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Eur J Cardiothorac Surg 2003;24:673
© 2003 Elsevier Science NL
Letter to the Editor |
a Department of Pulmonology, Heart Lung Centre Utrecht (HLCU), St Antonius Hospital, PO Box 2500, Koekoekslaan 1, Nieuwegein 3430 CM, The Netherlands
b Department Thoracic Surgery, Utrecht, The Netherlands
Received 19 July 2003; accepted 21 July 2003.
* Corresponding author. Tel.: +31-30-609-2428; fax: +31-30-605-2001
e-mail: j.vandenbosch{at}antonius.net
Key Words: Large-cell neuroendocrine carcinoma • Neuroendocrine • Lung cancer
We read with interest the letter to the Editor of colleague Filosso. With the recognition of large-cell neuroendocrine carcinoma (LCNEC) of the lung as a separate category in the WHO/IASLC classification of lung tumors, in the literature a growing number of studies on LCNEC is being published. LCNEC remains a relatively rare tumor, and the real incidence, treatment and prognosis is still not known.
Because the difficulty in making a preoperative diagnosis, almost all LCNEC patients are diagnosed with LCNEC after surgical resection. Filosso recommended preoperative octreotide (OCT) scintigraphy in patients with LCNEC [1]. Theoretically, OCT scanning could be helpful in patients with a preoperative diagnosis of LCNEC, possibly with a higher accuracy than chest computed tomography scan. The major problem however remains that it cannot be done preoperatively, because almost never the diagnosis LCNEC is made before surgical resection. Preoperative staging procedures using OCT are not routine procedures in lung tumors without preoperative diagnosis.
In bronchial carcinoids, another tumor type in the family of neuroendocrine tumors, OCT scintigraphy can be useful. In sharp contrast with LCNEC, in carcinoids almost always a preoperative diagnosis is known [2]. Bronchial carcinoids represent the relatively less aggressive malignant category in the neuroendocrine spectrum. Musi et al. [1] studied OCT in carcinoids, and found the primary tumors in all cases, as well as all recurrent and metastatic disease. Interpretation of a positive octreoscan has to be done with caution, because of the low specificity. Other tumors, but also granulomas and autoimmune diseases can result in a positive octreoscan. Positive OCT scintigraphy in non-neuroendocrine tumors, is probably due to activated lymphocytes surrounding the tumor [3]. On the other hand, we may not rely completely on a negative octreoscan.
Unfortunately LCNEC has a high rate of distant metastases. This is also what Filosso points out with the LCNEC-dilema; a correct preoperative staging is very important, but preoperative diagnosis even more.
Despite intensive combined-modality treatment, including surgical resection, adjuvant radio- and/or chemotherapy, survival remains poor. Filosso et al. have suggested the use of a biological therapy with OCT as adjuvant treatment. This treatment is based on the overexpression of somatostatin receptors in neuroendocrine tumors. In atypical carcinoids Filosse et al. [4] have shown OCT to be effective in controlling metastases, without important side-effects. Although in LCNEC still in the experimental phase, this treatment has a very promising potential in the treatment of LCNEC. The results of clinical trials are awaited.
References
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