Abstract
Simple SummaryPatients with neuroendocrine neoplasms (NETs) are a rare group of patients, 70% of which are diagnosed in the location of tumors in the digestive system, and the remaining 30% in the respiratory system. Building an appropriate therapeutic strategy in a patient with NET requires the involvement of a multidisciplinary team, which should include: oncology surgeon, clinical oncologist and radiation oncologist. One of the commonly used methods of treating lung NETs is the use of radiotherapy. However, the number of available recommendations for treatment of NET radiotherapy is negligible. This poses a significant problem for radiation oncologists when making qualification decisions for treatment with radiant energy. The aim of this article was to present the current knowledge on the use of radiotherapy in the treatment of lung NETs. In addition, we hope that the description of clinical cases in this publication will help radiation oncologists make the best, often personalized qualification decisions.The occurrence of neuroendocrine tumors among the diagnosed neoplasms is extremely rare and is associated with difficulties in undertaking effective therapy due to the histopathological differentiation of individual subtypes and the scarce clinical data and recommendations found in the literature. The choice of treatment largely depends not only on its type, but also on the location and production of excess hormones by the tumor itself. Common therapeutic approaches include surgical removal of the tumor, the use of chemotherapy, targeted drug therapy, peptide receptor radionuclide therapy, and the use of radiation therapy. This article reviews the current knowledge on the classification and application of radiotherapy in the treatment of lung NETs. Case reports were presented in which treatment with conventional radiotherapy, radical and palliative radiochemotherapy, as well as stereotactic fractionated radiotherapy in the treatment of typical (TC) and atypical (AT) lung carcinoids and large cell neuroendocrine carcinoma (LCNC) were used. We hope that the solutions presented in the literature will allow many radiation oncologists to make the best, often personalized decisions about the therapeutic qualifications of patients.
Highlights
The current classification of pathological neuroendocrine neoplasms (NENs) in various organs uses a number of terminology and site-specific criteria, which creates inaccuracies and confusion among patients, and among pathologists and treating physicians
There are four basic categories of lung neuroendocrine neoplasms. These are, There are four basic categories of lung neuroendocrine neoplasms. These are, respecrespectively: typical (TC) and atypical (AT) carcinoids belonging to well-differentiated tively: typical (TC) and atypical (AT) carcinoids belonging to well-differentiated neuroenneuroendocrine tumors (NETs) and small cell lung cancer (SCLC) and large cell docrine tumors (NETs) and small cell lung cancer (SCLC) and large cell neuroendocrine neuroendocrine carcinoma belonging to the poorly differentiated carcinoma (LCNEC)
The key aspects of an accurate diagnosis include taking into account other factors predisposing the patient to the incidence of this type of cancer, including an accurate family history, race and gender, age (45 years for a typical carcinoid tumor and 18 years for atypical carcinoid tumors) or environmental factors and diet [52] (Figure 3)
Summary
The current classification of pathological neuroendocrine neoplasms (NENs) in various organs uses a number of terminology and site-specific criteria, which creates inaccuracies and confusion among patients, and among pathologists and treating physicians. The number of diagnosed cases of this type of cancer around the world increases every year. Data from the SEER database (Surveillance, Epidemiology, and End Results Program) [8] indicate that the incidence in the period 1995–2012 increased from 3.96 to 6.61 per 100,000 cases. These diagnoses were made mainly in Caucasian patients (90.57%), and the dominant gender among whom they were diagnosed was women (54.74%). Detailed guidelines for the diagnosis, treatment and management of patients with diagnosed lung neuroendocrine tumors have been included in the recommendations of the European Society for Medical Oncology (ESMO) [21]. We hope that this publication will help radiation oncologists make the best, often personalized qualification decisions
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