Multidisciplinary Approach for the Management of Primary Tracheal Carcinoma”- Institutional Experience of 9 Bangladeshi Cases.

To further explicate the impact of multimodality management on the Disease Free Survival (DFS) and Overall Survival (OS). All the 9 cases of tracheal carcinoma from 2016 to 2017 was included with the diagnostic imaging and the histopathological confirmation.

There were 3 male and 6 female patients with ages that ranged from 30 to 60 years (M:F= 1:2). For these 9 patients the clinical manifestations and period from initial symptoms to diagnosis, histopathology, treatment and outcome are presented. The time from first symptoms to diagnosis varied, ranging from weeks to more than 1 year. All the patients presented with the following symptoms: Dyspnea (67%), Hemoptysis (44%), Cough (44%), Dysphagia (33%), and Throat Pain (11%). Tumor location for the upper and lower trachea was 67% & 33% respectively. Management includes interventional bronchoscopy, surgery and radiotherapy. All patients received adjuvant or definitive radiotherapy, 3 patients underwent surgery followed by Adjuvant External Beam Radiotherapy (EBRT), and the other 6 received definitive EBRT after having apple coring excision or Argon Plasma Coagulation (APC). Core excision done on 3 and APC with re-canalization done rest of the 3. EBRT was delivered with conformal 3D CRT with doses raging form 54Gy to 66Gy as per setting. Follow up done by appropriate guideline with imaging and bronchoscopy examination. Only 2 patients died after EBRT and rest of them on follow up. One out of 7 has DFS without any distant metastasis and only 1 patient on stable disease (SD) with bilateral lung nodules without having any local recurrence.

Tracheal carcinoma is extremely rare and rarely resectable. So multidisciplinary approaches with surgery or apple coring and even palliative APC for recanalization followed by EBRT showed improved outcome rather than single modality treatment like surgery alone in past history. The scarcity of chest surgeons in Bangladesh makes it difficult for upfront surgery. We have to choose the combination methods to treat the patients, so that we can achieve the DFS and improved OS.