title: Chemotherapy for locally advanced and metastatic pulmonary carcinoid tumors.
abstract: OBJECTIVE
  The optimal management of locally advanced and metastatic pulmonary carcinoid tumors remains to be determined.
  
  
  METHODS
  A retrospective review was conducted on patients with typical and atypical pulmonary carcinoid tumors treated at our institutions between 1990 and 2012.
  
  
  RESULTS
  300 patients were identified with pulmonary carcinoid, (80 patients with atypical carcinoid), of whom 29 presented with metastatic disease (16 atypical). Of evaluable patients, 26 (41%) with stages I-III atypical carcinoid tumors recurred at a median time of 3.7 years (range, 0.4-32), compared to 3 (1%) patients with typical carcinoid (range, 8-12.3). 39 patients were treated with chemotherapy, including 30 patients with metastatic disease (27 atypical), and 7 patients were treated with adjuvant platinum-etoposide chemoradiation (6 atypical, 1 typical, 6 stage IIIA, 1 stage IIB). At a median follow-up of 2 years there were 2 recurrences in the 7 patients receiving adjuvant treatment. Median survival after diagnosis of metastatic disease for patients with atypical pulmonary carcinoid was 3.3 years with a 5-year survival of 24%. Treatment regimens showing efficacy in pulmonary carcinoid include 15 patients treated with octreotide-based therapies (10% response rate (RR), 70% disease control rate (DCR), 15 month median progression-free survival (PFS)), 13 patients treated with etoposide+platinum (23% RR, 69% DCR, 7 month median PFS), and 14 patients treated with temozolomide-based therapies (14% RR, 57% DCR, 10 month median PFS). 8 of 10 patients with octreotide-avid disease treated with an octreotide-based regimen experienced disease control (1 partial response, 7 stable disease) for a median of 18 months (range 6-72 months).
  
  
  CONCLUSIONS
  These results support our previous finding that a subset of pulmonary carcinoid tumors are responsive to chemotherapy.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, United States.
authors.forename: Curtis R
authors.initials: CR
authors.lastname: Chong
authors.affiliation: Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, United States.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Wirth
authors.affiliation: Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02215, United States.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Nishino
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA 02215, United States.
authors.forename: Aileen B
authors.initials: AB
authors.lastname: Chen
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA 02215, United States.
authors.forename: Lynette M
authors.initials: LM
authors.lastname: Sholl
authors.affiliation: Center for Gastrointestinal Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, United States.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Kulke
authors.affiliation: Division of Thoracic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02215, United States.
authors.forename: Ciaran J
authors.initials: CJ
authors.lastname: McNamee
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, United States; Belfer Institute for Applied Cancer Science, Dana-Farber Cancer Institute, Boston, MA 02215, United States.
authors.forename: Pasi A
authors.initials: PA
authors.lastname: Jänne
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, United States. Electronic address: Bruce_Johnson@dfci.harvard.edu.
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002276:Carcinoid Tumor / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atypical carcinoid; DIPNECH; Typical carcinoid