Type 1 and 2 gastric carcinoid tumors: long-term follow-up of the efficacy of treatment with a slow-release somatostatin analogue

Abstract

Little is known about the long-term results of treating gastric carcinoid tumors with a slow-release somatostatin analogue. We report three patients with type 1 and 2 gastric carcinoid tumors who were treated in the above mentioned way and followed for 27-50 months. In all cases, alternative endoscopic or surgical management was considered but deemed inappropriate. Treatment with a slow-release somatostatin analogue was begun in light of a favorable recent report. The result was regression or complete disappearance of macroscopic fundal tumors. No side-effects were reported and, most notably, none of the patients developed gallstones. This small study may help define the optimal duration, dose, and administration interval of the treatment. Slow-release somatostatin analogue is a safe and efficacious treatment for type 1 and 2 gastric carcinoid tumors, and can be used when tumors are growing rapidly. Slow-release somatostatin analogue represents an alternative to repeated endoscopic treatment or high-risk surgery.

Type I Gastric Carcinoids: A Prospective Study on Endoscopic Management and Recurrence Rate

“…Proposals of TIGC management also include programs with different treatments according to TIGC number and size, performing surgery in cases of large polyps or frequently recurring multiple lesions, thus limiting a conservative approach to non-recurring cases of few small TIGCs [20,39]. On the other hand, promising results have been reported by SAs in selected patients having small multiple TIGCs without any sign of invasion [9,23,24,25,26,27]. …”

“…Gastric surgery has been proposed for multiple or large lesions, or for patients with recurrence after endoscopic resection, in order to definitively stop hypergastrinemia by antrectomy, or radically remove TIGC by total gastrectomy [9,20,21,22]. Somatostatin analogs (SAs) have also been proposed as they decrease tumor growth both in vitro and in vivo [9,23,24,25,26,27]. A further alternative evaluated is the conservative management by serial endoscopic controls and lesion removal; however, among the few studies evaluating this option, most of them are based on small sample sizes, include patients managed by different strategies and in addition to this, recurrence data are scanty [9,11,12,13,17,22,28,29].…”

Management of gastric neuro-endocrine tumours in a large French national cohort (GTE)

“…Somatostatin analogues reduce hypergastrinemia and have a direct antiproliferative effect on ECL cells. Although SSA are not yet recommended for types 1 and 2 GNETs, several case reports or cohort studies have reported reduction or disappearance of tumours treated with SSA (25,26,29,30). Even if SSA are considered as an over-treatment for types 1 and 2 GNETs, it is admitted that for selected cases SSA can be used, especially when endoscopic management is not feasible or not accepted by patients (31).…”

Gastric neuroendocrine tumors: management and challenges

“…28,29 Limited studies, including a few small prospective studies, have demonstrated regression or complete disappearance of tumors and marked decrease in serum gastrin, lasting up to several years. [30][31][32][33][34][35][36][37][38][39] SSAs (e.g. octreotide and lanreotide) can be considered in cases in which endoscopic resection is not feasible due to extensive multifocal disease, or submucosal/lymph node involvement, as well as recurrent disease after repeated endoscopic resection.…”