[Treatment strategy of neuroendocrine tumors].
Therapeutic strategy of neuroendocrine tumours is complex, due to their heterogeneity and to the fact that although generally slow growing, a significant proportion demonstrates aggressive tumour growth. Symptomatic carcinoid syndrome and various pancreatic endocrine tumours with symptomatic syndromes are well controlled with somatostatin analogues. Surgery remains the mainstay of treatment if the tumour can be resected. Metastatic pancreatic neuroendocrine tumour are treated when resection is not feasible with combination chemotherapy using adriamycin and streptozotocin, which remains a standard of care. In well differentiated tumour of the gut or the lung there is no clear standard of chemotherapy and treatment vary according to the tumour course. In indolent cases, somatostatin analogues are the best treatment, in case of aggressive tumours chemoembolisation should be preferred when the disease is located or predominant in the liver. Poorly differentiated tumours are treated by combination chemotherapy with etoposide and cisplatin, and surgery has no indication. Gastrinoma and other pancreatic tumours arising in the context of multiple endocrine neoplasia type I disease need a specific therapeutic strategy.
Ducreux
Michel
M
Unité de gastroentérologie Institut Gustave Roussy 94805 Villejuif. ducreux@igr.fr
Baudin
Eric
E
Schlumberger
Martin
M
D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016461:Chemoembolization, Therapeutic; D004317:Doxorubicin / Q000627:therapeutic use; D015408:Gastrinoma / Q000188:drug therapy; D013006:Growth Hormone / Q000627:therapeutic use*; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D008303:Malignant Carcinoid Syndrome / Q000188:drug therapy; D009377:Multiple Endocrine Neoplasia; D009362:Neoplasm Metastasis; D018358:Neuroendocrine Tumors / Q000188:drug therapy*; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D013311:Streptozocin / Q000627:therapeutic use
D000903:Antibiotics, Antineoplastic; D006728:Hormones; D013311:Streptozocin; D004317:Doxorubicin; D013006:Growth Hormone
Stratégie de traitement des tumeurs neuro-endocrines.