Experience in treatment of metastatic pulmonary carcinoid tumors

Background:The only cure for patients with pulmonarycarcinoids is surgery. In the present paper, we report the results ofmedical treatment of patients with metastatic tumors, their circulatinghormone markers, and immunohistochemical profile of the tumors.Patients and methods/Results:The response to systemicantitumoral treatment was studied in 31 patients with metastaticpulmonary carcinoids. Median survival from treatment start was 25months. Alpha-interferon treatment has resulted in stable disease in 4of 27 patients (median duration 15 months), while 23 patients showedprogressive disease. Somatostatin analogues given as single drugtreatment resulted in progressive disease. Streptozotocin and5-fluorouracil resulted in progressive disease in seven of sevenpatients. Stable disease was obtained for 8 and 10 months respectivelyin two of two patients treated with streptozotocin + doxorubicin. Two ofeight patients treated with cisplatinum + etoposide showed a significantdecrease in tumor size lasting six and eight months respectively, andone displayed stable disease for seven months. Elevation of plasmachromogranin A was seen in 93%.Conclusions:Theresults of systemic antitumoral treatment of pulmonary carcinoids withdistant metastases are generally discouraging. Chemotherapy withcisplatinum + etoposide, or doxorubicin combined with streptozotocin orpaclitaxel may be of value. Alpha-interferon and octreotide offerefficient symptomatic relief, but stabilizes tumor growth in merely15% of the cases. Plasma chromogranin A is the most frequentlyelevated tumor marker.