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Primary adenocarcinoma of the trachea is rare. We present a case that was successfully treated with radiotherapy followed by surgical resection. A 66-year-old man was admitted to our hospital because of cough, sputum and dyspnea. A chest CT film showed a tracheal tumor, and transtracheal biopsy specimen showed well-differentiated papillary adenocarcinoma. Other examinations excluded the diagnosis of metastatic adenocarcinoma from other organs. Since stenosis of the trachea was rapidly progressive, a tracheal stent was inserted to alleviate the obstruction. After radiotherapy, the tumor size decreased, after which surgical resection was performed. No recurrence had been observed 26 months after the operation.

We evaluated 9 patients with malignant tumors involving the tracheal carina. In 2 patients, carinal reconstruction was performed using Miyamoto's method and sleeve pneumonectomy was performed in another patient. All 3 patients had no anastomotic complications after the operation and were ambulatory at discharge. Two patients are still alive, and the others died by 15 months after surgery. Dynamic stenting was performed in 4 patients and a Dumon stent was used in 2 patients. Respiratory symptoms were relieved soon after stent placement, but none of the stented patients survived more than 3 months, except for one who also had surgery. Sometimes surgery is avoided because of its high morbidity and mortality, but the prognosis is very poor without resection. We think surgery should be performed where possible, when the disease is resectable. Miyamoto's method is superior to others and causes few complications.

Endoscopic brachytherapy (ESBT) is a new technique presently being investigated for the treatment of cancer involving the tracheobronchial tree. This paper reports on the potential application of ESBT to the local treatment of cancer of the respiratory tract. Between September 1992 and December 1998, ESBT was performed in 52 patients with early-stage tracheobronchial cancer at the National Cancer Center Hospital. In all 52 cases tracheobronchial cancer was histologically confirmed by biopsy before treatment. Of the 52 patients who received ESBT, 51 showed a complete response to this therapy. Of the 52 patients, 27 patients are alive 12-80 months after therapy with no apparent recurrence or metastasis, and 25 patients have died. The 5-year survival rate of the 52 patients is 72.6%.

From 1973 to 1990, 7 patients presented with a adenoid cystic carcinoma of tracheobronchial tree that was treated surgically. The locations were larger airways; 4 in the trachea, 1 in the carina, 2 in the basal bronchus. Surgical treatments were performed in all cases. The following resections were done: trachea only 3; carina 1; trachea plus larynx 1; left lower lobe (sleeve lobectomy) 1; left lung (pneumonectomy) 1. Except for tracheolaryngectomy and left pneumonectomy, all cases were undergone primary anastomosis. Operative death was only one patient who died of anastomotic separation. Irradiation was performed in 6 patients before or after operation. Two patients were died due to lung metastases or leukemia. According to the Kaplan-Meier's method, the 5 years survival rate of all patients was 68.6%. Our experience suggests that surgical treatment and adjunctive radiotherapy is beneficial in patients with adenoid cystic carcinoma.

Endobronchial intraluminal brachytherapy was conducted for 5 patients with tracheobronchial carcinoma using 192Iridium high dose-rate afterloading machine (microSelectron HDR) and guide tubes of 1.9 mm in outer diameter. Four patients with bronchial non-small cell carcinoma and one with tracheal adenocarcinoma were applied, and a dose of 6 Gy/Fr. at points 1 cm from the source once a week, and a cumulative dose of 18 Gy/3 Fr. was delivered. Guide tubes could be placed up to 3 tubes via the vocal airway, and new computer planning system could afford to calculate dose from independent lining of the source into optimization. This could be done with safety, and no remarkable acute side effects were observed attributable to this method.

A study was made on the prognosis of 26 tracheal adenoid cystic carcinoma surgery cases reported in Japan between January 1978 and January 1984. The study was based on a questionnaire sent to doctors who reported prognosis as of May 1991. Twelve cases out of the 26 cases underwent postoperative irradiation. Seven out of the 12 cases survived 9 to 13 years after surgery without any recurrence. Two out of the 12 cases survived 8 and 10 years after surgery with multiple pulmonary metastases. Three out of the 12 cases died of a local recurrence 3, 3 and 9 years after surgery. Four cases received irradiation after a local recurrence was revealed postoperatively. Three out of the 4 cases survived 9, 10 and 11 years after surgery, but 1 out of the cases died 6 years after surgery. Four cases received no irradiation not only after surgery but also after detection of a local recurrence. All of them died within 9 years after surgery. There were six cases who underwent no postoperative irradiation and showed no local recurrence. One out of the 6 cases died of pancreas cancer 7 years after surgery, but the other cases survived 8 to 11 years after surgery without any recurrence. A study was also made on the prognosis of 9 cases with adenoid cystic carcinoma of the trachea who underwent surgery at Keio University and Tokai University until April 1982 (4 cases overlap with the above-mentioned cases). Six out of 9 cases received postoperative irradiation. Four cases survived 9 to 12 years after surgery without any recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic Nd-YAG laser treatment and adjuvant therapy were performed in 44 cases with metastatic lesions of airway. The best results were obtained in 31 cases (93.9%) out of 33 cases complaining of ventilatory disturbance in which endoscopic Nd-YAG laser treatment was indicated as an emergency procedure. In most of these cases with metastatic lesions of airway consisted of respiratory tract invasion from mediastinal lymph nodes in cases of esophageal cancer or lung cancer. In these cases, after laser treatment for ventilatory disturbance, the patients condition improved to the extent that adjuvant therapy could be performed. Adjuvant therapy was performed in 38 cases, there were 7 cases treated surgically (resection of the metastatic lesions of airway in 3 cases, tracheal tube stent operation in 4 cases 0, 28 radiotherapy in 28 cases (Linac irradiation in 24 cases, 60Co intraluminal irradiation of the trachea in 4 cases 0, and 32 cases were treated with chemotherapy. Tracheal tube stent operation was useful for maintenance of the tracheal lumen following laser treatment, and 60Co intraluminal irradiation was effective for the residual intratracheal tumor. The 1-year survival rate of 44 cases with metastatic lesions of airway was 42% and the 2-year survival rate was 22%, so this result suggested endoscopic Nd-YAG laser treatment and adjuvant therapy for metastatic lesions of airway was useful to prolong survival time. However the main value of this modality is for the rapid relief of severe ventilatory disturbance due to obstructive airway lesions.

To August, 1988, we performed tracheobronchial reconstruction for 159 patients with malignant tumors. Operative methods in these patients and the operative results studied in the end of March, 1989, was reported. As for adenoid cystic carcinoma, we stressed, by illustrating cases, that postoperative radiation therapy was useful and that it should be given for all patients with this disease. About one half of patients with thyroid carcinoma infiltrating the trachea died of symptoms related with tracheal stenosis. However, tracheobronchial reconstruction improved 10 year survival rate in patients with advanced thyroid carcinoma remarkably, which became close to that in patients with non-infiltrating thyroid carcinoma. As for lung cancer, tracheobronchial reconstruction had good indication for squamous cell carcinoma.

A Case Report: A newly developed treatment method of local administration of OK-432 bronchoscopically combined with irradiation was applied to a patient with carcinoma of the Trachea complaining dyspnea and dysphagia. The tumor showed extra-wall growth. Dyspnea was improved in a week and the tumor disappeared after the treatment. A patient became to take food orally and could discharge in well condition.