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Chronic Treatment with Somatostatin Analogues in Recurrent Type 1 Gastric Neuroendocrine Tumors
Fernando Sebastian-Valles1, Blanca Bernaldo Madrid2, Carolina Sager1
1Endocrinology and Nutrition Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autonoma de Madrid, 28006 Madrid, Spain.
Background:
Type 1 gastric neuroendocrine tumors (GC-1) represent an uncommon subtype of neoplasms. Endoscopic resection has been proposed as the treatment of choice; active surveillance may be performed in those smaller than 1 cm, while gastric surgery may be performed for those with frequent recurrences. The antiproliferative effect of somatostatin analogues (SSA) is well known, and their action on GC-1s has been postulated as a chronic treatment to reduce recurrence.
Methods:
A two-centered, retrospective, observational study that included nine patients (55.6% women) diagnosed with GC-1, receiving long-term treatment with SSA, with a median follow-up from baseline of 22 months, was undertaken. Endoscopic follow-up, extension study, and analytical values of chromogranin A (Cg A) and gastrin were collected.
Results:
In total, 88.9% of patients presented partial or complete response. Treatment with SSA was the only independent factor with a trend to prevent tumor recurrence (Odds Ratio 0.054; p = 0.005). A nonsignificant tendency toward a decrease in CgA and gastrin was observed; lack of significance was probably related to concomitant treatment with proton pump inhibitors in some patients.
Conclusions:
Chronic treatment with SSA is a feasible option for recurrent GC-1s that are difficult to manage using endoscopy or gastrectomy. Randomized clinical trials to provide more scientific evidence are still needed.
Insights
Somatostatin analogues (SSA) show promise in managing recurrent Type 1 gastric neuroendocrine tumors (GC-1). This study found SSA treatment to be a feasible option, potentially reducing tumor recurrence in difficult-to-treat cases.
Area of Science:
- Gastroenterology
- Oncology
- Endocrinology
Background:
- Type 1 gastric neuroendocrine tumors (GC-1) are rare neoplasms.
- Endoscopic resection is a primary treatment, with surveillance for smaller tumors and surgery for recurrent cases.
- Somatostatin analogues (SSA) have known antiproliferative effects and are explored for GC-1 recurrence prevention.
Purpose of the Study:
- To evaluate the efficacy of long-term somatostatin analogue (SSA) treatment in patients with recurrent Type 1 gastric neuroendocrine tumors (GC-1).
- To assess the impact of SSA on tumor recurrence and relevant biomarkers.
Main Methods:
- A retrospective, observational study involving nine patients with GC-1 treated with SSA.
- Median follow-up of 22 months, including endoscopic assessment and measurement of chromogranin A (CgA) and gastrin levels.
Main Results:
- 88.9% of patients achieved partial or complete response to SSA treatment.
- SSA treatment was the sole independent factor showing a trend towards preventing tumor recurrence (OR 0.054, p=0.005).
- A non-significant trend for decreased CgA and gastrin was observed, potentially influenced by proton pump inhibitor use.
Conclusions:
- Chronic SSA treatment is a viable therapeutic option for recurrent GC-1, particularly when endoscopic or surgical management is challenging.
- Further randomized clinical trials are necessary to establish definitive evidence for SSA's role in managing recurrent GC-1.
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