Ducreux Michel, Baudin Eric, Schlumberger Martin
Unité de gastroentérologie Institut Gustave Roussy 94805 Villejuif.
Rev Prat. 2002 Feb 1;52(3):290-6.
Therapeutic strategy of neuroendocrine tumours is complex, due to their heterogeneity and to the fact that although generally slow growing, a significant proportion demonstrates aggressive tumour growth. Symptomatic carcinoid syndrome and various pancreatic endocrine tumours with symptomatic syndromes are well controlled with somatostatin analogues. Surgery remains the mainstay of treatment if the tumour can be resected. Metastatic pancreatic neuroendocrine tumour are treated when resection is not feasible with combination chemotherapy using adriamycin and streptozotocin, which remains a standard of care. In well differentiated tumour of the gut or the lung there is no clear standard of chemotherapy and treatment vary according to the tumour course. In indolent cases, somatostatin analogues are the best treatment, in case of aggressive tumours chemoembolisation should be preferred when the disease is located or predominant in the liver. Poorly differentiated tumours are treated by combination chemotherapy with etoposide and cisplatin, and surgery has no indication. Gastrinoma and other pancreatic tumours arising in the context of multiple endocrine neoplasia type I disease need a specific therapeutic strategy.
神经内分泌肿瘤的治疗策略很复杂，这是由于其异质性，以及尽管它们通常生长缓慢，但仍有相当一部分表现出侵袭性肿瘤生长。有症状的类癌综合征以及伴有症状性综合征的各种胰腺内分泌肿瘤，使用生长抑素类似物可得到很好的控制。如果肿瘤能够切除，手术仍然是主要的治疗方法。当无法进行切除时，转移性胰腺神经内分泌肿瘤采用阿霉素和链脲佐菌素联合化疗进行治疗，这仍然是一种标准的治疗方法。在分化良好的肠道或肺部肿瘤中，没有明确的化疗标准，治疗方法会根据肿瘤病程而有所不同。在惰性病例中，生长抑素类似物是最佳治疗方法；对于侵袭性肿瘤，如果疾病位于肝脏或在肝脏中占主导地位，应首选化疗栓塞。低分化肿瘤采用依托泊苷和顺铂联合化疗进行治疗，手术没有指征。胃泌素瘤和其他在I型多发性内分泌肿瘤疾病背景下发生的胰腺肿瘤需要特定的治疗策略。
