State of the art and future prospects in the management of neuroendocrine tumors

Neuroendocrine gastroenteropancreatic tumors are rather rare neoplasms with an incidence of 1-2 cases per 100,000 people. They show rather varying tum or biology and present sometimes distinct clinical symptoms such as hushing , diarrhoea, hypoglycemia and gastric ulcers. The biochemical diagnosis is today significantly improved by the introduction of chromogranin A as a gen eral tumor marker,which is also useful in histopathology. Today the localiz ation procedures include somatostatin receptor scintigraphy as the primary investigation together with CT or ultrasonography. The basis for treatment of neuroendocrine GEP tumors is not only a curative intent but merely ameli oration of clinical symptoms, abrogation of tumor growth, maintaining and i mprovement of quality of life. surgery has always to be considered in the t reatment of neuroendocrine GEP tumors. It can be performed whenever during the course of the disease but it may be more productive in earlier stages. Liver dearterialization procedures can furthemore reduce the tumor masses i n liver together with laser treatment or radiofrequency therapy. The medica l treatment includes cytotoxic agents, alpha interferons and somatostatin a nalogues. Somatostatin analogues will always be combined with the other two alternatives to reduce clinical symptoms. Chemotherapy is particularly use ful for patients with more aggressive tumors with high proliferation capaci ty, whereas alpha interferon Is beneficial in classical midgut carcinoids w ith low proliferation capacity. Quite recently somatostatin based radioacti ve tumor targeted treatment has evolved with preliminar promising data but further studies are needed to deliniate its future role in the treatment of neuroendocrine tumors in patients.