A. Carretta et al., Diagnostic and therapeutic management of neuroendocrine lung tumors - A clinical study of 44 cases, LUNG CANC, 29(3), 2000, pp. 217-225
Neuroendocrine tumors of the lung (NTL) are a distinct subset of tumors wit
h a wide range of histological patterns and clinical behavior. Controversy
still exists as to the ideal diagnostic and therapeutic approach to these n
eoplasms. A series of 44 consecutive NTL patients operated on at our Instit
ution was retrospectively reviewed in order to critically analyze the diagn
ostic and therapeutic management. A preoperative diagnosis was obtained in
11 patients (25%). All patients underwent an anatomical surgical resection
with lymphoadenectomy. Pathological diagnosis was typical carcinoid (TC) tu
mor in 36 cases, atypical carcinoid (AC) in three and large-cell neuroendoc
rine carcinoma (LCNEC) in five. One patient had preoperative chemotherapy.
Node-positive patients received postoperative radiotherapy on the mediastin
al area. Median follow-up time was 40 months for TC and 51.5 months for AC/
LCNEC. Recurrence of disease was observed in three patients with TC and in
two with AC/LCNEC. Actuarial 5-year survival was 93% for TC and 70% for AC/
LCNEC. Survival was not influenced by tumor size, while lymph node metastas
es were associated with a worse prognosis. However, due to the limited numb
er of patients, no statistical significance was observed. In conclusion, ou
r study confirms findings in the literature showing that TC and AC,LCNEC ar
e clinically different, and that a differential preoperative diagnosis and
treatment is necessary. Although the results of new diagnostic techniques s
uch as octreotide scintigraphy are encouraging, they need to be validated i
n a larger number of patients. Surgery. with anatomical resection and lymph
oadenectomy. remains the treatment of choice in all these tumors. Laser tre
atment should be considered only as a palliative procedure or as a compleme
ntary technique to surgery. The role of adjuvant treatments in AC and LCNEC
is uncertain and should be evaluated in larger trials. The prognostic role
of biological factors such as cytometry and genetic markers requires furth
er investigation before any definitive conclusions can be drawn. (C) 2000 E
lsevier Science Ireland Ltd. All rights reserved.