Conclusions The long-term prognosis is favorable if surgery is performed. In cases of an incomplete resection, good OS can still be achieved following adjuvant radiotherapy. For radiotherapy, irradiation with C 12 shows promising first results. However, more data is needed to prove the long-term advantage of C 12 over photons. Trial registration The ethics committee of the Heidelberg University Hospital approved the retrospective data analysis (S-174/2019).

BackgroundT4 esophageal cancer (EC) that invades the trachea or bronchus often has poorer prognosis than other T4 ECs. We investigated the long-term results of definitive chemoradiotherapy (dCRT) or induction chemoradiotherapy followed by surgery (iCRT-S) in patients with T4 EC with tracheobronchial invasion (TBI).Patients and MethodsFrom 2003 to 2013, 71 patients with T4 EC with TBI were treated in our institution; 58 underwent dCRT, and 13 underwent iCRT-S. The long-term results associated with survival were retrospectively analyzed, and prognostic factors were examined by univariable and multivariable analysis.ResultsThe 1-, 2-, and 5-year overall survival for all patients with T4 EC with TBI treated by dCRT or iCRT-S was 57, 29, and 19%, respectively. Multivariable analysis revealed that clinical lymph node (LN) metastasis and the treatment period were significant prognostic factors. Clinical LN positivity had significantly poorer prognosis than LN negativity. The treatment outcome in the later period was significantly better than that in the earlier period. In particular, the outcome after dCRT revealed significantly better prognosis in the later compared with the earlier period, whereas the outcome after iCRT-S did not show such a difference. With respect to treatment modality, no significant difference in survival was observed between dCRT and iCRT-S.ConclusionsClinical LN negativity and later treatment period were significantly good prognostic factors for T4 EC with TBI. The recent improvements in dCRT outcomes may help to achieve survival comparable to that of iCRT-S.

Tracheobronchial adenoid cystic carcinoma (ACC) is a rare type of malignancy. Although complete resection is standard treatment for localized ACC, treatment for unresectable ACC has not been established. It is unclear whether concurrent chemoradiotherapy (CCRT) followed by immune checkpoint inhibitor (ICI) therapy is effective for ACC. A 49-year-old man was admitted to our hospital for the treatment of dyspnea and thickening of the bronchial wall from the tracheal carina to the left main bronchus, as observed on a CT scan. Systemic examinations and transbronchial biopsy led to a diagnosis of locally advanced ACC. Although radiotherapy and chemotherapy are not regarded as very sensitive for ACC, a favorable response was obtained with CCRT. Following CCRT, he received ICI therapy with durvalumab for 1 year. The patient has remained in a stable condition 18 months after therapy, with no recurrence. ICI after CCRT might be a promising treatment option for unresectable tracheobronchial ACC.

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.

Background To describe the indications, techniques and preliminary experience of modified spiral tracheoplasty in the reconstruction of large tracheal defect after thyroidectomy. Methods The medical records of patients who underwent tracheal torsion to repair large tracheal defects after thyroid carcinoma surgery from January 2019 to January 2022 were retrospectively reviewed. The extent of tracheal defect, duration of tracheal reconstruction, postoperative complications and surgery results were analyzed. Results The duration of tracheal reconstruction was 30–60 min. No postoperative bleeding, incision infection, tracheostomy stenosis occurred. Recurrent laryngeal nerve palsy occurred in 5 patients. All patients were followed up for 24 to 60 months. The 2-year overall survival rate was 100%, the 2-year local control rate of trachea was 100%, and the 2-year tumor-free survival rate was 81.8%. Conclusion The modified spiral tracheoplasty is a safe and effective method to repair the large defect of trachea after thyroid carcinoma invading the trachea.

Background Follicular variant papillary thyroid carcinoma is a distinct subtype of papillary thyroid carcinoma that can occasionally present with aggressive features, including distant metastases and extrathyroidal extension. While radioactive iodine ablation is a well-established treatment for residual disease, its post-treatment effects on tracheal and paratracheal structures remain poorly characterized. Case presentation A 22-year-old male individual of Taiwanese descent presented with an enlarged neck mass and was diagnosed with follicular variant papillary thyroid carcinoma. He underwent thyroidectomy, modified radical neck dissection, and postoperative radioactive iodine-131 ablation (100 mCi). A total of 1 year later, a chest computed tomography revealed a paratracheal soft tissue nodule and tracheal nodularity. Bronchoscopy with endobronchial ultrasound-guided sampling identified multiple 2–3 mm submucosal tracheal nodules containing white exudate. Cytopathologic analysis of both the paratracheal soft tissue nodule and the tracheal wall nodules revealed mucinous material without evidence of malignancy or inflammation. Microbiologic studies were negative for infection. Conclusion These atypical bronchoscopic and pathologic findings likely represent post-radioactive iodine treatment changes. The patient remained without evidence of disease for 22 months, ongoing on thyroid suppression levels of thyroxine hormone replacement. The case represents successful radioactive iodine treatment of papillary thyroid carcinoma residual disease after surgical resection, with the first described pathologic findings to correlate with these post-treatment changes.

