Tracheal Adenocarcinoma Treated with Adjuvant Radiation: A Case Report and Literature Review
Our 60-year-old diabetic and hypertensive male patient had a 1-month history of cough associated with marked respiratory distress and occasional dyspnea in the right lateral lying position. The patient consulted a chest physician and underwent bronchoscopy, which showed a polypoid growth in the trachea extending to the larynx (fig. ). A computed tomography (CT) scan revealed irregular soft tissue thickening in the region of the trachea extending up to the adjacent larynx with no soft tissue calcification, and there was no definite lymphadenopathy in the cervical region and no involvement of the underlying bone. A repeat CT scan of the neck (fig. ) showed evidence of an ill-defined, irregular, nodular, infiltrating soft tissue growth arising from the posterior tracheal wall, bridging the lumen and reaching up to the anterior wall, with an infiltration of about 2.2 × 1.8 cm. The location was opposite the C7-D1 level involving the 5th or 6th tracheal ring, approximately 7 cm proximal to the carina with no significant evidence of cervical and mediastinal lymphadenopathy.\nExcision of the tracheal growth through a cervical transverse incision was performed, and a tracheostomy tube was inserted. Histopathology revealed an atypical carcinoid with lymphatic invasion. Immunocytochemistry was positive for pancytokeratin and negative for chromogranin-A. The case was finally diagnosed as adenocarcinoma of the trachea.\nSoon after surgery, the cough subsided and the patient attended Square Hospital, Dhaka, Bangladesh, for postoperative irradiation. The prescribed photon radiation dose was 56 Gy in 28 fractions. Ninety-five percent of the planning target volume (PTV) covered 97.3% of the prescribed dose. The minimum and maximum dose received by the PTV was 50.05 and 63.68 Gy, respectively. The dose distribution is illustrated below (fig. ). Three multileaf collimator fields (left anterior oblique, right anterior oblique and posterior) were used for three-dimensional conformal radiation therapy (3DCRT). The radiation dose distribution within the PTV is shown by color wash (fig. ). Complete response was documented, and the patient is still alive without any evidence of disease during 30 months of follow-up.