Safety and feasibility of arterial embolization before endobronchial typical carcinoid tumors resection

Purpose: typical carcinoid tumors are low-grade malignant tumors with slow growth and high survival. The gold standard treatment is surgery. However, in some inoperable patients with endoluminal tumors, bronchial selective arterial embolization before rigid bronchoscopy could be useful as a complementary technique to avoid bleeding and ensure an accurate radical resection. Materials and methods: 5 inoperable patients between 17 to 82 years with endoluminal carcinoid and significant bronchial obstruction have been treated endoscopically 24 h after embolization. Debulking was achieved with rigid bronchoscopy and YAP laser coagulation. Bronchial arterial embolization was performed with microcoils and PVA particles. Final pathologic diagnoses rendered 4 typical and one atypical carcinoid. Results: no inmediatly or short term complications after embolization have been registred. In all patients endoscopic treatment executed without significant bleeding, allowing a complete and accurate resection. A successful follow-up (2 to 22 months) was observed by CT and autofluorescence bronchoscopy. Conclusions: Arterial embolization of endobronchial carcinoid tumors is a feasible and safe method to avoid bleeding during rigid bronchoscopy ensuring an accurate endobronchial resection. Impact on recurrences and distant disease, should wait for a long term follow up in a multicenter study.