KEY POINTS
- This case series included 4 patients from a prospective institutional cohort who underwent tracheal or tracheobronchial resection for adenoid cystic carcinoma followed by reconstruction with a cryopreserved aortic allograft.
- All tumors had peritracheal soft-tissue invasion; 3/4 patients had microscopically positive margins, while the remaining R0 case had perineural invasion. RT began a median of 95 days after surgery.
- Postoperative VMAT delivered 54 Gy in 27 fractions, using a split-course schedule of 30 Gy in 15 fractions followed by 24 Gy in 12 fractions. Limited portions of the graft were included in the CTV in three patients when directly adjacent to high-risk regions.
- All four patients completed RT without interruption. One developed a transient inflammatory syndrome with cough and fever that resolved conservatively, while no other acute grade ≥2 toxicity was observed.
- Importantly, there were no graft-related inflammatory reactions, imaging abnormalities, stenoses, fistulas, or dysphagia after irradiation.
- At a median follow-up of 12 months (range 4.5–52), all patients were alive and no local recurrences had occurred; three had no evidence of disease and one developed distant pulmonary metastases.
CLINICAL TAKEAWAY
Postoperative RT appears technically possible after tracheal reconstruction with a cryopreserved aortic graft, and this series offers a useful planning precedent for an exceptionally rare situation. It does not establish long-term graft tolerance or an optimal dose: only four patients were treated, and the 54 Gy regimen was lower than typical postoperative doses used for high-risk adenoid cystic carcinoma.