TumorDiagnostik & Therapie 2012; 33(4): 219-223
DOI: 10.1055/s-0032-1312846
Thieme Onkologie aktuell
© Georg Thieme Verlag KG Stuttgart · New York

Expertendialog: Neuroendokrine Tumore der Lunge und des gastroenteropankreatischen Systems

Expert Dialogue: Neuroendocrine Tumours of the Lungs and Gastroenteropancreatic System
D. Hörsch
1   Zentrum für Neuroendokrine Tumore Bad Berka – ENETS Center of Excellence und Klinik für Innere Medizin, Gastroenterologie und Endokrinologie
,
Y. Sayeg
2   Klinik für Pneumologie
,
R. Bonnet
2   Klinik für Pneumologie
,
D. Kaemmerer
3   Klinik für Allgemein- und Viszeralchirurgie
,
N. Presselt
4   Klinik für Thorax- und Gefäßchirurgie
,
R. P. Baum
5   Klinik für Nuklearmedizin/PET Zentrum, Zentralklinik Bad Berka, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
15 June 2012 (online)

Zusammenfassung

Hintergrund: Neuroendokrine Tumore der Lunge weisen eine deutlich ansteigende Inzidenz auf. Über Diagnose und Therapie dieser Tumoren existieren jedoch nur wenig gesicherte Informationen. Demgegenüber liegen deutlich mehr Daten für die neuroendokrinen Tumore des gastroenteropankreatischen Systems vor.

Methode: Dialog mit Fachexperten für neuroendokrine Tumore (NET) des gastroenteropankreatischen Systems und der Lunge am 25. und 26. Februar 2011 in Weimar, um Gemeinsamkeiten und Unterschiede zwischen den neuroendokrinen Tumoren der Lunge und des gastroenteropankreatischen Systems herauszustellen.

Ergebnisse: Die neuroendokrinen Tumoren der Lunge weisen viele Gemeinsamkeiten, aber auch einige Unterschiede mit den gastroenteropankreatischen NETgastroenteropankreatischen Tumoren auf. Gemeinsamkeiten bestehen vor allem in der Pathologie, der Diagnosestellung und der Therapie. Unterschiede bestehen in den Empfehlungen zur systemischen Therapie und der deutlich geringeren Inzidenz paraneoplastischer Syndrome. Das Somatostatinrezeptor-PET/CT mit Gallium-68 konjugierten Somatostatinanaloga und die Peptid-Rezeptor vermittelte Radiorezeptortherapie sind innovative Verfahren für die neuroendokrinen Tumore der Lunge. An erster Stelle der Therapie steht jedoch die komplette kurative Resektion. Erste Ergebnisse von Studien mit molekularen Wirkstoffen wie Everolimus (Afinitor®) zeigen eine Wirksamkeit an.

Schlussfolgerungen: Es existieren deutliche Schnittmengen in der Diagnose und Therapie der neuroendokrinen Tumore der Lunge und des gastroenteropankreatischen Systems. Weitere Studien sind geplant und notwendig, um die Datenlage zu verbessern. Ein Register zur Erfassung der neuroendokrinen Tumore der Lunge wäre sinnvoll.

Abstract

Background: Neuroendocrine tumours of the lung exhibit an increasing incidence and prevalence. However, data on the diagnosis of and therapy for these tumours are sparse compared to neuroendocrine tumours of the gastroenteropancreatic system.

Methods: The present article reflects a dialogue between experts on neuroendocrine tumors of the lung and the gastroenteropancreatic system held on February 25th and 26th in Weimar, Germany.

Results: Many similarities exist between neuroendocrine tumours of the lung and the gastroenteropancreatic system but there are also significant differences. Similarities exist mainly concerning pathology, diagnosis and therapy. Differences exist regarding the systemic therapy and the significantly lower incidence of paraneoplastic syndromes. Somatostatin receptor PET/CT with gallium-68 labelled somatostatin analogues and peptide receptor radiotherapy are innovative methods for the diagnosis of and therapy for neuroendocrine tumours of the lung. The first treatment option remains complete resection of the tumour. Small molecules like everolimus (Afinitor®) have been tested in clinical trials and have been shown to prolong progression-free survival.

Conclusions: Additional studies are necessary and efforts should be undertaken to establish a registry to increase data on methods suitable for he diagnosis of and therapy for neuroendocrine tumours of the lung.

