What are the treatment guidelines for bronchopulmonary neuroendocrine tumors (NETs)?

Updated: Dec 23, 2018
  • Author: Evan S Ong, MD, MS; more...
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Answer

Answer

NCCN recommendations for bronchopulmonary NETs are as follows [7] :

  • Stage I, II, and IIIA: Lobectomy or wedge resection for peripheral low-grade neuroendocrine carcinoma and lymph node dissection or sampling

  • Stage IIIA low grade nonresectable tumors: Radiation therapy

  • Stage IIIA intermediate grade nonresectable tumors: Cisplatin/etoposide and radiation therapy

  • Stage IIIB (except for T4 due to multiple lung nodules): Cisplatin/etoposide with or without radiation therapy

  • Stage IIIBm (T4 due to multiple lung nodules) or stage IV: Systemic therapy; no preferred regimen; options include cisplatin/etoposide, temozolomide with or without capecitabine, sunitinib, or everolimus; consider octreotide for symptoms of malignant carcinoid syndrome

The NANETS guidelines and the ESMO guidelines are similar to those of the NCCN, with some minor variances. [14, 6] The ESMO guidelines include the following additional recommendations [6] :

  • Bronchoscopic laser excision should be considered a suboptimal treatment and be reserved for inoperable patients or performed as a preoperative disobliterating procedure

  • Lobectomy and sleeve resection are preferred for locoregional tumors and systemic nodal dissection should be performed

  • Pneumonectomy should be avoided

Additionally, NANETS suggests that interferon alpha should be considered for metastatic or unresectable disease. [14]


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