Complexity in the treatment of pulmonary large cell neuroendocrine carcinoma.
OBJECTIVE
According to the World Health Organization (WHO) classification of pulmonary large cell neuroendocrine carcinoma (LCNEC), one of the neuroendocrine tumors of the lung, is considered as a variant of non-small cell lung carcinoma. The objective of this study was to investigate the treatment strategy for LCNEC.


METHODS
We retrospectively reviewed the clinical information of 12 patients with LCNEC.


RESULTS
Three patients with stage I disease underwent curative resection but all relapsed within 20 months. One with stage IIA disease underwent non-curative resection received adjuvant chemoradiotherapy (cisplatin plus etoposide) and is well with no evidence of recurrence. Two with stage IIIB disease received concurrent chemoradiotherapy. Both achieved partial response (PR) but relapsed within 2 months. One elderly patient with stage IIIA disease received vinorelbine alone and did not respond. Of five patients with stage IV disease, three received platinum-based chemotherapy but no patient achieved PR. Of five patients with gefitinib as salvage therapy, one achieved PR.


CONCLUSIONS
The prognosis of LCNEC is poor. To improve the outcome, we must evaluate the effectiveness of adjuvant or neoadjuvant therapy in patients with resectable disease. In addition, the evaluation of systemic and multimodality treatment strategies similar as in small cell lung cancer is worthy of consideration.
Kozuki
Toshiyuki
T
Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine and Density, Okayama, Japan.
Fujimoto
Nobukazu
N
Ueoka
Hiroshi
H
Kiura
Katsuyuki
K
Fujiwara
Keiichi
K
Shiomi
Katsuhiko
K
Mizobuchi
Koichi
K
Tabata
Masahiro
M
Hamazaki
Shuji
S
Tanimoto
Mitsune
M
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D018287:Carcinoma, Large Cell / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D011799:Quinazolines / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D011799:Quinazolines; D005047:Etoposide; D002945:Cisplatin; D000077156:Gefitinib