Background Nuclear protein in testis (NUT) carcinoma is a rare and highly aggressive solid tumor with a poor overall survival outcome. There’s no recognized treatment or consensus on the management for NUT carcinoma. To date, few cases of tracheal NUT carcinomas have been reported, and the prognosis of these cases was dismal. We report a rare case of tracheal resection and reconstruction performed under non-intubated anesthesia for tracheal NUT carcinoma with good outcomes, aiming to contribute our experience in the surgical treatment of tracheal NUT carcinoma. Case presentation A 42-year-old male with a 20-packyear smoking history presented to the hospital with dyspnea and cough and was diagnosed with a tracheal malignant carcinoma. Fluorodeoxyglucose positron emission tomography showed FDG accumulation in the upper tracheal wall. The patient underwent tracheal resection and reconstruction under non-intubated anesthesia, with the final diagnosis of NUT carcinoma confirmed via immunohistochemical staining. The patient then received adjuvant platinum-based chemotherapy postoperatively. Neither complication nor cancerous recurrence was observed during the 12-month follow-up. Conclusions Surgery remains the preferred choice for early tracheal malignant tumors, including rare tumors like NUT carcinoma. This case report provides valuable insights into the imaging characteristics, pathological diagnosis, and treatment approach for tracheal NUT carcinoma. Future studies should aim to expand the case series to enhance our understanding and management of this aggressive neoplasm.

Background Indications for and efficacy of paratracheal nodal dissection (PTND) in patients undergoing laryngectomy (salvage) for persistent or recurrent laryngeal squamous cell carcinoma are not well-defined. Methods A retrospective cohort study was performed for patients undergoing salvage laryngectomy with clinically and radiographically negative neck disease between 1998 and 2015 ( n  = 210). Univariate and multivariate Cox regression analyses were performed. Results PTND was performed on 77/210 patients (36%). The PTND cohort had a greater proportion of advanced T classification (rT3/rT4) tumors (78%) than subjects without PTND (55%; p  = 0.001). There was a 14% rate of occult nodal metastases in the paratracheal basin; of these, 55% did not have pathologic lateral neck disease. Multivariate analysis controlling for tumor site, tumor stage, and pathologic lateral neck disease demonstrated that PTND was associated with improved overall survival [OS] ( p  = 0.03; hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.38–0.96), disease-free survival [DFS] ( p  = 0.03; HR 0.55, 95% CI 0.31–0.96), and distant DFS survival ( p  = 0.01; HR 0.29, 95% CI 0.11–0.77). The rate of hypocalcemia did not differ between subjects who underwent bilateral PTND, unilateral PTND, or no PTND ( p  = 0.19 at discharge, p  = 0.17 at last follow-up). Conclusions PTND at the time of salvage laryngectomy was more common in patients with rT3/rT4 tumors and was associated with improved OS and DFS, with no effect on hypocalcemia. In patients undergoing PTND, the finding of occult paratracheal metastases was often independent of lateral neck metastases.

Primary tumours of the trachea can be benign or malignant and account for fewer than 0·1% of tumours. However, they are a diagnostic and therapeutic challenge. Benign tumours are usually misdiagnosed as asthma or chronic lung disease, and can delay diagnosis for months or years. Because of their rapid growth and onset of haemoptysis, malignant tumours are often diagnosed earlier than benign tumours and patients thus often present with locally advanced disease. Inappropriate treatment is an equally frustrating issue. Modern techniques for tracheal surgery—laryngotracheal, tracheal, or carinal resection—combined with radiotherapy, can be offered curatively with low perioperative risks. Nevertheless, the low numbers of patients undergoing resection and the associated poor survival in epidemiological studies over the past two decades have shown that surgery is rarely considered outside referral centres, with radiotherapy or another form of local treatment (eg, endotracheal stents, debridement, brachytherapy) generally preferred. The liberal use of these other techniques should be avoided because surgery has the potential to cure all patients with benign and low-grade tumours and most patients with malignant primary tracheal tumours, and other techniques are usually palliative at best.