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J Thorac Cardiovasc Surg 1998;116:402-406
© 1998 Mosby, Inc.

General Thoracic Surgery

Bronchoscopic treatment of intraluminal typical carcinoid: a pilotstudy

From the Departments of Pulmonary Medicine and Surgery, Free UniversityHospital Amsterdam, The Netherlands.

Received for publication Nov 4, 1997. Revisions requested Jan 6, 1998; revisions received May 15, 1998. Accepted for publication May 18, 1998 Address for reprints: G. Sutedja, MD, PhD, FCCP, Department ofPulmonary Medicine, Free University Hospital, PO Box 7057, 1007 MB Amsterdam,The Netherlands

Objective: The curative potential ofvarious bronchoscopic treatments such as Nd:YAG laser, photodynamic therapy, andbrachytherapy for the treatment of intraluminal tumor has been reportedpreviously. Bronchoscopic treatment can be used to treat small intraluminaltumor with curative intent, such as in patients with roentgenologically occultsquamous cell cancer. In a retrospective study, we showed that bronchoscopictreatment provided excellent local control with surgical proof of cure in 6 of11 patients with intraluminal typical bronchial carcinoid.
Methods: In a prospective study, 19 patients (8 women and11 men) with resectable intraluminal typical bronchial carcinoid have undergonebronchoscopic treatment under general anesthesia. Median age was 44 years(range, 20-74 years). If tumor persisted after 2 bronchoscopic treatmentsessions, surgery was performed within 4 months after the treatment.
Results: Bronchoscopic treatment was able to completelyeradicate 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 afterbronchoscopic treatment, and sleeve lobectomy was necessary. No residualcarcinoid was found in the resected specimen. In the remaining 5 patients,bronchoscopic treatment did not result in a complete response and radicalsurgical resection was performed afterward with confirmation of residualcarcinoid in the resected specimen. Median follow-up of the surgical group is 34months (range, 12-62 months).
Conclusions:Current data suggest that bronchoscopic treatment may be an effectivealternative to surgical resection in a subgroup of patients with resectableintraluminal typical bronchial carcinoid. It alleviated the necessity ofsurgical resection in 68% (95% CI: 43%-87%) of thepatients.

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