Multi-modality Treatment Achieving Long-term Control for Inoperable Adenoid Cystic Carcinoma of Trachea: A Case Report with Review of Medical Literature

Abstract

Background: Adenoid cystic carcinoma (ACC) is a tumor commonly originating from the salivary glands, but can rarely arise from the upper airway and be life threatening when causing central airway obstruction. While surgical resection is considered as the definitive treatment, ACC of the airway is frequently unresectable for a variety of reasons including tumor size, location, local extension or patient comorbidities. There is no consensus on the best treatment for locally advanced inoperable ACC of trachea. Objective: To present a case of inoperable ACC of trachea managed in our institute using multi-modality treatment and review on medical literature. Materials and Methods: A case report including history, relevant radiological findings and clinical photos. Results: Our patient, a 39-year-old lady, was diagnosed to have inoperable ACC of trachea in April 2010. She presented with progressive increase in shortness of breath and needed oxygen therapy. Chest X-ray noted total collapse of the left lung. CT revealed a soft tissue mass at left subcarinal region with involvement of the left main bronchus. There was no regional lymph node involvement or metastasis. Flexible bronchoscopy found tumor extending from carina down to left main bronchus with complete obstruction. Biopsy confirmed adenoid cystic carcinoma. She received multi-modality treatment: endoscopic stenting then radical radiotherapy using 3D conformal technique with 60Gy in 30 fractions over 6 weeks which was completed in July 2010. She has no evidence of disease progression or metastasis in interval CT imaging after a 24-month follow-up period. Conclusions: Most of the medical literature about this rare disease focused on surgical resection. Only few case reports are about radiotherapy with mixed results. Though ACC of the airway could be locally invasive and inoperable, this does not preclude a patient from receiving radical treatment. Multi-modality treatment using endoscopic intervention as a bridge before radical radiotherapy should be considered aiming at a better and long-term control.