Objective response of malignant carcinoid to radiation therapy.

Abrams RA, King D, Wilson JF.  Int J Radiat Oncol Biol Phys 1987 Jun;13(6):869-73

In a retrospective review, we were able to identify records for 18 patients who were treated for malignant carcinoid in our Departments of Radiation Oncology from 1974-1985. At postmortem examination, one was found not to have malignant carcinoid. In 4 cases irradiation was administered postoperatively to patients whose subsequent courses did not permit assessment of objective response. Using standard criteria for objective response, an objective response rate of 54% was observed in the 13 cases whose records were adequate to make this assessment. Of the 7 responses, 3 were complete within the treated field as judged by clinical findings (2 patients) or postmortem examination (1 patient). Of the 6 nonresponders, 2 interrupted treatment prematurely, 2 were treated to a planned dose of only 2000 and 2500 cGy, and 2 were treated palliatively to limited ports which included only partial volumes of tumor. We conclude that radiation therapy is an effective treatment modality with a high rate of objective response in the management of those patients with malignant carcinoid tumors who require non-surgical, anti-neoplastic therapy.

Radiation therapy in the management of patients with malignant carcinoid tumors.

Chakravarthy A, Abrams RA.   Cancer 1995 Mar 15;75(6):1386-90

Johns Hopkins Oncology Center, Division of Radiation Oncology, Baltimore, MD 21287-8922.

BACKGROUND. The purpose of this study was to analyze the effectiveness of radiotherapy for symptomatic, metastatic, and/or unresectable carcinoid tumors. METHODS. From 1975 to 1991, 18 patients with histologically proven carcinoid tumors, including 7 with symptomatic hepatic involvement, received radiotherapy to a total of 31 anatomic sites of metastatic or unresectable carcinoid tumors. Symptomatic response to treatment, date of symptomatic or radiographic progression, and survival after diagnosis and completion of radiotherapy were determined. Clinical improvement was defined as symptomatic relief and/or objective reduction in size of tumor mass sustained for at least 4 weeks. RESULTS. After radiotherapy of 31 sites in 18 patients, 3 patients died in less than 3 months. Of the remaining 15 patients, survival from initial radiotherapy ranged from 8 to 108 months (median, 23 months), and 8 (53%) died without symptomatic progression in the treated region. Clinical improvement occurred in 27/31 sites (87%). Acute side effects were mild, and no late side effects were recorded. Median survivals from diagnosis were: 39 months for patients with primary tumors of the lung, 33 months for patients with brain metastases, and 32 months for patients with hepatic involvement. Patients with the carcinoid syndrome responded in 19/22 sites (86%) compared with 8/9 sites (89%) for patients without the syndrome (P = not significant). CONCLUSIONS. Radiation therapy can achieve symptomatic palliation for patients with metastatic/unresectable malignant carcinoid tumors, and it is well tolerated. Clinical improvement occurs after irradiation in patients with or without the carcinoid syndrome.

Evaluation of the response of unresectable carcinoid tumors to radiotherapy.

Samlowski WE, Eyre HJ, Sause WT.  Int J Radiat Oncol Biol Phys 1986 Mar;12(3):301-5

Sixteen patients with unresectable primary or metastatic carcinoid tumors were treated with radiotherapy. Objective responses (CR + PR) were documented in 4 of 16 patients (25%). The median survival of the responders was 46 months following radiotherapy, as compared to the 10-month median survival of the entire group of 16 patients. There were five additional patients who improved symptomatically or had minor responses. The seven patients who received the highest doses of radiotherapy (greater than 29 GY), to local or regional treatment ports, had the best response rate (43%). Many patients eventually had objective evidence of relapse or tumor progression within the radiotherapy port, in part reflecting the relatively low radiotherapy doses used in the treatment of the nine patients with abdominal carcinoids. One patient remains disease free at 103 months. Patients who exhibited the carcinoid syndrome appeared to respond less frequently to radiotherapy than patients who did not have ectopic hormone secretion, although the number of patients with ectopic hormone secretion was too small to establish this point in a definitive manner. The results of this study demonstrate that carcinoid tumors respond to moderate doses of radiotherapy in a manner similar to many other epithelial tumors.

The role of radiation therapy in the treatment of locally unresectable or metastatic carcinoid tumors.

Schupak KD, Wallner KE.  Int J Radiat Oncol Biol Phys 1991 Mar;20(3):489-95

Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

Forty-four patients irradiated for metastatic or unresectable carcinoid tumors at Memorial Sloan-Kettering Cancer Center from 1950 to 1986 were studied. The response to radiation was analyzed at four sites: epidural space (11 pts), brain (8 pts), bone (8 pts), and abdominal (17 pts). Although survival was generally poor, substantial palliation was achieved in most cases. No patient with brain metastases had progression of intracranial disease after radiation therapy (median dose: 3300 cGy); all died of progression of systemic metastases (median survival: 4 months). Infield control following radiation therapy for epidural and osseous metastases was achieved in 77% and 78% of sites, respectively, with median doses of 3000 cGy and 4000 cGy. Median survival for epidural and bone metastases was 11 and 13 months, respectively. In-field control was obtained in 62% of patients with intraabdominal disease (median dose: 2700 cGy). Among the subset of seven patients who were irradiated at ten sites of unresectable abdominal (non-hepatic) disease, the median survival was 23 months with 80% achieving a complete or partial response and 50% maintaining permanent in-field control. No dose-response relationship was demonstrated. Radiation therapy can achieve local control and symptomatic palliation in most patients with metastatic carcinoid tumors. Our current recommendation would be to treat non-hepatic sites with 4500-5000 cGy in 4-5 weeks. More rapid fractionation schemes could be used for patients with limited life expectancies.