Witaj Gustofka,
Niestety LCNEC to rzadka i agresywna postac raka pluc
Lektura:
http://www.medscape.com/viewarticle/550291_8
(...)
stage-for-stage survival is worse for LCNEC than for NSCLC. In efforts to improve cure rates of LCNEC, postoperative adjuvant chemotherapy or radiotherapy has been used in several series of this dis-ease.[4,13,19,29,30] Unfortunately, a definitive survival advantage for postoperative adjuvant therapy has yet to be reported in these patients.
One series from Iyoda et al [31] did find a survival benefit to adjuvant chemotherapy in a small subgroup of 5 patients with stage I disease treated with cisplatin, carboplatin, or cyclophosphamide. As a result of the small numbers in each study and the relative infrequency of LCNEC, no standard adjuvant therapy regimen has been developed. It has previously been suspected that LCNEC tumors are resistant to conventional chemotherapeutic agents. A majority of lung neoplasms with neuroendocrine markers were found to express the multidrug resistance gene (MDR1), a harbinger of resistance to chemotherapy, in a study reported by Lai et al. [32]
The somatostatin analog octreotide represents a potential novel adjuvant biologic therapy. It has been shown to control metastatic growth while being well tolerated in the treatment of other neuroendocrine tumors.[24,33] The role of adjuvant therapy for early-stage LCNEC or mixed LCNEC should be examined in large-center prospective, randomized trials.
http://www.dovepress.com/...ed-article-DDDT
Abstract: Large-cell neuroendocrine carcinoma (LCNEC) is a relatively uncommon variant of non-small cell lung cancer. Since the biological characteristics of LCNEC are similar to those of small cell lung cancer, LCNEC is usually treated with chemotherapy regimens used for small cell lung cancer. However, the outcomes are usually dismal.
http://priory.com/med/Largecell.pdf
Discussion
Primary tumors exhibiting neuroendocrine differentiation are frequently
encountered by clinicians. A wide range of clinical manifestation occur with these
tumors, from the extremely virulent small cell anaplastic carcinomas to the indolent
clinical course of bronchial carcinoid tumors. These tumors exhibit certain morphologic
and immunocytochemical characteristics, which allow them to be included as members of
the amine precursors uptake and decarboxylation system, or dispersed neuroendocrine
system. Such tumors are distinguished ultra structurally by the presence of variable
numbers of dense core neuorsecretory granules and immonocytochemically by the
production of small poly peptides2,3.
The classification of pulmonary neuroendocrine tumors of the lung has evolved
significantly over the past several years. Initially, only two major categories of
pulmonary neuroendocrine tumors were recognized: the carcinoid and small cell lung
carcinoma. Arrigoni et. al.4, was the first to describe the criteria for the atypical carcinoid
tumor. Neuroendocrine tumors of the lungs have frequently been classified into three
categories: typical carcinoid, atypical carcinoid, and small cell carcinoma5. In 1991,
Travis et. al. 6, utilizing electron microscopy reported a category of neuroendocrine tumor
known as a large cell neuroendocrine carcinoma for the higher grade non-small cell
carcinoma tumors, to be distinguished from large cell carcinoma with neuroendocrine
features.
Overall, statistically significantly survival data for these patients with large cell
neuroendocrine carcinomas must await accumulation of a larger series of patients7.
However, these tumors appear to be uncommon as only fifteen cases were collected by
Volmer8,in twenty years. The data from Travis et. al. 6, suggest that the survival of the
patients is intermediate between that observed in patients with atypical carcinoid and the
small cell lung carcinoma. Travis et. al. 6, used ancillary techniques of
immunohistochemistry, electron microscopy, and DNA analysis, and found no advantage
in comparison with the conventional histological features in terms of prediction of
prognosis of this large cell pulmonary endocrine tumor.
The vast majority of large cell endocrine carcinomas of the lung are central, but
they also may be peripheral. The mass is circumscribed and nodular and composed of
large polygonal cells, having low nuclear/cytoplasmic ratio, coarse or vesicular nuclear
chromatin, frequent nucleoli, high mitotic rate and frequent foci of necrosis. If
Immunohistochemical studies or electron microscopy are not available, by light
microscope, alone the tumor may be confused with a large cell carcinoma. The result of
Immunohistochemical findings in a series of thirty –five cases were positive as follows:
neuron specific enolase ( 100% ), chromogranin ( 80% ), Leu-7 ( 40% ), and
synaptophysin ( 40% )6.This is an aggressive neoplasm with prognosis approaching that
observed in small cell carcinoma.
http://www.ncbi.nlm.nih.gov/pubmed/19659656
http://cat.inist.fr/?aMod...&cpsidt=1031404
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