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Published on: February 12, 2017
Multidisciplinary management of advanced lung neuroendocrine tumors
Pier Luigi Filosso1, Piero Ferolla1, Francesco Guerrera1
11 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee.
Abstract:
The optimal clinical management of aggressive/advanced lung neuroendocrine tumors (NETs) is still debated, due to their rarity and the lack of prospective randomized studies. Results derive from retrospective mono-Institutional series, and few dedicated prospective trials, recently designed, are still ongoing. In low-grade tumors [bronchial carcinoids (BCs)] surgery, whenever feasible, remains the mainstay of treatment, and chemo/radiotherapy (RT) should be reserved to progressive diseases (PD). In case of resected N1-N2 BCs, a "watch and see" policy associated with a close clinical/radiological follow-up is recommended. Somatostatin analogs (SSA) seem to be effective in controlling BCs associated endocrine syndromes, while SSA antiproliferative effect has also been reported in the past. Targeted therapy with new drugs (Everolimus) seems to be very promising, but further trials are needed. Surgery alone is not sufficient to treat high-grade NETs: adjuvant CT is required also in early stages. Platinum-Etoposide regimen demonstrated to be the most effective; irinotecan and other biological drugs are considered very promising. In conclusion, the management of advanced lung NETs should be individualized by multidisciplinary teams which include Medical and Radiation Oncologists, Surgeons, Pathologists, Pulmonologists, Endocrinologists, Interventional Radiologists, and the prognosis is mainly dependent on tumor grade and its anatomical extent.
Insights
Optimal management for advanced lung neuroendocrine tumors (NETs) requires individualized multidisciplinary care. Treatment strategies vary by tumor grade, with surgery for low-grade bronchial carcinoids (BCs) and chemotherapy for high-grade NETs.
Area of Science:
- Oncology
- Pulmonology
- Endocrinology
Background:
- The optimal clinical management of aggressive/advanced lung neuroendocrine tumors (NETs) remains debated due to rarity and limited prospective studies.
- Current evidence largely stems from retrospective series and ongoing prospective trials.
Purpose of the Study:
- To review and summarize current management strategies for lung neuroendocrine tumors (NETs).
- To highlight the importance of individualized treatment based on tumor grade and extent.
Main Methods:
- Review of retrospective institutional series and available prospective trial data.
- Analysis of treatment outcomes for low-grade (bronchial carcinoids) and high-grade lung NETs.
Main Results:
- Surgery is the primary treatment for resectable bronchial carcinoids (BCs); chemotherapy/radiotherapy (RT) reserved for progressive disease.
- Somatostatin analogs (SSA) manage endocrine syndromes and show antiproliferative effects; targeted therapy (e.g., Everolimus) is promising.
- High-grade NETs require adjuvant chemotherapy (CT), with platinum-etoposide being highly effective; other agents show promise.
Conclusions:
- Management of advanced lung NETs necessitates a multidisciplinary team approach.
- Prognosis is significantly influenced by tumor grade and anatomical extent.
- Individualized treatment plans are crucial for optimal patient outcomes.
