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  NEUROENDOCRINE TUMORS
Guest Editors: Bombardieri E.
 

The Quarterly Journal of Nuclear Medicine 2000 March;44(1):3-12

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

State of the art and future prospects in the management of neuroendocrine tumors

Öberg K.

From the Endocrine Oncology Unit Chairman Department of Medical Sciences University Hospital, Uppsala, Sweden


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Neu­ro­en­do­crine gas­troen­te­rop­an­creatic ­tumors are ­rather ­rare neo­plasms ­with an inci­dence of 1-2 ­cases per 100,000 ­people. ­They ­show ­rather var­ying ­tumor ­biology and ­present some­times dis­tinct clin­ical symp­toms ­such as ­flushing, diar­rhoea, hypo­gly­cemia and gas­tric ­ulcers. The bio­chem­ical diag­nosis is ­today sig­nif­i­cantly ­improved by the intro­duc­tion of chro­mo­granin A as a gen­eral ­tumor ­marker, ­which is ­also ­useful in his­top­a­thology. ­Today the local­iza­tion pro­ce­dures ­include som­a­tos­tatin ­receptor scin­tig­raphy as the pri­mary inves­ti­ga­tion ­together ­with CT or ultra­so­nog­raphy. The ­basis for treat­ment of neu­ro­en­do­crine GEP ­tumors is not ­only a cura­tive ­intent but ­merely ame­li­o­ra­tion of clin­ical symp­toms, abro­ga­tion of ­tumor ­growth, main­taining and improve­ment of ­quality of ­life. Sur­gery has ­always to be con­sid­ered in the treat­ment of neu­ro­en­do­crine GEP ­tumors. It can be per­formed when­ever ­during the ­course of the dis­ease but it may be ­more pro­duc­tive in ear­lier ­stages. ­Liver dear­te­ri­al­iza­tion pro­ce­dures can furthe­more ­reduce the ­tumor ­masses in ­liver ­together ­with ­laser treat­ment or radio­fre­quency ­therapy. The med­ical treat­ment ­includes cyto­toxic ­agents, ­alpha inter­ferons and som­a­tos­tatin ana­logues. Som­a­tos­tatin ana­logues ­will ­always be com­bined ­with the ­other two alter­na­tives to ­reduce clin­ical symp­toms. Chem­o­therapy is par­tic­u­larly ­useful for ­patients ­with ­more aggres­sive ­tumors ­with ­high pro­life­ra­tion ­capacity, ­whereas ­alpha inter­feron is ben­e­fi­cial in clas­sical ­midgut car­ci­noids ­with low pro­life­ra­tion ­capacity. ­Quite ­recently som­a­tos­tatin ­based radio­ac­tive ­tumor tar­geted treat­ment has ­evolved ­with pre­lim­inar prom­ising ­data but fur­ther ­studies are ­needed to delin­iate its ­future ­role in the treat­ment of neu­ro­en­do­crine ­tumors in ­patients.

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