Lege Artis Medicinae

[Therapeutic options for the treatment of neuroendocrine tumors]

TÓTH Miklós

NOVEMBER 20, 2013

Lege Artis Medicinae - 2013;23(10-11)

[This paper provides an overview of the latest clinical advances regarding state-of-theart treatment of neuroendocrine tumours. The first-line treatment of any localized neuroendocrine tumour is surgical removal of the tumour. The only exceptions are certain small gastric carcinoids and small, hormonally inactive pancreatic tumours associated with multiple endocrine neoplasia type I. The treatment strategies of disseminated neuroendocrine tumours should be based on a pathological diagnosis that uses the 2010 WHO classification (neuroendocrine tumours G1 and G2, neuroendocrine carcinoma G3). Debulking surgery and radiofrequency ablation can be used effectively not only as an anti-tumour treatment but also in patients with severe symptoms and hormone overproduction resistant to treatment. The use of somatostatin-analogs is considered to be standard treatment in functional neuroendocrine tumours of any origin, as well as in the anti-tumour therapy of G1/G2 small intestinal neuroendocrine tumours. For progressive G1-G2 neuroendocrine pancreatic tumours, streptozocin-based combined chemotherapy is the first-line treatment. Targeted drug therapies, such as mTOR inhibitors and tyrosine kinase inhibitors are used as second- or third-line agents in patients with inoperable pancreatic neuroendocrine tumours. Peptide receptor radiotherapy is increasingly used in Europe; however, its final place amongst other therapeutic modalities remains to be investigated.]

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