Introduction: Non-metastatic digestive carcinoid tumors are treated surgically, allowing in most cases recovery. In patients with metastasis and intestinal primary tumor, resection of the latter is proposed to avoid occlusion.
Current knowledge and key points: Cytoreductive surgery of liver metastasis should be both contemplated and discussed if 80 to 90% of the tumor can be resected. In all other patients, intravenous chemotherapy or hepatic arterial chemoembolization should be discussed if metastases are located mainly in the liver. Response rates related to both treatments reach 30% and 50-80%, respectively, without clearly proven benefit in regard to survival. However, carcinoid tumors are often slowly progressive and symptomatic treatment of the carcinoid syndrome is a major concern. Long-acting somatostatin analogs, particularly slow-release formulations, have greatly improved patients' management. Diarrhea and flushing are controlled by long-term treatment involving either octreotide or lanreotide, a recently available somatostatin analog with slow release, without major side-effects even at high dosages.
Perspectives: Randomized studies currently in progress are aimed at comparing these various therapeutic modalities.