title: Long-acting somatostatin analogues are an effective treatment for type 1 gastric carcinoid tumours.
abstract: BACKGROUND
  Gastric carcinoid tumours type 1 (GCA1) originate from hyperplastic enterochromaffin-like (ECL) cells secondary to hypergastrinaemia. Treatment with somatostatin analogues (SSA) might impede ECL-cell hyperplasia by suppressing gastrin secretion and/or by a direct anti-proliferative effect on ECL cells. We conducted a multicentre prospective study to assess the effects of long-acting SSA on hypergastrinaemia and ECL-cell proliferation in patients with GCA1.
  
  
  METHODS
  We studied 15 patients with GCA1 treated with monthly long-acting release octreotide (LAR) (20-30 mg; n=14) or Lanreotide 90 mg (n=1) for at least 6 months. Patients had serum gastrin and chromogranin A measurements performed and biopsies taken from both tumours and surrounding mucosa before, and every 6-12 months following treatment. Sections were immunostained for neuroendocrine markers. The cell proliferation index Ki-67, intensity of staining before and after treatment and the degree of gastric wall invasion were also assessed.
  
  
  RESULTS
  All patients tolerated treatment well (mean follow-up of 18 months). In 11 patients (73%), a complete disappearance of the tumours at 1 year of treatment was observed on endoscopy, while in three patients (20%), the tumours decreased significantly in number and size. Gastrin levels normalized in 25% of patients, and were reduced by more than 80% in the remaining 75%.
  
  
  CONCLUSIONS
  Treatment with SSAs in GCA1 leads to a substantial tumour load reduction, with a concomitant decrease of serum gastrin levels. Our data indicate an important anti-proliferative effect of SSA on ECL cells, providing clinical benefit and obviating, at least temporarily, the need for invasive therapies for GCA1.
authors.affiliation: Institutes of Endocrinology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 49500, Israel. simonag@clalit.org.il
authors.forename: Simona
authors.initials: S
authors.lastname: Grozinsky-Glasberg
authors.forename: Gregory
authors.initials: G
authors.lastname: Kaltsas
authors.forename: Chamutal
authors.initials: C
authors.lastname: Gur
authors.forename: Eyal
authors.initials: E
authors.lastname: Gal
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Thomas
authors.forename: Susana
authors.initials: S
authors.lastname: Fichman
authors.forename: Krystallenia
authors.initials: K
authors.lastname: Alexandraki
authors.forename: Dganit
authors.initials: D
authors.lastname: Barak
authors.forename: Benjamin
authors.initials: B
authors.lastname: Glaser
authors.forename: Ilan
authors.initials: I
authors.lastname: Shimon
authors.forename: David J
authors.initials: DJ
authors.lastname: Gross
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D002276:Carcinoid Tumor / Q000188:drug therapy* / Q000473:pathology; D004759:Enterochromaffin Cells / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000008:administration & dosage*; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide