Page 76 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
MODERATED e-POSTER SESSION 07:
Lung Cancer
OUTCOME OF ENDOBRONCHIAL LASER RESECTION FOR CARCINOID TUMOURS IN A CAREFULLY SELECTED COHORT
Amyn Bhamani, Jeremy George, Samuel Janes, Neal Navani, Ricky Thakrar
University College London Hospitals NHS Foundation Trust, London, United Kingdom
PP47
Introduction: Carcinoid tumours of the lung arise from neuroendocrine cells and make up about 2% of all primary lung tumours (Caplin 2015). They are not sensitive to chemo- or radiotherapy and therefore, surgery remains the treatment of choice. However, these tumours frequently arise in central airways and patients often require pneumonectomy or a sleeve resection (Detterbeck 2010). Endobronchial therapy such as laser resection is generally reserved for patients considered high risk for surgery and has been associated with good outcomes.We aimed to evaluate our experience of laser resection as an alternative to surgical resection in patients with carcinoid tumours.
Methods: A retrospective analysis of patients referred to our institution for curative laser resection of typical carcinoid tumour was performed. All patients underwent assessment with contrast enhanced CT chest, 68Galium-DOTATATE PET-CT, and diagnostic autofluorescence bronchoscopy and biopsy. Where there was suspicion of nodal disease, EBUS TBNA was also performed. Following lung cancer multidisciplinary meeting, definitive endobronchial therapy was carried out using ablation with a semiconductor diode laser after applying the exclusion criteria in Figure 1.A surveillance bronchoscopic assessment was carried out 2 months after initial treatment and then every 6-12 months with patients remaining under surveillance for >2 years.
Results: Forty-one patients were referred between 2012 and 2018. Fifteen patients with large tumours (>30mm), twelve with a visible extra-bronchial component and two with nodal disease were considered more suitable for surgical resection. Twelve underwent definitive endobronchial laser therapy for carcinoid tumour as an alternative to surgical resection. Eleven (92%) had a complete pathological response to laser resection at their first check bronchoscopy.The patient with residual disease received repeat laser therapy and had no further detectable microscopic disease. During surveillance, 2 patients developed recurrence at a median surveillance interval of 12 (8-36) months. Both had suspicion of extraluminal disease at bronchoscopy and went on to have a curative surgical resection. Further analysis revealed that tumour diameter <20mm predicted whether a complete response to laser was achieved (odds ratio 3.0, 95% CI 1.0—9.4; p=0.03). No complications were observed.
Conclusion: Our study shows that carcinoid tumours appear to be exquisitely sensitive to bronchoscopic laser therapy and treatment can result in complete ablation of the disease in carefully selected patients. While further studies are needed, it would appear that endobronchial laser treatment is safe and effective and may defer the need for surgical resection.
Figure 1: Patient selection and exclusion criteria Figure 2: Patient demographics
76 6th European Congress for Bronchology and Interventional Pulmonology