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J Thorac Cardiovasc Surg 2003;125:1182-1183
© 2003 The American Association for Thoracic Surgery

Letters to the Editor

Large cell neuroendocrine carcinoma of the lung: What we have to do

University of Torino Italy, San Giovanni Battista Hospital, Department of Thoracic Surgery, Via Genova, 3, 10126 Torino, Italy

To the Editor:

I read with interest the excellent article of Takei and colleagues ¹ about large cell neuroendocrine carcinoma (LCNC) of the lung. This series represents the largest ever published in English language literature.

The family of neuroendocrine tumors of the lung has recently been the object of study by several pathologists and surgeons. The recent World Health Organization classification criteria ² consider neuroendocrine tumors of the lung as a distinct subset of neoplasm with specific morphologic, ultrastructural, immunohistochemical, and molecular characteristics. Travis and associates ³ distinguish between typical and atypical carcinoid, LCNC, and small cell neuroendocrine carcinoma of the lung. Of these tumors, LCNCs appear to have an intermediate biologic behavior between atypical carcinoid and small cell carcinoma. ³ LCNCs have a tendency to spread early, yielding mediastinal lymph node metastases or distant metastases (generally in the liver or in the brain) at the time of diagnosis.

Correct preoperative diagnosis of neuroendocrine carcinoma of the lung (and also of LCNC) is really difficult to obtain either by bronchoscopy or by transthoracic biopsy; in the case of clinical N2 neuroendocrine carcinoma, a surgical approach can be considered, because these tumors do not respond to neoadjuvant therapy. ⁴ This could be appropriate in case of bronchial carcinoid, but not in case of LCNC. For these tumors, I believe, neoadjuvant treatment is mandatory because of their aggressive biologic behavior.

In this study Takei and colleagues ¹ pointed out the importance of the immunohistochemical assessment, with the detection of chromogranin A staining in neoplastic cells. We must remember that LCNCs, because they are neuroendocrine carcinomas, express somatostatin receptors, which can be easily detected in vitro by reverse transcriptase polymerase chain reaction. ⁵ In vivo expression of these receptors is provided by indium 111-tagged diethylenetriaminepentaacetic acid pentetreotide (OctreoScan, OCT) scintigraphy. ^6,7 This procedure is widely accepted both in the preoperative evaluation of neuroendocrine carcinoma, because of its effectiveness in detecting mediastinal or distant metastases with high sensitivity, and in follow-up for early detection of tumor recurrences or distant metastases. ⁸ In case of positive OCT scintigraphy result, therapy with octreotide (new generation somatostatin analog) might be considered, alone or in association with chemotherapy. I believe that such an important biologic concept might be considered in the correct multidisciplinary treatment of LCNC of the lung. Octreotide has been proved to be effective in controlling metastatic growth, well tolerated by the patient, and without important side effects. ^8,9

In conclusion, I congratulate Takei and colleagues ¹ for this excellent article on such a difficult matter. I recommend the use of OCT scintigraphy in the preoperative evaluation of these patients and in their follow-up. Furthermore the use of octreotide (in the case of positive results of OCT scintigraphy), in association with traditional adjuvant therapy, might be considered to reduce the risk of tumor recurrence or distant metastases.

References

1. Takei H, Asamura H, Maeshima A, Suzuki K, Kondo H, Niki T, et al. Large cell neuroendocrine carcinoma of the lung: a clinicopathologic study of eighty-seven cases. J Thorac Cardiovasc Surg. 2002;124:285-92.[Abstract/Free Full Text]
   
2. World Health Organization. Histological typing of lung and pleural tumours. 3rd ed. Geneva: The Organization; 1999.
   
3. Travis WD, Colby TV, Corrin B, Shimosato Y, Brambilla E. Histological typing of lung and pleural tumours. 3rd ed. Berlin: Springer Verlag; 1999.
   
4. Martini N, Zaman MB, Bains MS, Burt ME, McCormack PM, Rusch VW, et al. Treatment and prognosis in bronchial carcinoids involving regional lymph nodes. J Thorac Cardiovasc Surg. 1994;107:1-6.[Abstract/Free Full Text]
   
5. Papotti M, Croce S, Bello M, Bongiovanni M, Allia E, Schindler M, et al. Expression of somatostatin receptor types 2, 3 and 5 in biopsies and surgical specimens of human lung tumours. Vircows Arch. 2001;439:787-97.
   
6. Kwekkeboom DJ, Kho GS, Lamberts SW, Reubi JC, Laissue JA, Krenning EP. The value of octreotide scintigraphy in patients with lung cancer. Eur J Nucl Med. 1994;21:1106-13.[Medline]
   
7. Musi M, Carbone RG, Bertocchi C, Cantalupi DP, Michetti G, Pugliese C, et al. Bronchial carcinoid tumours: a study on clinicopathological features and role of octreotide scintigraphy. Lung Cancer. 1998;22:97-102.[Medline]
   
8. Filosso PL, Ruffini E, Oliaro A, Papalia E, Donati G, Rena O. Long-term survival of atypical bronchial carcinoid with liver metastases, treated with octreotide. Eur J Cardiothorac Surg. 2002;21:913-7.[Abstract/Free Full Text]
   
9. O'Byrne KJ, Schally AV, Thomas A, Carney DN, Steward WP. Somatostatin, its receptors and analogs, in lung cancer. Chemotherapy. 2001;47:78-108.
   

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				R. Hage, A. B. de la Riviere, and J.M.M. van den Bosch Reply to Filosso Eur. J. Cardiothorac. Surg., October 1, 2003; 24(4): 673 - 673. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pier Luigi Filosso Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Filosso, P. L. Search for Related Content PubMed PubMed Citation Articles by Filosso, P. L.