 
  • Literatur

  • 1 Gosney J, Travis WD. Pathology and genetics: tumors of the lung, pleura, thymus and heart. In: Travis W, Brambilla E, Müller-Hermelink H, Harris C, eds. World Health Organization classification of tumors. Lyon, France: IARC; 2004: 76-77
  • 2 Travis WD, Rush W, Flieder DB et al. Survival analysis of 200 pulmonary neuroendocrine tumors with clarification of criteria for atypical carcinoid and its separation from typical carcinoid. Am J Surg Pathol 1998; 22: 934-944
  • 3 Naalsund A, Rostad H, Strøm EH et al. Carcinoid lung tumors – incidence, treatment and outcomes: a population-based study. Eur J Cardiothorac Surg 2011; 39: 565-569
  • 4 Cardillo G, Sera F, Di Martino M et al. Bronchial carcinoid tumors: nodal status and long-term survival after resection. Ann Thorac Surg 2004; 77: 1781-1785
  • 5 Gustafsson BI, Kidd M, Chan A et al. Bronchopulmonary neuroendocrine tumors. Cancer 2008; 113: 5-21
  • 6 DeLellis RA, Shin SI. Chapter 9: Immunohistology of endocrine tumors. in: Dabbs ID, ed. Immunohistochemistry. New York: Churchill Livingstone; 2006: 267-276
  • 7 Travis WD, Brambilla E, Noguchi M et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6: 244-248
  • 8 Rindi G. The ENETS guidelines: the new TNM classification system. Tumori 2010; 96: 806-809
  • 9 Phan AT, Oberg K, Choi J et al. North American Neuroendocrine Tumor Society (NANETS): NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the thorax (includes lung and thymus). Pancreas 2010; 39: 784-798
  • 10 Kaemmerer D, Peter L, Lupp A et al. Molecular imaging with ⁶⁸Ga-SSTR PET/CT and correlation to immunohistochemistry of somatostatin receptors in neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2011; 38: 1659-1668
  • 11 Baum RP, Prasad V, Hommann M et al. Receptor PET/CT imaging of neuroendocrine tumors. Recent Results Cancer Res 2008; 170: 225-242
  • 12 Vinik AI, Woltering EA, Warner RR et al. North American Neuroendocrine Tumor Society (NANETS): NANETS consensus guidelines for the diagnosis of neuroendocrine tumor. Pancreas 2010; 39: 713-734
  • 13 Ambrosini V, Castellucci P, Rubello D et al. 68Ga-DOTA-NOC: a new PET tracer for evaluating patients with bronchial carcinoid. Nucl Med Commun 2009; 30: 281-286
  • 14 Jindal T, Kumar A, Venkitaraman B et al. Role of (68)Ga-DOTATOC PET/CT in the evaluation of primary pulmonary carcinoids. Korean J Intern Med 2010; 25: 386-391
  • 15 Öberg K, Astrup L, Eriksson B et al. Nordic NE Tumour Group: Guidelines for the management of gastroenteropancreatic neuroendocrine tumours (including bronchopulmonary and thymic neoplasms). Acta Oncol 2004; 617-636
  • 16 Stamatis G, Freitag L, Greschuchna D. Limited and radical resection for tracheal and bronchopulmonary carcinoid tumour. Report on 227 cases. Eur J Cardiothorac Surg 1990; 4: 527-532
  • 17 Aubry MC, Thomas CF Jr, Jett JR et al. Significance of multiple carcinoid tumors and tumorlets in surgical lung specimens: analysis of 28 patients. Chest 2007; 131: 1635-1643
  • 18 Escalon J, Detterbeck FC. Carcinoid Tumors. In Shields TW, LoCicero JIII, Reed CE, Feins RH. General Thoracic Surgery. 7th. edition. Philadelphia: Lippincott Williams & Wilkins; 2009: 1539-1554
  • 19 Modlin IM, Pavel M, Kidd M et al. Review article: somatostatin analogues in the treatment of gastroenteropancreatic neuroendocrine (carcinoid) tumours. Aliment Pharmacol Ther 2010; 31: 169-188
  • 20 Imhof A, Brunner P, Marincek N et al. Response, survival, and long-term toxicity after therapy with the radiolabeled somatostatin analogue [90Y-DOTA]-TOC in metastasized neuroendocrine cancers. J Clin Oncol 2011; 29: 2416-2423
  • 21 van Essen M, Krenning EP, Bakker WH et al. Peptide receptor radionuclide therapy with 177Lu-octreotate in patients with foregut carcinoid tumours of bronchial, gastric and thymic origin. Eur J Nucl Med Mol Imaging 2007; 34: 1219-1227
  • 22 Yamazaki S, Sekine I, Matsuno Y et al. Clinical responses of large cell neuroendocrine carcinoma of the lung to cisplatin-based chemotherapy. Lung Cancer 2005; 49: 217-223
  • 23 Ekeblad S, Sundin A, Janson ET et al. Temozolomide as monotherapy is effective in treatment of advanced malignant neuroendocrine tumors. Clin Cancer Res 2007; 13: 2986-2991
  • 24 Yao JC, Shah MH, Ito T et al. RAD001 in Advanced Neuroendocrine Tumors, Third Trial (RADIANT-3) Study Group: Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med 2011; 364: 514-523
  • 25 Raymond E, Dahan L, Raoul JL et al. Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med 2011; 364: 501-513
  • 26 Wolin EM, Fazio N, Saletan S et al. Everolimus plus octreotide LAR versus placebo plus octreotide LAR in patients with advanced neuroendocrine tumours: Analysis by primary tumour site from RADIANT-2. J Clin Oncol 2011; 29 (suppl; abstr 4075)