Management of unresectable malignant endocrine tumors of the pancreas.

Abstract

Malignant endocrine tumors of the pancreas are a heterogenous group of tumors with a multipotential secretory capacity. The lesions are generally slow growing with a relatively long life expectancy from the time of diagnosis. Death results from a combination of local and metastatic disease and the sequelae of excess hormone secretion. While potentially successful curative resections are rare, long term survival is frequently possible based on the rate of growth and the inhibition of the bioactive effects of the secretory products of the tumor. Regional control with palliative surgical debulking and transcatheter arterial embolization of hepatic metastases has an important role in terms of symptomatic relief and long term survival. These tumors respond frequently to chemotherapy. Combination chemotherapy is more effective than single agent treatment. Preliminary information suggests that leukocyte interferon is useful in treatment, but this agent still requires careful prospective evaluation. While current data do not support the use of octreotide for an antitumor effect, it is capable of producing prompt and substantial symptomatic relief with minimal side effects in a large proportion of patients with functional malignant endocrine tumors of the pancreas. Many advances have been made in the recognition, diagnosis and management of patients with malignant endocrine tumors of the pancreas. Additional basic cellular research is necessary to define the molecular and cell biologic factors of these tumor cells. Particular facets that require further understanding include their basic cytogenetic abnormality, regulation of peptide production and the role of peptides and other growth factors in endocrine, paracrine and autocrine regulatory relationships. The answers to these questions will hopefully promulgate the discovery of improved cytotoxic agents, better peptide pharmacotherapeutic agents and improve the overall management of patients with unresectable malignant endocrine tumors of the pancreas.