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Correspondence |

Therapeutic Role of Endoscopic Resection in Typical, Noninvasive, Carcinoid Tumors FREE TO VIEW

Simone Scarlata, MD; Raffaele Antonelli Incalzi, MD; Gianni Galluccio, MD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Simone Scarlata, MD, Geriatrics, Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Via Alvaro del Portillo 200, 00128, Rome, Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):283-284. doi:10.1016/j.chest.2015.09.030
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The article by Raz et al in CHEST (April 2015), as well as the comment letter by Schwartz and Henson, expanded our knowledge on the natural history of carcinoid tumors. The authors repeat the assumption that surgery is always recommended as first-line treatment of typical carcinoids. However, the high tolerability, the very low mortality, and the lack of conclusive evidence regarding the role of endobronchial treatment challenge this recommendation.

Raz et al further compared the survival curves of two different lung-sparing resection techniques (lobectomy and sublobectomy) vs a defined no-treatment group that also included a sample (51 of 306) of patients who underwent endoscopic tumor destruction with laser, cautery/fulguration, or otherwise specified procedures. We believe this approach is incorrect. Indeed, endoscopic treatment seems reasonably safe and effective in typical, noninvasive, lymph node-negative carcinoids., Although carcinoid recurrence has been shown to occur more frequently in patients managed endoscopically than in surgically treated patients, morbidity and long-term mortality rates are extremely low. In a case series of 35 patients with endoscopically resected carcinoids, Cavaliere et al reported no recurrence after a follow-up period of up to 198 months. In another series of 28 patients undergoing endobronchial treatment, the median follow-up was 8.8 years, and the 1- and 10-year survival rates were 89% and 84%, respectively. Among survivors, 100% and 94% were disease free at 1 and 10 years.

The endoscopic approach thus seems valuable, at least in selected situations, and worthy of further research, although it should not be considered a nontreatment. It would be very useful to generate a Kaplan-Meier survival curve for the endoscopic treatment group compared with the other groups. Furthermore, a baseline characterization of comorbidity and performance status of patients undergoing endoscopic treatment would clarify which patients are deemed suitable for such a treatment in real-life practice. Finally, in the study by Raz et al, only a minority of subjects belonging to the no-treatment group had a centrally located tumor, the only site amenable to endoscopic resection, thus supporting the hypothesis that the carcinoid was not treated because of concurrent conditions.

In conclusion, the valuable data by Raz et al should prompt further investigations to highlight the role of endobronchial resection in the treatment of typical carcinoid tumors regarding recurrence and mortality as well as other clinical outcomes such as patient tolerability and quality of life.

References

Raz D.J. .Nelson R.A. .Grannis F.W. .Kim J.Y. . Natural history of typical pulmonary carcinoid tumors: a comparison of nonsurgical and surgical treatment. Chest. 2015;147:1111-1117 [PubMed]journal. [CrossRef] [PubMed]
 
Schwartz A.M. .Henson D.E. . Analysis of surveillance, epidemiology, and end results database for carcinoid tumors. Chest. 2015;148:e104-e105 [PubMed]journal. [CrossRef] [PubMed]
 
Vallières E. .Shepherd F.A. .Crowley J. . and the International Association for the Study of Lung Cancer International Staging Committee and Participating Institutionset al The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4:1049-1059 [PubMed]journal. [CrossRef] [PubMed]
 
Ferguson M.K. .Landreneau R.J. .Hazelrigg S.R. .et al Long-term outcome after resection for bronchial carcinoid tumors. Eur J Cardiothorac Surg. 2000;18:156-161 [PubMed]journal. [CrossRef] [PubMed]
 
Díaz-Jiménez J.P. .Canela-Cardona M. .Maestre-Alcacer J. . Nd:YAG laser photoresection of low-grade malignant tumors of the tracheobronchial tree. Chest. 1990;97:920-922 [PubMed]journal. [CrossRef] [PubMed]
 
Cavaliere S. .Foccoli P. .Toninelli C. . Curative bronchoscopic laser therapy for surgically resectable tracheobronchial tumors: personal experience. J Bronchology. 2002;9:90-95 [PubMed]journal
 
Luckraz H. .Amer K. .Thomas L. .Gibbs A. .Butchart E.G. . Long-term outcome of bronchoscopically resected endobronchial typical carcinoid tumors. J Thorac Cardiovasc Surg. 2006;132:113-115 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Raz D.J. .Nelson R.A. .Grannis F.W. .Kim J.Y. . Natural history of typical pulmonary carcinoid tumors: a comparison of nonsurgical and surgical treatment. Chest. 2015;147:1111-1117 [PubMed]journal. [CrossRef] [PubMed]
 
Schwartz A.M. .Henson D.E. . Analysis of surveillance, epidemiology, and end results database for carcinoid tumors. Chest. 2015;148:e104-e105 [PubMed]journal. [CrossRef] [PubMed]
 
Vallières E. .Shepherd F.A. .Crowley J. . and the International Association for the Study of Lung Cancer International Staging Committee and Participating Institutionset al The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4:1049-1059 [PubMed]journal. [CrossRef] [PubMed]
 
Ferguson M.K. .Landreneau R.J. .Hazelrigg S.R. .et al Long-term outcome after resection for bronchial carcinoid tumors. Eur J Cardiothorac Surg. 2000;18:156-161 [PubMed]journal. [CrossRef] [PubMed]
 
Díaz-Jiménez J.P. .Canela-Cardona M. .Maestre-Alcacer J. . Nd:YAG laser photoresection of low-grade malignant tumors of the tracheobronchial tree. Chest. 1990;97:920-922 [PubMed]journal. [CrossRef] [PubMed]
 
Cavaliere S. .Foccoli P. .Toninelli C. . Curative bronchoscopic laser therapy for surgically resectable tracheobronchial tumors: personal experience. J Bronchology. 2002;9:90-95 [PubMed]journal
 
Luckraz H. .Amer K. .Thomas L. .Gibbs A. .Butchart E.G. . Long-term outcome of bronchoscopically resected endobronchial typical carcinoid tumors. J Thorac Cardiovasc Surg. 2006;132:113-115 [PubMed]journal. [CrossRef] [PubMed]
 
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