RADIATION-THERAPY IN THE MANAGEMENT OF PATIENTS WITH MALIGNANT CARCINOID-TUMORS

Background. The purpose of this study was to analyze the effectiveness of radiotherapy for symptomatic, metastatic, and/or unresectable carc inoid tumors. Methods. From 1975 to 1991, 18 patients with histologica lly proven carcinoid tumors, including 7 with symptomatic hepatic invo lvement, received radiotherapy to a total of 31 anatomic sites of meta static or unresectable carcinoid tumors. Symptomatic response to treat ment, date of symptomatic or radiographic progression, and survival af ter diagnosis and completion of radiotherapy were determined. Clinical improvement was defined as symptomatic relief and/or objective reduct ion in size of tumor mass sustained for at least 4 weeks. Results. Aft er radiotherapy of 31 sites in 18 patients, 3 patients died in less th an 3 months. Of the remaining 15 patients, survival from initial radio therapy ranged from 8 to 108 months (median, 23 months), an 8 (53%) di ed without symptomatic progression in the treated region. Clinical imp rovement occurred in 27/31 sites (87%). Acute side effects were mild, and no late side effects were recorded. Median survivals from diagnosi s were: 39 months for patients with primary tumors of the lung, 33 mon ths for patients with brain metastases, and 32 months for patients wit h hepatic involvement. patients with the carcinoid syndrome responded in 19/22 sites (86%) compared with 8/9 sites (89%) for patients withou t the syndrome (P = not significant). Conclusions. Radiation therapy c an achieve symptomatic palliation for patients with metastatic/unresec table malignant carcinoid tumors, and it is well tolerated. Clinical i mprovement occurs after irradiation in patients with or without the ca rcinoid syndrome.