From the Guidelines
Surgical resection is the primary treatment for neoplastic well-defined neuroendocrine tumors of the lung, with the goal of removing the tumor while preserving as much lung tissue as possible, as recommended by the most recent guidelines 1. The management of these tumors requires a multidisciplinary approach, taking into account the tumor's size, location, and grade.
- For typical carcinoids, surgical resection alone often provides excellent outcomes with high 5-year survival rates.
- For atypical carcinoids or higher-grade neuroendocrine tumors, adjuvant therapy may be necessary, which can include chemotherapy regimens or somatostatin analogs. Some key points to consider in the management of lung neuroendocrine tumors include:
- The use of contrast CT scan as the diagnostic gold standard, with pathology examination mandatory for correct classification 1.
- The potential role of somatostatin receptor imaging in visualizing primary tumors and metastatic disease, as well as the use of plasma chromogranin A as a diagnostic marker 1.
- The importance of regular surveillance with CT scans and chromogranin A blood tests to monitor recurrence, as recommended by recent guidelines 1. Overall, the treatment approach for neoplastic well-defined neuroendocrine tumors of the lung should be individualized, taking into account the tumor's characteristics, the patient's overall health, and the potential benefits and risks of different treatment options, with the goal of optimizing morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Octreotide acetate injection may be administered subcutaneously or intravenously. ... Carcinoid Tumors The suggested daily dosage of octreotide acetate injection during the first 2 weeks of therapy ranges from 100 to 600 mcg/day in 2 to 4 divided doses (mean daily dosage is 300 mcg)
The FDA drug label does not answer the question about neoplastic well-defined neuroendocrine tumor lung.
From the Research
Neoplastic Well-Defined Neuroendocrine Tumor Lung
- Neuroendocrine tumors (NETs) of the lung are divided into 4 major types: small cell lung cancer (SCLC), large cell neuroendocrine carcinoma (LCNEC), atypical carcinoid (AC) or typical carcinoid (TC) 2.
- The treatment of well-differentiated pulmonary carcinoid (PC) tumors typically involves a multidisciplinary approach, with surgical management being the mainstay of therapy and potentially curative 2.
- For patients with advanced disease, medical treatments may include somatostatin analog (SSA) therapy, targeted therapy, chemotherapy, or peptide receptor radionuclide therapy 2, 3, 4.
Surgical Management
- Surgical resection is the treatment of choice for curative intent, with lobectomy with radical lymphadenectomy considered the gold standard surgical procedure in the case of limited disease 5, 6.
- The rate of surgical resection is quite low, particularly for SCLC, ranging from 1 to 6% in limited diseases 5.
- Upfront surgery is suggested in early stages (from I to IIB), while a multimodality approach is recommended in locally advanced stages (III) 5.
Medical Treatments
- Somatostatin analogs (SSAs) are a reasonable first-line choice for patients with tumors expressing somatostatin receptors 4.
- Everolimus is an appropriate first-line choice for somatostatin receptor-negative tumors and for any patients with progressive disease 4.
- Peptide receptor radionuclide therapy (PRRT) can also be considered for progressive tumors expressing somatostatin receptors 2, 3, 4.
- Cytotoxic chemotherapy can be selected in patients with progressive tumors, primarily when cytoreduction is needed 4.