Bronchoscopic treatment of intraluminal typical carcinoid: a pilot study.
OBJECTIVE
The curative potential of various bronchoscopic treatments such as Nd:YAG laser, photodynamic therapy, and brachytherapy for the treatment of intraluminal tumor has been reported previously. Bronchoscopic treatment can be used to treat small intraluminal tumor with curative intent, such as in patients with roentgenologically occult squamous cell cancer. In a retrospective study, we showed that bronchoscopic treatment provided excellent local control with surgical proof of cure in 6 of 11 patients with intraluminal typical bronchial carcinoid.


METHODS
In a prospective study, 19 patients (8 women and 11 men) with resectable intraluminal typical bronchial carcinoid have undergone bronchoscopic treatment under general anesthesia. Median age was 44 years (range, 20-74 years). If tumor persisted after 2 bronchoscopic treatment sessions, surgery was performed within 4 months after the treatment.


RESULTS
Bronchoscopic treatment was able to completely eradicate tumor in 14 of the 19 patients (complete response rate 73%, 95% CI: 49%-91%). Median follow-up of these patients is 29 months (range, 8-62 months). One patient had severe cicatricial stenosis after bronchoscopic treatment, and sleeve lobectomy was necessary. No residual carcinoid was found in the resected specimen. In the remaining 5 patients, bronchoscopic treatment did not result in a complete response and radical surgical resection was performed afterward with confirmation of residual carcinoid in the resected specimen. Median follow-up of the surgical group is 34 months (range, 12-62 months).


CONCLUSIONS
Current data suggest that bronchoscopic treatment may be an effective alternative to surgical resection in a subgroup of patients with resectable intraluminal typical bronchial carcinoid. It alleviated the necessity of surgical resection in 68% (95% CI: 43%-87%) of the patients.
van Boxem
T J
TJ
Department of Pulmonary Medicine, Free University Hospital Amsterdam, The Netherlands.
Venmans
B J
BJ
van Mourik
J C
JC
Postmus
P E
PE
Sutedja
T G
TG
D000328:Adult; D000768:Anesthesia, General; D001984:Bronchial Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D001999:Bronchoscopy; D002276:Carcinoid Tumor / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D004564:Electrocoagulation; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation; D008297:Male; D010778:Photochemotherapy; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome