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• W4387247890 abstract "SESSION TITLE: Procedures Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm INTRODUCTION: Lung neuroendocrine tumors (NETs) are rare neoplasms from peptide and amine-producing neuroendocrine cells. Although NETs can arise in various sites of the body, the lung is the second most common site. For localized lung NETs, surgical resection is the treatment of choice. Endobronchial techniques include laser resection, argon plasma coagulation (APC), and cryotherapy. These techniques are accepted since low-grade lung NETs are not spread submucosally; however, the endobronchial approach is deemed unfavorable for definitive treatment. Current data suggests that endobronchial management has not been preferred due to poor visualization of tumor recurrence upon follow-up imaging and due to the slow-growth of the lung NET recurrence. However, there has not been sufficient data to address the limitations of the endobronchial approach and guidelines for definitive treatment are tailored for surgery at this time. Endobronchial management has typically been reserved for patients not amenable to surgery, for palliative management, or for perioperative preparation. The purpose of our case is to increase data within the literature of successful definitive treatment of low-grade lung NETs by endobronchial therapy. CASE PRESENTATION: We present an 81-yo male with shortness-of-breath on exertion, unintentional weight-loss of 8-10 Ibs with diarrhea 1-2 times weekly for one year. He quit smoking over 30 years ago after smoking 8-10 cigarettes daily for 4-5 years. His shortness-of-breath also occurred at night relieved by antihistamines. Computerized-tomographic imaging (CT) revealed a left lower lobe intraluminal mass of the proximal lobar bronchus with post-obstructive atelectasis. Stepwise endobronchial procedures were performed over a three month period. First, biopsy was obtained elucidating lung carcinoid tumor with cryotherapy and snare debulking. Second, snare resection and argon plasma coagulation (APC) ablation were performed. Third, APC ablation was performed with complete tumor resection as final result. Follow-up with CT-imaging for about two years revealed no recurrence and symptomatic improvement was achieved. DISCUSSION: Our case demonstrates the use of endobronchial approach for definitive treatment of typical lung NETs not accessible by surgery. Upon follow-up, our patient achieved symptomatic improvement and was additionally able to monitor recurrence with CT-imaging. We broaden the literature of endobronchial management as definitive therapy with CT imaging as the mainstay of post-procedural monitoring. Additionally, we suggest that endobronchial removal of typical lung NETs and follow-up imaging post-endobronchial treatment should become standardized through implementing new guidelines by the Commonwealth Neuroendocrine Tumor Society and the North American Neuroendocrine Tumor Societies (CommNETS/NANETS) specific to post-endobronchial resection. This will allow for an evidence-based framework to guide definitive endobronchial treatment of these tumors as minimally-invasive approaches increase. CONCLUSIONS: Endobronchial approaches highlight that minimally-invasive techniques may take precedence for lung NETs resection. Few case reports have documented endobronchial techniques for definitive therapy. We describe the successful endobronchial management of central typical lung NETs with CT-imaging follow-up without evidence of recurrence. In the advent of endobronchial therapeutic techniques, guidelines should address and reflect these advances. Surgery remains as the gold standard of definitive treatment of typical centrally-located neuroendocrine lung tumors; however, with continued research and guideline development, endobronchial resection may take future precedence. REFERENCE #1: Alahmed S, Arishi H, Alabdulatif M, Bamefleh H, Alghamdi R. Bronchoscopic resection of typical carcinoid tumors: literature review and case series. J Surg Case Rep. 2022 May 17;2022(5):rjac180. doi: 10.1093/jscr/rjac180. PMID: 35592453; PMCID: PMC9113435. REFERENCE #2: Dalar L, Ozdemir C, Abul Y, Sokucu SN, Karasulu L, Urer HN, Altin S. Endobronchial Treatment of Carcinoid Tumors of the Lung. Thorac Cardiovasc Surg. 2016 Mar;64(2):166-71. doi: 10.1055/s-0035-1549274. Epub 2015 May 18. PMID: 25984778. REFERENCE #3: Fuks L, Fruchter O, Amital A, Fox BD, Abdel Rahman N, Kramer MR. Long-term follow-up of flexible bronchoscopic treatment for bronchial carcinoids with curative intent. Diagn Ther Endosc. 2009;2009:782961. doi: 10.1155/2009/782961. Epub 2010 Feb 7. PMID: 20169101; PMCID: PMC2821777. DISCLOSURES: No relevant relationships by Mudher Al Shathir No relevant relationships by Idil Askar No relevant relationships by Michael Jagoda No relevant relationships by A. Margarita Saludes" @default.
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• W4387247890 date "2023-10-01" @default.
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• W4387247890 title "LUNG CARCINOID TUMOR: CAN ENDOBRONCHIAL RESECTION OF TYPICAL NEUROENDOCRINE TUMOR BE THE NEW DEFINITIVE TREATMENT OF CHOICE AS OPPOSED TO SURGERY?" @default.
• W4387247890 doi "https://doi.org/10.1016/j.chest.2023.07.3511" @default.
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