The incidence of GNT appears to be increasing, what can be explained by the increased detection caused by the common use of the endoscopy and the pervasive use of acid suppressive therapy leading to enterochromatofine like cells proliferation. There are numerous new diagnostic/therapeutic GNT methods in use like: EUS, SRS, somatostatin therapy and 90Y/177Lu-DOTA-TATE radiotherapy.
Materials and methods: In 19982007, 25 patients were diagnosed with the hist. path. confirmed GNT (mean age 59±12; 19 F, 5 M). In all patients gastroscopy, CT/MRI, EUS 99Tc-EDDA/HYNIC-Octerotate scintigraphy, chromogranin A serum level, clinical manifestation of the disease and type and efficacy of the therapy were assessed.
Results: Among 25 GC patients, in 65% type I in 5% type II and in 30% type III was diagnosed. During 4 years of the observation 6 patients with dissemination died (2 patients- type I, 1- type II and 3 -type III). The best detective value was found for the 99Tc-EDDA/HYNIC-Octerotate scintigraphy both for the primary and the metastatic lesions. In all patients, the increased level of chromogranin A was found (55.8±98 U/l; n: 218 U/l), maximum value in patients with dissemination (max. 295 U/l). In most cases partial/total gastric resection was performed. However, in 3 patients with type I GNT treated only with the somatostatin a complete endoscopic remission was observed in 1 case, and partial remission in 2 cases.
Conclusion: As the number of GNT is increasing the extensive diagnostic and therapeutic methods development are needed. However, the endoscopic or surgical gastric resection are still a basic treatment, the use of somatostatin in type 1, somatostatin and 90Y/177Lu-DOTA-TATE radiotherapy in nonoperative, disseminated cases seems to be very promising. Due to the different clinical course of the disease it seems that the treatment should be individually tailored to reach the best and optimal effect.
03 - 07 May 2008
European Society of Endocrinology