CHEST Guidelines-Response

Response_chest (6)

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The document discusses the role of endobronchial treatment in managing central typical carcinoid tumors and provides insights and critique on recent research findings. Raz et al. compared two lung-sparing surgical techniques, lobectomy and sublobectomy, with a no-treatment group, some of which received endobronchial treatments like laser and cautery. Scarlata and colleagues argue that while endoscopic treatments have shown to result in more frequent recurrences compared to surgical methods, the associated morbidity and long-term mortality are low, making it a viable option in specific scenarios, like noninvasive, lymph node-negative carcinoids. They encourage further research and propose generating Kaplan-Meier survival curves for endoscopic treatment groups and characterizing comorbidities to understand better which patients are suitable for such treatments in practice.<br /><br />The response from Dr. Dan J. Raz acknowledges the potential of endoscopic management but highlights certain limitations. These include the inability to assess lymph node status during procedures, procedural risks like bleeding, and the necessity of repeated interventions over a patient's lifetime. Due to these concerns, Raz et al. recommend surgical treatments as the first-line therapy for patients with a suitable operative risk until more data comparing the efficacy of endoscopic versus surgical treatment is available.<br /><br />Furthermore, another section of the document references a study exploring cough intensity and its implications for patients with chronic cough, suggesting that further investigations into respiratory muscle activation could aid understanding the mechanisms underlying chronic cough symptoms and how these relate to cough-related quality of life.<br /><br />Overall, the document stresses the importance of further research into both endoscopic treatments for carcinoid tumors and the evaluation of chronic cough intensity, underlining the necessity for careful patient selection and consideration of both efficacy and quality of life in treatment assessments.

Keywords

endobronchial treatment

central typical carcinoid tumors

lung-sparing surgical techniques

endoscopic treatments

Kaplan-Meier survival curves

lymph node status

chronic cough intensity

respiratory muscle activation

quality of life

patient selection