Pulmonary Neuroendocrine Tumors: Treatment

Pictured: David Finley David Finley (center) performs an operation to remove a pulmonary endocrine tumor. Surgery often offers the best chance for a cure for these uncommon tumors.

There are several options for treating pulmonary neuroendocrine tumors. Patients may receive one or more treatments, such as surgery, hormone therapy, chemotherapy, radiation therapy, and liver tumor embolization (described below).

Surgery

Surgery is the preferred treatment for most early-stage pulmonary carcinoid tumors. Depending on the size and location of the tumor, doctors may remove the tumor and a portion of lung surrounding it (wedge resection), a lobe of the lung (lobectomy), or an entire lung (pneumonectomy). Surgeons at Memorial Sloan Kettering have experience performing more complex reconstructive surgeries that often permit removal of the tumor while preserving more of the healthy portion of the lung (sleeve resection). Lymph nodes in the chest are often removed during surgical removal of the tumor to determine whether cancer cells have spread. For more information about surgery to remove lung tumors, visit the Lung Cancer overview on our Web site.

Memorial Sloan Kettering offers minimally invasive surgical procedures, including video-assisted thoracic surgery (VATS), also known as thoracoscopy, for the removal of some pulmonary carcinoid tumors. Like laparoscopic surgery or “keyhole” surgery, VATS allows the surgeon to remove the tumor using thin, specialized instruments that are placed in small incisions between the ribs under image guidance. Recovery time and hospital stay is shorter for patients who have VATS compared with those who have traditional “open” surgery.

Chemotherapy and Hormone Therapy

Adjuvant (additional) treatment with platinum-based chemotherapy may be recommended for select patients following surgical removal of pulmonary carcinoid tumors, depending on the stage of the cancer. Because these tumors are so rare, there is no standard chemotherapy regimen for patients with pulmonary carcinoid tumors that have spread to other organs and cannot be surgically removed. Some of these patients may be treated with chemotherapy regimens used to treat small cell lung cancer. Others may be eligible for ongoing clinical trials.

Patients with pulmonary carcinoid tumors that cannot be surgically removed may benefit from monthly injections of a synthetic hormone, octreotide, which controls hormone-related symptoms and may have the potential to slow tumor growth.

Radiation Therapy

External-beam radiation therapy, which delivers radiation from a machine outside of the body, is the most common form of radiation therapy used to treat neuroendocrine lung tumors. Radiation therapy is occasionally recommended following surgery or to relieve symptoms in patients who are not candidates for surgery, particularly when the tumor has spread, or metastasized, to the bone or brain.

Radiofrequency Ablation

Interventional radiologists at Memorial Sloan Kettering have helped to pioneer the treatment of image-guided tumor ablation. This technique uses either heat (radiofrequency) or cold (cryoablation) to treat lung tumors. During ablation, we use CT imaging to place a needle into the tumor, and then apply either cold or heat to destroy tumor cells. This technique requires no incisions and is useful for some patients who are not good candidates for surgery and have isolated tumors.

Liver Tumor Embolization

Embolization, a localized approach to destroying liver tumors, may be used to treat neuroendocrine lung tumors that have metastasized to the liver. The portal vein channels blood and nutrients to the liver, but the hepatic artery directs blood to liver tumors. Guided by imaging techniques such as CT or ultrasound, embolization involves the injection of tiny particles through a small tube, or catheter, threaded into the hepatic artery. These particles block the flow of blood to the tumor, depriving it of the nutrients and oxygen it needs to survive. Embolization may be used alone or in combination with surgery.

Treatment for Advanced Cancers

Because small cell and large cell neuroendocrine tumors are usually found at an advanced stage, treatment often begins with a combination of platinum-based chemotherapy drugs. In the rare instances in which these aggressive tumors are localized, radiation and/or surgery may be recommended in addition to chemotherapy.

No standard of care has been established for large cell neuroendocrine carcinoma, which is very uncommon. Depending on the stage of the tumor, adjuvant chemotherapy may be recommended for select patients following surgical removal of a large cell neuroendocrine tumor. Chemotherapy also may be recommended if the tumor has spread to other organs. Generally, patients with large cell neuroendocrine carcinoma are treated with chemotherapy regimens used to treat small cell lung cancer.