Image-guided volumetric modulated arc therapy (IG-VMAT) for unresectable ACC of the trachea: a feasible curative option

A middle-aged man presented with progressively worsening breathlessness and non-productive cough for the last 3 months. On examination, his breathing was stridulous and air entry was decreased bilaterally. He underwent emergency fibre-optic bronchoscopy, which revealed a tracheal growth causing lumi...

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Bibliographic Details
Published in:BMJ case reports 2019-03, Vol.12 (3), p.e227128
Main Authors: Chowdhary, Rahul Lal, Chufal, Kundan Singh, Pahuja, Anjali Kakria, Bhushan, Manindra, Singh, Rajpal, Ahmad, Irfan
Format: Article
Language:English
Subjects:
Airway management
Cancer therapies
Carcinoma, Adenoid Cystic - therapy
Case reports
Cellular biology
Chemotherapy
Cytotoxicity
Head & neck cancer
Humans
Inhibitor drugs
Male
Metastasis
Middle Aged
Oncology
Ostomy
Patients
Radiation therapy
Radiotherapy, Adjuvant - methods
Radiotherapy, Intensity-Modulated - methods
Rare Disease
Targeted cancer therapy
Tomography
Tracheal Neoplasms - therapy
Treatment Outcome
Tumors
Citations: Items that this one cites
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Summary:A middle-aged man presented with progressively worsening breathlessness and non-productive cough for the last 3 months. On examination, his breathing was stridulous and air entry was decreased bilaterally. He underwent emergency fibre-optic bronchoscopy, which revealed a tracheal growth causing luminal narrowing, and after tumour debulking, he improved symptomatically. Histopathological evaluation of the specimen revealed an adenoid cystic carcinoma of the trachea, and systemic evaluation revealed metastatic dissemination. Systemic molecular-targeted therapy was initiated (gefitinib and later imatinib mesylate) and continued for 5 years, in view of stable disease on periodic follow-up. He subsequently presented with breathlessness again, which was managed with an emergency tracheostomy. In view of stable systemic disease and local progression only, he received definitive radiotherapy with image-guided volumetric modulated arc therapy, which resulted in a complete radiological response. The patient has been disease-free for the last 9 months.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2018-227128