NEUROENDOCRINE TUMORS
Guest Editors: Bombardieri E. 

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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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.