Divergent management strategies for typical versus atypical carcinoid tumors of the thoracic cavity.
OBJECTIVE
At our institution, limited surgical techniques are reserved only for suspected typical carcinoids, and nodal dissection and multimodality therapy are frequently used for atypical carcinoids. We describe the results of these differing management strategies based on initial clinicopathologic characteristics.


METHODS
Retrospective review of patients treated for thoracic carcinoid from 1995 to 2009. Information was abstracted concerning surgical and nonsurgical treatments, pathology results, and outcomes. Event-free and survival endpoints were compared.


RESULTS
The median follow-up was 5.0 years (range, 0.5 to 17.4 y). Fifty-two patients underwent resection. The 5-year event-free survival for typical carcinoid patients was 88.2%. Atypical carcinoids had a tendency for nodal involvement (50% vs. 15%) and greater likelihood for disease recurrence, with a 5-year event-free survival of 50%.


CONCLUSIONS
These data support the appropriateness of divergent management strategies for typical versus atypical bronchial carcinoids. We propose the following: (1) nonanatomic resection is acceptable only for peripheral typical carcinoids; (2) extended mediastinal dissection should be limited to central presentations, clinically aggressive, or atypical carcinoids; (3) atypical histology, especially with nodal involvement, is prognostic for recurrence and metastasis; (4) nonsurgical therapies only rarely achieve long-term freedom from disease.
Departments of *Radiation Oncology †Surgery, Division of Adult Cardiothoracic Surgery ‡Medicine, Division of Medical Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
Christian C
CC
Okoye
David M
DM
Jablons
Thierry M
TM
Jahan
Jasleen
J
Kukreja
Shayne
S
Cardozo
Sue S
SS
Yom
D000293:Adolescent; D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery* / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008482:Mediastinum / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D010166:Palliative Care; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D013899:Thoracic Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult