The incidence of gastric neuroendocrine tumors (GNT) is 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 19982008 37 patients were diagnosed with the hist.path. confirmed GNT (mean age − 61±12; 27F, 10 M). 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 37GC patients in 26 patients type I in 2 type II and in 3 type III was diagnosed. During 4 years of the observation seven patients died (two patients- type I, death not related to GC, 2- 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. The mean increased level of chromogranin A was found (366.1±587.2 U/l; n:218 U/l), with maximum value in patients with dissemination (over 1000 U/l). In 43% of patients partial/total gastric resection was performed. However in four patients with type I GNT treated with the somatostatin analoque complete endoscopic remission was observed.
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 I, 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.
25 - 29 Apr 2009
European Society of Endocrinology