Chest
Volume 107, Issue 2, February 1995, Pages 556-558
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Bronchoscopy
Bronchoscopic Therapy in Patients With Intraluminal Typical Bronchial Carcinoid

https://doi.org/10.1378/chest.107.2.556Get rights and content

Objective

To study the efficacy of bronchoscopic therapy in patients with intraluminal typical bronchial carcinoid.

Design

Retrospective analysis of the data of patients with bronchial carcinoid, treated primarily with bronchoscopic techniques such as Nd-YAG laser in various hospitals in the Netherlands.

Subjects

Eleven patients with pulmonary complaints, ages 22 to 60 years, who were found to have intraluminal typical bronchial carcinoid.

Bronchoscopic interventions

Six of the 11 patients received Nd-YAG laser treatments, one received Nd-YAG laser plus photodynamic therapy, and the other four had mechanical tumor removal.

Results

Six patients were surgically treated after bronchoscopic therapy. The resected specimens showed no residual carcinoid. Median follow-up has been 70 months (range, 9 to 170 months). Five patients were not surgically treated after bronchoscopic therapy. Follow-up has been 27 to 246 months (median, 47 months) without signs of recurrence.

Conclusions

In 11 patients with typical, intraluminal, bronchial carcinoids, bronchoscopic treatment seemed to result in excellent local control, with surgical proof of cure in 6 of 11 patients. Bronchoscopic approach may provide a tissue-sparing alternative for bronchoplastic surgery in a subset of patients with typical intraluminal bronchial carcinoids.

Section snippets

MATERIALS AND METHODS

The characteristics of the patients who underwent any bronchoscopic intervention are shown in Table 1. Seven patients were male and four were female; median age was 51 years (range, 22 to 60 years). Initial chest radiographic abnormalities were present in four patients: three had atelectasis, and in one patient a round tumor in the right main bronchus was seen on a well-penetrated posteroanterior chest radiograph. On standard conventional tomography or on computed tomographic (CT) scans, no

RESULTS

Six of the 11 patients received Nd-YAG laser treatment and one had a combination of Nd-YAG laser and photodynamic therapy. Four patients had mechanical removal of the tumor only. Six patients underwent surgery afterwards, because bronchoscopic evaluation could not rule out possible residual disease as judged by the bronchoscopists (Table 2). However, in the resected lung specimens of these six patients, no residual carcinoid was found. Median follow-up of this surgical group has been 70 months

DISCUSSION

The presentation of bronchial carcinoids is variable; in most patients, tumors are visible radiologically and the bronchoscopically visible intraluminal part may be the “tip of an iceberg.”1, 6 In a minority of patients, the tumor presents as a polyp-like structure in the airway lumen without gross roentgenologically detectable abnormalities.

Bronchoscopic therapy, such as tumor removal, Nd-YAG laser, and photodynamic therapy have been used for palliation in patients with malignant central

REFERENCES (20)

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