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    MTE03 - Neuroendocrine Tumours of the Lung (ID 47)

    • Event: WCLC 2013
    • Type: Meet the Expert (ticketed session)
    • Track: Medical Oncology
    • Presentations: 1
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      MTE03.1 - Neuroendocrine Tumours of the Lung (ID 595)

      07:00 - 08:00  |  Author(s): J. Guigay

      • Abstract
      • Presentation
      • Slides

      Abstract
      Neuroendocrine Tumours of the Lung encompass low grade tumors (typical and atypical carcinoids) and high grade carcinomas (large cell neuroendocrine lung carcinoma and small cell lung carcinoma). Typical carcinoids (TC) and atypical carcinoids (AC) are usually diagnosed in front of symptoms (bleeding or pneumonia) or abnormal chest Xray or CT scan. Patients with TC are younger. Association with MEN1 syndrom is rare. Bronchial endoscopy often shows the tumor and biopsies made with caution usually confirms the diagnosis of carcinoid. However, the pathological analysis of the whole tumour is necessary to distinguish TC and AC, according to WHO criteria based on mitotic count (less or more than 2 per 2mm[2]) and necrosis. Staging differs from that of other lung cancers, including somatostatin receptor scintigraphy (SRS), hepatic MRI and bone MRI. Treatment of typical or atypical bronchial carcinoid is implemented in the multidisciplinary setting after an in depth characterization of host and tumor presentations. Goals of the treatment are both to control hormone-related symptoms if they exist, and tumor growth. Surgery remains the gold standard of treatment of bronchial carcinoids. Thoracic surgery should not differ from that of lung cancer, while it should be conservative for young patients, with complete resection and lymph node dissection. In case of lymph node involvement, there is no consensus about adjuvant treatment, which is not recommended by ENETS. Prognostic heterogeneity and absence of cure at the metastatic stage make quality of life a key issue of advanced bronchial carcinoid management. Advanced atypical carcinoids are more aggressive than typical carcinoids. The spontaneous slope without treatment, the number of tumor organs including the primary, SRS grade of uptake and quality of control of hormone-related symptoms are key parameters to be characterized before any therapeutic decision. Based on the limited number of studies available in patients with bronchial primary, recommendations of treatment also take into account data established from the field of digestive NET. Treatment is based on locoregional therapies for bone and liver metastasis, and/or systemic treatment (somatostatin analogues, everolimus, chemotherapy, Peptide receptor radionuclide therapy). Large cell neuroendocrine carcinomas (LCNEC) are high grade malignant tumours. Their behavior is very different from that of bronchial carcinoids. Patients are usually male and smokers. Locally advanced or metastatic stages are usual at presentation. Brain metastases are frequent. Surgery is possible only in one third of patients. Adjuvant chemotherapy with platinum-etoposide based chemotherapy is recommended. For more advanced LCNEC, prognosis is poor and treatment does not differ from that of SCLC, without any significant progress made these last years.

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