Cutting Edge without Cutting Corners: Bronchoscopic Treatment for Bronchial Carcinoids

In line with this normal tissue-sparing approach, bronchoscopic treatment has been utilized in selected patients who were either unfit to undergo surgical resection or who had too extensive disease progression and were treated in a palliative setting, for tumor located in the central tracheobronchial tree. Current understanding of tumor growth and behavior with regard to the development of local and distant disease has enabled us to consider alternative strategies that are aimed toward optimal outcome in terms of maximum preservation of quality of life. Furthermore, an increased use of minimally invasive techniques has improved our abilities for a more tailored approach and evaluation of disease processes, allowing us to consider more balanced tissue-sparing alternatives to surgical intervention. A tendency towards tissue-preserving treatment modalities, respecting oncologic principles, accounts for treatment in nearly all fields of oncology nowadays. With respect to the treatment of bronchial carcinoids, more and more authors report on ever-expanding tissue-preserving curative modalities (i.e. intraluminal bronchoscopic treatment) as sound alternatives to (immediate) surgical resection. They increasingly question the firmly based dogma that surgical resection is the only justifiable treatIn this issue of Respiration Katsenos et al. [1] report on the long-term palliation by bronchoscopic treatment of a patient with recurrent atypical carcinoid. They show that multiple recurrences of a bronchial carcinoid can be controlled with local, i.e. bronchoscopic, treatment over a long period of time. It is of special interest that although the initial treatment modality in this case was surgical resection, i.e. ‘enucleation’ as described, the tumor recurred at another site in the lungs 9 years later, making surgical resection necessary. In the course of many years of follow-up, several recurrences developed and were treated sufficiently by bronchoscopic means and by liver segmentectomy for a distant metastasis. The gold standard for treatment of bronchial carcinoids traditionally has been radical surgical resection. From an oncologic point of view, radical surgery should be regarded as the standard approach. However, more conservative resection is now considered to be an accepted strategy in the treatment of bronchial carcinoids because it is more parenchymal sparing with justifiable long-term survival results for a disease entity that may harbor a low malignant potential [2–4] . Some authors advocated more aggressive therapeutic approaches based on the classification of atypical histology [5] . Published online: January 25, 2011