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Image-guided volumetric modulated arc therapy (IG-VMAT) for unresectable ACC of the trachea: a feasible curative option
  1. Rahul Lal Chowdhary,
  2. Kundan Singh Chufal,
  3. Anjali Kakria Pahuja,
  4. Manindra Bhushan,
  5. Rajpal Singh and
  6. Irfan Ahmad
  1. Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
  1. Correspondence to Dr Rahul Lal Chowdhary, rahul.gill04{at}


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.

  • radiotherapy
  • tyrosine kinase inhibitor
  • respiratory cancer

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  • Contributors RLC is the treating senior resident (radiation oncology), author of the paper, responsible for drafting the manuscript and revising it. He is the guarantor. KSC is the treating senior consultant (radiation oncology), responsible for article formulation, editing and oversight. AKP is the treating consultant (radiation oncology) and participated in article formulation, editing and oversight. MB is the medical physicist, responsible for generating the radiation treatment plan, performing quality assurance of delivered plan and also participated in article editing. RS and IA are the senior resident and attending consultant (radiation oncology), respectively, and participated in article drafting and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.