Metastatic carcinoid tumor: changing patterns of care over two decades. 
Metastatic carcinoid tumors (MCTs), an important subgroup of neuroendocrine tumors, occur infrequently and often have an indolent course, limiting data on long-term treatment outcomes.  We aimed to assess treatment trends at a single center over time and the impact on the outcome.  Patients diagnosed with carcinoid tumors in the North West Adelaide Health Service between January 1, 1985 and March 1, 2007 were identified from the South Australian Cancer Registry.  We identified 92 patients with carcinoid tumors; 49 had MCT.  Although treatment options increased over time, the most significant change was to access octreotide therapy, with 24 receiving long-acting somatostatin analogs.  Survival improved over time and the median overall survival for patients receiving long-acting somatostatin analogs was 112 months compared with 53 months for those who did not (P=0.021, hazard ratio: 2.46).  Ten year survival was 40% and 22%, respectively.  About 75% of evaluable patients had a biochemical response to initial therapy and a measurable response occurred in 3 of 24 (13%) patients.  This single center experience has provided insight into current treatment options for MCT, and suggests the use of long-acting somatostatin analogs may impact on disease control and survival.  However, the uptake of other treatment options seems limited and there is a need for agents that target tumor progression.