title: Metastatic carcinoid tumor: changing patterns of care over two decades.
abstract: BACKGROUND
  Metastatic carcinoid tumors (MCTs), an important subgroup of neuroendocrine tumors, occur infrequently and often have an indolent course, limiting data on long-term treatment outcomes. We aimed to assess treatment trends at a single center over time and the impact on the outcome.
  
  
  METHODS
  Patients diagnosed with carcinoid tumors in the North West Adelaide Health Service between January 1, 1985 and March 1, 2007 were identified from the South Australian Cancer Registry.
  
  
  RESULTS
  We identified 92 patients with carcinoid tumors; 49 had MCT. Although treatment options increased over time, the most significant change was to access octreotide therapy, with 24 receiving long-acting somatostatin analogs. Survival improved over time and the median overall survival for patients receiving long-acting somatostatin analogs was 112 months compared with 53 months for those who did not (P=0.021, hazard ratio: 2.46). Ten year survival was 40% and 22%, respectively. About 75% of evaluable patients had a biochemical response to initial therapy and a measurable response occurred in 3 of 24 (13%) patients.
  
  
  CONCLUSIONS
  This single center experience has provided insight into current treatment options for MCT, and suggests the use of long-acting somatostatin analogs may impact on disease control and survival. However, the uptake of other treatment options seems limited and there is a need for agents that target tumor progression.
authors.affiliation: Department of Medical Oncology, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia. Amanda.townsend@health.sa.gov.au
authors.forename: Amanda
authors.initials: A
authors.lastname: Townsend
authors.forename: Tim
authors.initials: T
authors.lastname: Price
authors.forename: Sue
authors.initials: S
authors.lastname: Yeend
authors.forename: Ken
authors.initials: K
authors.lastname: Pittman
authors.forename: Kevin
authors.initials: K
authors.lastname: Patterson
authors.forename: Colin
authors.initials: C
authors.lastname: Luke
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002276:Carcinoid Tumor / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D015282:Octreotide / Q000627:therapeutic use*; D012042:Registries; D012189:Retrospective Studies; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D013021:South Australia; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013004:Somatostatin; D015282:Octreotide