Bronchial neuroendocrine tumors: A retrospective review of management and outcomes in 116 patients.

Abstract

e17543 Background: Bronchial neuroendocrine tumours, represent 1–3% of all primary lung tumours and 25% of all neuroendocrine tumours (NETs). They are classified into: typical carcinoids (TC), atypical carcinoids (AC), large cell neuroendocrine carcinomas (LCNEC) and small cell lung carcinomas (SCLC). The aim of our study was to assess diagnostic features, management and outcome, focusing on the differences between TC and AC. Methods: 116 patients were identified from our NET database. WHO histopathological classification was used. Follow-up was complete in all patients (mean follow-up 59.8 months). Disease-free survival (DFS), and progression-free survival (PFS) were evaluated for each therapy. Results: The average age of presentation was 55.30 years (range 16-85 years, M:F ratio=1:1.5). The commonest presenting symptom was cough (19%) followed by haemoptysis (18%). 36% were TC, 45% AC, and 19% LCNEC/SCLC. 16% TC and 28% AC patients had metastases at diagnosis. Octreoscan was positive in 76% TC and 66% AC. In 2 patients with TC and negative Octreoscan, Ga-68 Octreotate PET showed avid uptake in lung lesions. 46 patients had surgery. In 35 of AC, the disease relapsed (DFS=29.8 months) compared to 24% TC (DFS=48months). 12 patients received somatostatin analogues (SSTA) with PFS for TC 60 months and AC 21 months. 16 patients received systemic chemotherapy with PFS for TC 72 months and AC 21 months. 4/5 patients achieved disease stability with 90Yttrium-DOTAoctreotate. 5-years survival after surgery, chemotherapy or SSTA, was 91%, 86% and 81% respectively. Overall five year survival was 91% (100 % TC, 75% AC). Conclusions: AC and SCLC/LCLC more often present with metastatic disease with shorter DFS and PFS compared to TC. Molecular imaging is helpful for staging and predicting appropriateness for SSTA or radionuclide targeted therapy. Surgery confers the best survival rates. AC have higher relapse rates and metastatic potential. Further clinical trials are required to define the best treatment algorithm.