Gastroenteropatic Neuroendocrine tumors: multidisciplinary approach in therapy
Sona Kinova, Lubos Kekenak, Eva Kovacova, Izabela Makaiova & Michal Koren
Introduction: Gastroenteropancreatic neuroendocrine tumors (GEP-NET) are classified on the basis of hormonal activity of tumor cells to functional and non-functional tumors. Therapy of well differentiated NETs includes surgical procedures, debulking of tumor mass, biotherapy and peptid receptor radionuclid therapy.
Aim of the study: Analysis of therapeutic modalities in group of patients with well differentiated GEP-NETs.
Results: In time period from 1.1.2005 to 31.12.2009 we followed up 50 pts (19 men/31 women) with well differentiated GEP neuroendocrine tumors. Primary localisation was: stomach 6 times, pancreas 9×, duodenum- 1×, jejunum- 4×, appendix- 3×, illeum- 23×, rectum- 4×. Metastatic dissease was affirmed in time of diagnosis in 36 patients. Carcinoid syndroma had 20 pts, 4 pts with pancreatic tumor had functional tumors (2× overproduction of calcitonine, 1× of gastrin,1 × of insuline). Surgical treatment was performed in 45 pts.resection of primary tumor and debulking of metastases, in 5 pts with pancreatic tumor resection was not possible due to invasion to sorrounding tissue and vessels. Biological treatment with long acting somatostatin analogues was indicated in 20 pts with carcinoid syndroma and in 4 pts with functional pancreatic tumors. In 3 pts with non resectable neuroendocrine carcinoma of pancreas peptid radionuclide receptor therapy (PRRT) was indicated: in 2 of them with 90 Ytrium -DOTA-octreotid and in 1 patient with MIBG. In all 3 pts a reduction of tumor volume was noticed. Biotherapy with somatostatin analogues reduced symptoms of hormonal activities and brought on stabilisation of dissease in most of patients. In period of follow up 5 patient died.
Conclusion: Complex therapy surgical procedure, biological therapy with somatostatin analogues and PRRT in patients with well differentiated neuroendocrine tumors markedly contributes to prolongation of survival of patients and also to enhancement quality of their life.