MEDICAL TREATMENT OF NEUROENDOCRINE TUMORS (NETs) OF THE LUNG

Abstract

The improvement in histological diagnostic tools, including neuroendocrine markers by immunohistochemistry (IHC), has led to an increased recognition of pulmonary neuroendocrine tumors. This may explain their rapid increase in incidence, representing roughly 30% of all neuroendocrine tumors. NETs represent about 3% of all lung cancers. The incidence of pulmonary NETs is low, although reported to have increased over the past 30 years. According to the surveillance, epidemiology and end results program (SEER) database from 2003, the combined incidence has been 1.57/100 000 inhabitants. The median age at diagnosis for bronchial NETs is 64 years and for thymic NETs 59 years. The main therapy for bronchial NETs is surgical resection. The surgical approach is dependent on the size, location and tissue type. Bronchoscopic laser excision of intraluminal typical bronchial NETs should be considered a suboptimal treatment and reserved for inoperable patients or performed as preoperative disobliterating procedure. Cytotoxic treatment combined with surgical resection when indicated has been the standard for metastatic bronchial and thymic NETs, although the available chemotherapy regimens demonstrate a rather poor effect. Chemotherapy for small-cell lung cancer (SCLC), which is a chemosensitive but not curable cancer, is discussed in the appropriate guidelines.