Complete histological regression of metastatic carcinoid tumour after treatment with octreotide

Abstract

A 69-year-old woman was admitted with facial flushing, weight loss and intermittent diarrhoea. Urinary 5-hydroxyindole-acetic acid (5-HIAA) level was elevated at 200 micromol/24 h (normal: < 50). Computerized tomography (CT) demonstrated multiple enhancing liver metastases with biopsy proven carcinoid metastases with no evidence of primary tumour at this stage. Octreotide was initiated, resulting in marked improvement in carcinoid symptoms. Nine years later, she presented with abdominal pain and slightly deranged liver function tests. Repeat colonoscopy at this stage, showed an ileal tumour causing impending obstruction, necessitating urgent right hemicolectomy. Histology demonstrated primary carcinoid tumour. She continued on octreotide. Three years later at the age of 81 years, she suffered a fatal haemorrhagic stroke. Autopsy revealed complete regression of hepatic carcinoid metastases.

Regression of metastatic carcinoid tumors with octreotide therapy: Two case reports and a review of the literature

“…However, the majority of these cases combined octreotide with other treatment modalities including alpha-interferon, chemoembolization, and systemic chemotherapy, making the interpretation of the antiproliferative effects of octreotide alone dif®cult. Complete regression of the metastatic carcinoid tumors on octreotide treatment alone has been reported in one case [25]. In this study, we present two cases of metastatic small bowel carcinoid tumors that had responded temporally with complete macroscopic regression of their liver and lymph node metastates on octreotide alone.…”

“…There is one recent case report of a 69-year-old women demonstrating complete histologic regression of carcinoid liver metastases following octreotide monotherapy [25]. This patient presented with carcinoid syndrome and was treated with octreotide therapy.…”

“…In contrast, octreotide has little or no effect on the tumor growth of VIPomas and glucagonomas [2]. Although observations such as stabilization of growth or the decrease in size of carcinoid tumors once octreotide therapy has been instituted suggests an anti proliferative effect, complete regression of these tumors has rarely been seen [1,12,25]. The indolent course of the majority of carcinoid tumors makes stabilization of disease while on octreotide dif®cult to quantify as a true antiproliferative effect.…”

Management of Gastro-intestinal Neuroendocrine Tumors with Liver Metastases: A Comprehensive Review

“…Carcinoid tumors are not very radiosensitive, but external beam radiotherapy may be helpful in patients with painful bone metastases [65], and there has been a suggestion that some secondary deposits in the liver and elsewhere shrink in response to radiotherapy [66].…”

Thymic Neuroendocrine Carcinoma Presenting as Cushing’s Syndrome: Treatment with Octreotide Combined with Surgery and Radiotherapy

“…The mainstayoftreatmentissurgery,evenifcompleteresectionis notpossible [4,8,9].Theuseofradiotherapyorchemotherapeuticagentsiscontroversial.Theuseofsomatostatinanalogs suchasoctreotideasadjuvanttherapyhasbeenproposedin recentyearsandseemsapromisingapproach [10][11][12][13][14].Here, we report on a patient with TNC presenting with Cushing's syndrome, who was successfully treated with radical surgery followedbyradiotherapyandadministrationofoctreotide. …”