Metastatic carcinoid tumour (MCT): 20 years experience at the Queen Elizabeth Hospital. Does management by a medical oncology unit (MOU) improve outcome?

Abstract

15581 Background: MCTs have unique treatment approaches and often have an indolent course. Until recently, data on survival and treatment outcome was limited by the infrequent nature of these tumors. We aim to retrospectively assess the impact of care by a MOU (as a measure of active multidisciplinary intervention) on patient outcome. Methods: Patients diagnosed with carcinoid tumors at the QEH/LMH after 1/1/1985 were identified from the SA cancer registry. For patients with MCT the following data was collected; histology, primary site, treatment and survival. Patients with MCT were classified into two groups; those managed by a MOU, and those managed by an alternative specialist (other). The characteristics and outcomes of these groups were compared. Results: 90 patients with carcinoid were identified; mean age = 63, M/F=50/40. The primary site of disease (MCT v local) was: small bowel 54% v 20%, lung 2% v 30%, large bowel 17% v 2%, appendix 0% v 18%. Of the patients with MCT (n=46), 25 were referred to a MOU. The median age for MOU v other was 62 v 75 yrs. Treatment received by the two groups (MOU v other) was; octreotide LAR (76% v 10%), resection of primary tumor (76% v 86%), liver resection (4% v 5%), chemotherapy (8% v 0%), and MIBG (12% v 5%). The median time from diagnosis to commencement of octreotide LAR was 19.6 mths for functional MCT, with >50% reduction in 5HIAA to initial treatment in 79% of patients and no deaths in responders. Median overall survival (MOU v other) was 112 mths v 32 mths (HR 3.07 (1.43 - 7.65), p=0.005), and 10yr survival was 40% v 17%. Survival increased with octreotide LAR use (112 mths v 53 mths, p=0.017) and resection of primary (93 mths v 21 mths, p=0.02). Using Cox proportional hazards regression analysis, age at diagnosis and site of primary disease did not significantly affect survival. The impact of year of diagnosis on outcome will be presented. Conclusions: This single centre experience suggests active multidisciplinary intervention improves survival. Patients not seen in a MOU received minimal observation and few received octreotide LAR. Outcome may reflect referral bias, as referral to a MOU increased in the past 10 years, when more interventions have become available. No significant financial relationships to disclose.