Well differentiated thoracic neuroendocrine tumors: clinical management and therapy

The bronchial tree represents the most frequent site of origin of carcinoid (around 25% of the total). The spectrum of differentiation of lung neuroendocrine tumors rang from low-aggressivity forms to the high aggressive feature of small cell lung carcinoma. Diagnostic and therapeutical strategies therefore greatly varies at the opposite of the spectrum. In the well differentiated forms (carcinoids) the symptomatology is mainly related to respiratory symptoms in the central forms, while the peripheral forms are in most of cases accidentally discovered when asymptomatic. Clinical or subclinical paraneoplastic syndromes are associated in a significant minority of cases. Diagnostic work-up include CT multislice, bronchial endoscopy and octreoscan with Chest SPECT. Further contribute may be added by the Ga68 DOTATOC, 5-HTP PET-CT, actually available only in few centers and by the echo-bronchoscopy and virtual bronchoscopy. Therapeutical approach of choice is surgical, while medical therapy is indicated to control the hypersecretion in paraneoplastic syndromes and to control tumor proliferation in metastatic or/and inoperable disease. Among these mono or polichemioterapic approach were associated with very limited results, while due to the limited toxicity biological therapy appear of choice in this class of tumors. Besides to somatostatin analogues many promising molecules, that seems more efficacious in some association have been recently added to improve the effects of biological therapy in the future years.