Endobronchial Treatment of Carcinoid Tumors of the Lung

Abstract

IntroductionBronchial carcinoid tumors are rarely seen neuroendocrine tumors accounting for more than 1 to 5% of all lung tumors and approximately 20 to 30% of all carcinoid tumors.1-3 The majority of these tumors originated from the proximal airways and most of them are symptomatic with obstructing symptoms or hemoptysis due to the tumor's hypervascularity. AbstractBackground Bronchial carcinoid tumors are known as low-grade malignancies. Surgery has been proposed as the best treatment of choice for lung carcinoids. However, less invasive treatment approaches may be considered due to low-grade malignancy potential of such tumors. The aim of this study was to review the results of endobronchial treatments of carcinoid tumors of the lung and to compare with the outcome after surgery.Methods Initial complete tumor eradication with an endobronchial treatment was attempted for 29 patients. Diode laser or argon plasma coagulation was used during these treatments. Cryotherapy or laser treatments were applied consecutively in patients for whom there was good bronchoscopic visualization of the distal and basal tumor margins and no evidence of bronchial wall involvement. Surgery was performed in cases of atypical carcinoid and in cases of nonvisualization of the basal and distal part of the tumor. Results Overall, 29 patients have been included (median age 58 years; range, 23-77 years). Median follow-up has been 49 months (range, 22-94 months). A total of 24 patients (69%) had typical carcinoid tumor, 5 patients (31%) had atypical carcinoid tumor. Initial endobronchial treatment provided complete tumor eradication in 21 of 29 patients (72%). Of the eight other patients (28%), two were atypical carcinoids, and underwent surgical treatment. There was no tumor-related death and no recurrence during the follow-up in both groups. There was no difference for survival or recurrence between the surgical and the endobronchial treatment group of patients (p > 0.05). Conclusion Endobronchial treatment may be considered as safe, effective treatment for typical carcinoid tumors in the central airways. Addition of initial endobronchial treatment had no negative effect on the surgical outcome.

Multimodality multistaged management of large endobronchial carcinoid causing respiratory failure: A case report with review of literature

“…The clinicodemographic profile of cases and types of bronchoscopic intervention including outcome of treatment has been described in Supplementary Tables and , respectively. [789101112131415161718192021222324252627282930313233343536] Various bronchoscopic treatment options as mentioned in these studies were practiced depending on the physician's discretion, expertise, and available resources. All studies have reported high success rates with minimal complications and good long-term outcome.…”

“…[3637] However, few studies have reported BT to be curative even in atypical histology or in case of residual or recurrence. [717222333] Bleeding especially uncontrolled is considered to be one of major complications. Few studies including the current one have used BAE before BT in order to reduce the risk of bleeding.…”

Endobronchial and surgical treatment of pulmonary carcinoid tumors: A systematic literature review

“…All studies were non-randomized cohort studies (7 retrospective and 2 prospective), performed in Europe and published in the 21th century. Six studies included patients with TC only [4,5,7,[9][10][11], whereas 3 included patients with both TC and AC [6,8,12]. For resection of the carcinoid tumor, 7 studies used laser therapy [4][5][6][7]9,11,12], of which 5 also used cryotherapy [4][5][6]8,12], 1 study described diode laser or argon plasma coagulation [8] and 1 study used a forceps [10].…”

“…Six studies included patients with TC only [4,5,7,[9][10][11], whereas 3 included patients with both TC and AC [6,8,12]. For resection of the carcinoid tumor, 7 studies used laser therapy [4][5][6][7]9,11,12], of which 5 also used cryotherapy [4][5][6]8,12], 1 study described diode laser or argon plasma coagulation [8] and 1 study used a forceps [10]. Pre-treatment evaluation of intrabronchial and/or extrabronchial tumor localization was assessed with both CT scan and bronchoscopy in 7 studies [4][5][6][8][9][10]12], and not reported in 2 studies [7,11].…”

The technique of endoscopic airway tumor treatment

“…Furthermore, the addition of initial endobronchial treatment has no negative effect on the surgical outcome (28).…”