John Libbey Eurotext




Medical treatment and new treatment options for well-differentiated endocrine tumors of the gastrointestinal tract (out of duodenal and pancreatic tumors)
Hépato-Gastro. Volume 16, 37-42, octobre 2009, Mini-revue
Résumé Article gratuit
Author(s) : Thomas Walter, Catherine Lombard-Bohas
Summary : Management of a well-differentiated endocrine tumor of the gastrointestinal tract aims at controlling the secretory syndrome and treating the tumor. Carcinoid syndrome is usually due to metastatic spread to the liver. Control of this syndrome with somatostatin analogs is a priority. Even if there is metastatic spread, surgical treatment of the primitive tumor should be discussed in order to avoid any acute local complication. Surgical treatment of intrahepatic lesions is an option only if a complete resection of all lesions seems possible, and, if liver resection is to be large, an observation period is advisable. Chemoembolisation is the best option if liver metastases are not resectable, with no extrahepatic lesions. Diffuse and non-evolving lesions should simply be monitored. Interferon, somatostatin analogs, chemotherapy, radionuclides, ablation therapies should be proposed only in cases of demonstrated progressing lesions. Surgical options should be reassessed at each stage of the disease, and include hepatic transplant in some exceptional cases of slowly evolving lesions that are strictly intrahepatic. Finally, it has to be emphasized that it is of the utmost importance to enrol those patients with very rare disease in prospective clinical trials assessing new therapeutic strategies or therapies (targeted therapies, new radio-isotopes, etc.).
Keywords : neuroendocrine tumors, carcinoid tumors, somatostatin analogs, chemoembolisation, surgery

Medical treatment and new treatment options for well-differentiated endocrine tumors of the gastrointestinal tract (out of duodenal and pancreatic tumors)