A multidisciplinary approach to the work up and management of pulmonary carcinoid tumors and DIPNECH: a narrative review

Robert A Ramirez; Amanda S Cass; Satya Das; See-Wei Low; Mitra Mehrad; Otis B Rickman; Philip M Scherer; Katharine E Thomas; Erin A Gillaspie

doi:10.21037/tlcr-22-415

A multidisciplinary approach to the work up and management of pulmonary carcinoid tumors and DIPNECH: a narrative review

Transl Lung Cancer Res. 2022 Dec;11(12):2567-2587. doi: 10.21037/tlcr-22-415.

Authors

Robert A Ramirez¹, Amanda S Cass¹, Satya Das¹, See-Wei Low², Mitra Mehrad³, Otis B Rickman², Philip M Scherer⁴, Katharine E Thomas⁵, Erin A Gillaspie⁶

Affiliations

¹ Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
² Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
⁴ Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
⁵ Division of Hematology and Oncology, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
⁶ Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

Abstract

Background and objective: Low and intermediate grade neuroendocrine tumors of the lung are uncommon malignancies representing 2% of all lung cancers. These are termed typical and atypical pulmonary carcinoid tumors. These can arise in the setting of diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). The presentation, workup, management and outcomes of patients with these tumors can overlap with more common lung cancers but differ in that many of these patients have a prolonged clinical course. The objective of this narrative review is to summarize the literature and provide evidence and expert-based algorithms for work up and treatment of pulmonary carcinoids and DIPNECH.

Methods: A search of PubMed and Web of Science databases ending April 15, 2022, with the following keywords "lung carcinoid", "DIPNECH", "lung neuroendocrine," and "bronchopulmonary carcinoid".

Key content and findings: Pulmonary carcinoid tumors benefit from a multidisciplinary approach. Pre-treatment imaging with contrast-enhanced computed tomography, and DOTATATE positron emission tomography is required. Surgical resection is the gold standard for curative intent, and possibly including sublobar resections. Patients can recur or develop new primaries thus emphasizing the importance of surveillance; national guidelines recommend at least a 10-year follow up. A growing body of literature support the use of endobronchial therapy, with long responses documented. Systemic therapy consists of everolimus, somatostatin analogs, peptide receptor radionuclide therapy, and chemotherapy. Diffuse idiopathic pulmonary neuroendocrine tumor cell hyperplasia is rare, but series suggest somatostatin analogs may confer clinical benefit.

Conclusions: Pulmonary carcinoid tumors and DIPNECH are rare. Despite lack of regulatory approvals for advanced disease, multiple options are available but should be sequenced according to the clinical status and disease biology. Each patient should be discussed in a multidisciplinary setting and clinical trials should be considered if available.

Keywords: Lung carcinoid; bronchopulmonary, neuroendocrine; diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH).

Publication types

Review