P124 Localized Esophageal Neuroendocrine Tumors. Report on Clinical and Treatment Parameters From a Tertiary Hospital

Abstract

Aim We retrospectively analyzed the medical files of patients treated with neuroendocrine neoplasms (NENs) of the esophagus in our unit. Background & Methods Esophageal NENs are rare and lacking functional symptoms. This results in a delay of diagnosis that may compromise patient survival. Numerous single cases are reported in literature, without a consensus on their management. The true incidence of esophageal NETs is unknown but evidence indicated geographic variability while smoking and alcohol abuse are the major risk factors. Men (60-70 years) are most commonly afflicted and usual symptoms include dysphagia and loss of appetite with consequent weight loss. The histologic subtypes reported in the literature include high or low-grade NETs and mixed neuroendocrine neoplasms (MINENs). Central pathology assessment significantly contributes to the accurate diagnosis and management. Personalised treatment depends on the grade, involved anatomic region and stage of disease and most commonly comprises combination chemotherapy and radiotherapy and rarely surgery. Results We report on three cases with localized esophageal NET diagnosed with endoscopic biopsies and staged with FDG or Gallium-PET CT scan. The mean age was 56, two were men and histologies included 1 MINEN (lower thoracic esophagus), 1 NET G3 (upper thoracic esophagus) and 1 NET G2 (middle thoracic esophagus). The patient with MINEN was stage 1b and was treated with complete esophagectomy and lymph nodal dissection without any further adjuvant therapy. Two patients with upper and middle thoracic esophagus were treated with combination chemotherapy and definitive IMRT radiotherapy. All patients remain disease free at 12 months follow up. Conclusion Localized esophageal NET are often diagnosed following endoscopic investigation. Long-term survival may be achieved with excellent quality of life after careful evaluation of the clinicopathologic characteristics by a dedicated multidisciplinary group.