Five-year follow-up of patients treated for 1 year with octreotide long-acting release for enterochromaffin-like cell carcinoids.
BACKGROUND
Gastric carcinoids type 1 (GC1) are neuroendocrine tumors (NETs) arising from the enterochromaffin-like (ECL) cells in patients with chronic atrophic gastritis (CAG). The treatment of GC1 has been endoscopic polypectomy or surgical tumor excision and antrectomy. One year treatment with somatostatin analogs (SSAs) diminished tumor load and ECL cell density. The effect persisted 1 year after treatment was discontinued. However, the optimal SSA dose and treatment duration are unknown.


OBJECTIVE
The aim of the present work was to study macroscopic and histopathological changes in the stomach and serum markers gastrin and chromogranin A (CgA) in GC1 patients 5 years after 1 year of octreotide long-acting release (LAR) treatment.


METHODS
Five patients with GC1 were included 5 years after the initial year of octreotide LAR treatment. All patients underwent upper gastrointestinal endoscopy including tumor and mucosal biopsies from oxyntic mucosa, chest and abdominal computer tomography and octreotide scintigraphy. Fasting serum gastrin and CgA were also measured.


RESULTS
At 5 years, one patient had a highly malignant gastric tumor, one patient had an increased number of GCs, regional and distant metastases and three patients had an increased number of GCs. Serum gastrin and CgA increased to pre-treatment levels after 1 year of follow-up and were unchanged at the 5-year follow-up.


CONCLUSIONS
The disease had progressed in all five GCs patients treated with octreotide for 12 months at 5 years of follow-up. This suggests that, if started, octreotide treatment should not be discontinued in these patients.
Department of Gastroenterology and Hepatology, St. Olavs Hospital, Trondheim, Norway. constantin.jianu@ntnu.no
Constantin S
CS
Jianu
Reidar
R
Fossmark
Unni
U
Syversen
Øyvind
Ø
Hauso
Vidar
V
Fykse
Helge L
HL
Waldum
D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000494:pharmacology / Q000627:therapeutic use*; D001706:Biopsy; D002276:Carcinoid Tumor / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D053379:Chromogranin A / Q000097:blood; D018450:Disease Progression; D019861:Enterochromaffin-like Cells / Q000187:drug effects / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000473:pathology; D005755:Gastrins / Q000097:blood; D005757:Gastritis, Atrophic / Q000150:complications; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000494:pharmacology / Q000627:therapeutic use*; D013274:Stomach Neoplasms / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden
D018931:Antineoplastic Agents, Hormonal; D053379:Chromogranin A; D005755:Gastrins; D015282:Octreotide