title: Multidisciplinary management of advanced lung neuroendocrine tumors.
abstract: The optimal clinical management of aggressive/advanced lung neuroendocrine tumors (NETs) is still debated, due to their rarity and the lack of prospective randomized studies. Results derive from retrospective mono-Institutional series, and few dedicated prospective trials, recently designed, are still ongoing. In low-grade tumors [bronchial carcinoids (BCs)] surgery, whenever feasible, remains the mainstay of treatment, and chemo/radiotherapy (RT) should be reserved to progressive diseases (PD). In case of resected N1-N2 BCs, a "watch and see" policy associated with a close clinical/radiological follow-up is recommended. Somatostatin analogs (SSA) seem to be effective in controlling BCs associated endocrine syndromes, while SSA antiproliferative effect has also been reported in the past. Targeted therapy with new drugs (Everolimus) seems to be very promising, but further trials are needed. Surgery alone is not sufficient to treat high-grade NETs: adjuvant CT is required also in early stages. Platinum-Etoposide regimen demonstrated to be the most effective; irinotecan and other biological drugs are considered very promising. In conclusion, the management of advanced lung NETs should be individualized by multidisciplinary teams which include Medical and Radiation Oncologists, Surgeons, Pathologists, Pulmonologists, Endocrinologists, Interventional Radiologists, and the prognosis is mainly dependent on tumor grade and its anatomical extent.
authors.affiliation: 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee.
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.affiliation: 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee.
authors.forename: Piero
authors.initials: P
authors.lastname: Ferolla
authors.affiliation: 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guerrera
authors.affiliation: 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.affiliation: 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee.
authors.forename: William D
authors.initials: WD
authors.lastname: Travis
authors.affiliation: 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee.
authors.forename: Giulio
authors.initials: G
authors.lastname: Rossi
authors.affiliation: 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee.
authors.forename: Paolo Olivo
authors.initials: PO
authors.lastname: Lausi
authors.affiliation: 1 Department of Thoracic Surgery, University of Torino Italy, Torino, Italy ; 2 Multidisciplinar Group for Diagnosis and Therapy of Neuroendocrine Tumors, Umbria Regional Cancer Network, Orbassano, Italy ; 3 Department of Pathology Memorial Sloan Kettering Cancer Center, New York, USA ; 4 Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy ; 5 The European Society of Thoracic Surgeons (ESTS) Neuroendocrine Tumors of the Lung Working-Group Steering Committee.
authors.forename: Alberto
authors.initials: A
authors.lastname: Oliaro
keywords: Lung; biological therapy; chemotherapy; metastases; neuroendocrine tumors (NETs); radiotherapy (RT); recurrence; surgery; survival