1. Greater efforts to improve treatment would therefore seem justifiable. Unlike bronchial carcinoma which occurs predominantly in men, sex incidence appears to be equal in tracheal tumours; evidence suggesting an association with smoking was found in squamous and small cell carcinomas. Small cell carcinoma of the trachea was previously considered very rare but we found an incidence of about 6% (a similar incidence to that reported by Roston and Morgan'2). The survival rates in the few cases we had were perhaps better than one might expect in comparison with bronchial tumours, since most were treated predominantly with radiotherapy and did not have modem chemotherapy regimes.'5
2. This study highlights the need for referral to specialised centres so that treatment can be best coordinated to patients' needs and better prospective data obtained. Only a randomised prospective comparative trial of surgery and radiotherapy can show which is best and the rarity of these tumours makes recruitment to such a study very difficult. Nevertheless, it appears that prognosis for these tumours could be improved and, in view of the miserable deaths which otherwise occur, we believe such studies should be pursued. With the collaboration of the British Thoracic Society Research Committee we are now establishing a study to monitor prospectively treatment of primary tracheal tumours on a national scale by interested surgeons and radiotherapists which should overcome the limitations of this retrospective study
3. Mortality statistics England and Wales 1990. London: HMSO.
4. Role of the neodymium YAG laser in the management of tracheal tumours;George, P.J.M.; Garrett, C.P.O.; Hetzel, M.R.;Thorax,1987
5. Cryotherapy for advanced carcinoma of the trachea and bronchi;Maiwand, M.O.;BMJ,1986