Pulmonary Carcinoid Tumours: Indolent but Not Benign

Abstract

Background: The aim of this retrospective study was to analyse the malignant behaviour of low-grade pulmonary neuroendocrine tumours (NETs) treated at our institution. Patients and Methods: We reviewed 48 consecutive patients with pulmonary NETs referred to our Medical Oncology Unit between 1998 and 2006, including 33 subjects with typical carcinoids (TCs) and 15 with atypical carcinoids (ACs). Results: At diagnosis, there were 37 metastatic and 11 non-metastatic patients. Medical treatments used were somatostatin analogues, combined chemotherapy, within study protocols, 5-fluorouracil/dacarbazine/epiadriamycin (FDE), and oxaliplatin plus capecitabine (XELOX). Median disease-free survival was 72 months for the TC patients and 38 months for the AC patients. Actuarial 5-year survival was 93% for those with TCs and 73% for those with ACs. The mean overall survival was 68 months for the non-metastatic patients (78 months for TC patients and 58 months for AC patients) and 36 months for patients with advanced disease (42 and 32 months, respectively). Conclusion: Cell type is the strongest determinant of prognosis, and the degree of malignancy increases from TCs to ACs. Moreover, the prognosis of metastatic pulmonary carcinoids is not as good as expected. Our analysis suggests that patients with advanced disease should receive first-line therapy with a somatostatin analogue, with chemotherapy regimens (FDE, XELOX) used in progressing cases.

Incidence and Outcomes of Malignant Pediatric Lung Neoplasms

“…In our study, survival was very good in these endocrine tumor cases, however, it varies in the adult population when separated based on histologic type of carcinoid. Adult patients with typical pulmonary carcinoid have a similar prognosis with 5-y survival of 93%, however atypical histology portends a much worse prognosis of 73% [21]. Other studies have shown similar results, and report dismal prognosis with additional subtypes, such as large cell neuroendocrine carcinoma [22].…”

Low Grade Neuroendocrine Tumors of the Lung

“…Somatostatin receptors are often overexpressed on the surface of low-grade lung NETs (27). SSAs bind to the somatostatin receptor, blocking the release of peptides and amines, and thus help to control symptoms.…”

“…Peptide receptor radioligand therapy specifically delivers a radiolabeled agent to a target, such as somatostatin receptors which often overexpressed on the surface of metastatic lung NETs (27). PRRT using yttrium Y-90 labeled octreotide was first used to treat this disease in the early 1990 and has been delivered and used in many centers for decades, despite the lack of phase III trials confirming benefit.…”

A persisting puzzling pneumonia in a young man

“…4 Radiotherapy has a limited role in the treatment of these tumours and is mostly indicated for non-resectable and palliative cases only.…”