title: Long-term follow-up after first-line bronchoscopic therapy in patients with bronchial carcinoids.
abstract: BACKGROUND
  Carcinoid of the lung is considered to be a low-grade malignancy. A subgroup presents as an endobronchial tumour. Surgical resection is considered the standard approach because of its metastatic potential and the possibility of an iceberg phenomenon for the endobronchial subgroup. Advances in non-invasive and minimally invasive technologies seem to justify a more lung parenchyma-sparing approach.
  
  
  METHODS
  In patients presenting with bronchial carcinoids, initial bronchoscopic treatment (IBT) is first attempted for complete tumour eradication and sufficient tissue sampling for the proper differentiation of typical (TC) versus atypical (AC) histological type. Furthermore in cases with postobstruction problems the desobstruction is aimed at improving the patient's condition and by that alleviate surgery if that is needed. High resolution CT is performed 6 weeks post IBT to determine local tumour growth. Surgical resection follows in case of extraluminal disease, residual carcinoid inaccessible for IBT, or late recurrences not salvaged by repeat IBT.
  
  
  RESULTS
  Minimum follow-up was 5 years from start of treatment for 112 patients (65 women, 47 men), with a median age of 47 years (range 16-77 years). Eighty-three patients (74%) had TC, and 29 (26%) AC. IBT only was ultimately curative in 42% of the cases (47/112): 42 TC, 5 AC. Disease-specific mortality including surgical mortality has been 2.6% (3/112) in patients with extraluminal carcinoids (3 AC).
  
  
  CONCLUSIONS
  IBT, if with unsuccessful rescue surgery, is justifiable with excellent long-term outcome. IBT made surgery unnecessary in 42% of the cases. Iceberg phenomenon and metastatic potential in this group of patients with bronchial carcinoids are clinically insignificant.
authors.affiliation: Department of Surgery, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Hes A P
authors.initials: HA
authors.lastname: Brokx
authors.affiliation: Department of Surgery, VU University Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marinus A
authors.initials: MA
authors.lastname: Paul
authors.affiliation: Clatterbridge Cancer Centre, Liverpool Heart & Chest Hospital, University of Liverpool, Liverpool, UK.
authors.forename: Pieter E
authors.initials: PE
authors.lastname: Postmus
authors.affiliation: Department of Pulmonology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Sutedja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001984:Bronchial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001999:Bronchoscopy; D002276:Carcinoid Tumor / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018365:Neoplasm, Residual; D011013:Pneumonectomy; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bronchoscopy; Lung Cancer; Thoracic Surgery