Somatostatin analogues in digestive neuroendocrine tumors

Introduction: In contrast with other digestive cancers, the majority of neuroendocrine tumors are well diferentiated, slowly growing and with a better survival. The incidence of neuroendocrine tumors is continuously growing, mostly because of increasing interest concerning this type of tumors. The somatostatin analogues (SS analogues), alone or in combination with systemic chemotherapy, have proven their efficacy in slowing the disease progression. Methods: We performed a retrospective study for 10 years period (between 2005-2015), that included the patients diagnosed with digestive neuroendocrine tumors in our center, in the gastroenterology unit. From the data obtained, we selected the patients that received somatostatin analogues, for studiyng the features of these patients. Results: We included 86 patients diagnosed with digestive neuroendocrine tumors, with 25 (29,06%) receiving somatostatin analogs. In patients receiving somatostatin analogs, the most frequent localisation of the primary tumor was the pancreas (12/25 patients-48%). The majority of these patients (18/25, 72%) were classified as stage IV at the time of the diagnosis. In 5 patients (20%), the primary site of the tumor was unidentified. Regarding the activity index, 5/25 (20%) were tumors poorly differentiated (G3), and 10/25 (40%) were classified as G2. 14/25 (56%) presented typical manifestations of a carcinoid syndrome. 18/25 (72%) had metastasis (15/25 having liver metastasis), explaining the treatment choice of somatostatin analogue for controlling disease progression. 11/25 (44%) received also systemic chemotherapy. Conclusions: The neuroendocrine tumors are silent, rarely being diagnosed in early stages. The somatostatin analogues have been recommended in the majority of patients with pancreatic origin and liver metastasis. The majority of patients were classified as advanced disease (stage IV), with high activity index, suggesting the aggressive potential of metastatic tumors. We found patients with neuroendocrine tumors with unknown origin that also received somatostatin analogues. Discussion: The neuroendocrine tumors consist a rare medical entity, in contrast with other digestive cancers. The management for these tumors should be conducted in a reference center. Increasing the availability of imaging techniques and biological markers can improve the early diagnosis and correct follow-up of these patients. The somatostatin analogues represent an adjuvant therapy, given in order to control disease progression and the carcinoid syndrome, but the only curative treatment remains the surgery.