Role of radiation alone concurrent chemoradiotherapy in surgically ineligible patients with tracheobronchial squamous cell carcinoma.

BACKGROUND

Primary tracheobronchial squamous cell carcinoma (SCC) is a rare and aggressive malignancy, with limited evidence guiding optimal treatment strategies. We aimed to evaluate treatment outcomes for primary tracheobronchial SCC, explicitly focusing on the potential benefits of adding concurrent chemotherapy to definitive radiotherapy (RT).

METHODS

Nineteen patients with tracheobronchial SCC treated at the Samsung Medical Center between January 1995 and April 2023 were identified. Surgical interventions were determined using a multidisciplinary approach, and patients who were ineligible for surgery received RT with or without concurrent chemotherapy. The progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method.

RESULTS

Of the 19 patients included in the study 5 underwent surgery, whereas the remaining 14 underwent RT. For total patients, the median PFS and OS were 28.2 and 43.3 months, respectively. The 3-year OS rates were 16.7%, 83.3%, and 60.0% in the RT alone, concurrent chemoradiotherapy (CCRT), and surgery groups, respectively. With a median follow-up period of 19.1 months, eight patients experienced disease progression, with the lungs and trachea being the most common sites for recurrence. Univariate analysis demonstrated that large tumor size, low radiation dose, pretreatment stent insertion, and radiation-only treatment correlated with inferior survival. In the 12 patients receiving curative RT, a trend towards improved OS was observed in the CCRT group (RT alone CCRT; 25.0% 83.3% at 3 years, P=0.08).

CONCLUSIONS

CCRT may improve survival outcomes in patients with inoperable tracheobronchial SCC, offering a possible alternative to surgical interventions.