1
|
Acher AW, Hallet J. Advances in Management of Nonfunctional Pancreas Neuroendocrine Tumors. Surg Clin North Am 2024; 104:1095-1111. [PMID: 39237166 DOI: 10.1016/j.suc.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
This article presents updates in the surgical management of non-functional sporadic pancreas neuroendocrine tumors NET, including considerations for assessment of biologic behavior to support decision-making, indications for surgery, and surgical approaches tailored to the unique nature of neuroendocrine tumors.
Collapse
Affiliation(s)
- Alexandra W Acher
- Department of Surgery, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5
| | - Julie Hallet
- Department of Surgery, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5; Susan Leslie Clinic for Neuroendocrine Tumors, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| |
Collapse
|
2
|
Fosse A, Hadoux J, Girot P, Beron A, Afchain P, Cottereau AS, Baudin E, Dierickx LO, Lecomte T, Perrier M, Lepage C, Bouhier-Leporrier K, Goichot B, Lachachi B, Walter T, Durand A. Peptide Receptor Radionuclide Therapy or Everolimus in Metastatic Neuroendocrine Tumors: The SeqEveRIV Study, a National Study from the French Group of Endocrine Tumors and Endocan-RENATEN Network. J Nucl Med 2024; 65:1416-1422. [PMID: 39089810 DOI: 10.2967/jnumed.123.267363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 06/05/2024] [Indexed: 08/04/2024] Open
Abstract
Everolimus and peptide receptor radionuclide therapy (PRRT, 177Lu-DOTATATE) are 2 treatments recommended in guidelines for gastroenteropancreatic metastatic neuroendocrine tumors. However, the best treatment sequence remains unknown. Methods: We designed a retrospective multicenter study that included patients from the national prospective database of the Groupe d'Étude des Tumeurs Endocrines who had been treated using everolimus and PRRT between April 2004 and October 2022. The primary aim was to compare the 2 treatments (everolimus and PRRT) in terms of efficacy and safety, and the secondary aim was to evaluate the sequences (PRRT followed by everolimus or everolimus followed by PRRT) based on overall progression-free survival (PFS) (PFS during first treatment + PFS during second treatment) in patients with metastatic neuroendocrine tumors. Results: Both treatments were used for 84 patients. The objective response rate and median PFS were 5 (6.0%) and 16.1 mo (95% CI, 11.5-20.7 mo), respectively, under everolimus and 19 (22.6%) and 24.5 mo (95% CI, 17.7-31.3 mo), respectively, for PRRT. The safety profile was also better for PRRT. Median overall PFS was 43.2 mo (95% CI, 33.7-52.7 mo) for the everolimus-PRRT sequence and 30.6 mo (95% CI, 17.8-43.4 mo) for the PRRT-everolimus sequence (hazard ratio, 0.69; 95% CI, 0.39-1.24; P = 0.22). Conclusion: PRRT was more effective and less toxic than everolimus. Overall PFS was similar between the 2 sequences, suggesting case-by-case discussion if the patient is eligible for both treatments, but PRRT should be used first when an objective response is needed or in frail populations.
Collapse
Affiliation(s)
- Aurelien Fosse
- Service d'Oncologie Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France;
| | - Julien Hadoux
- Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave-Roussy, Villejuif, France
| | - Paul Girot
- Service d'Hépatologie et Gastro-Entérologie, CH Loire Vendée Océan, La-Roche-Sur-Yon, France
| | - Amandine Beron
- Service de Médecine Nucléaire, Hôpital Claude Huriez, CHU Lille, Lille, France
| | - Pauline Afchain
- Service d'Oncologie Médicale, Hôpital Saint-Antoine, Paris, France
| | | | - Eric Baudin
- Service de Médecine Nucléaire et de Cancérologie Endocrinienne, Institut Gustave-Roussy, Villejuif, France
| | - Lawrence O Dierickx
- Service de Médecine Nucléaire, Institut Universitaire Cancer Toulouse Oncopole, Toulouse, France
| | - Thierry Lecomte
- Service d'Hépato-Gastro-Entérologie et de Cancérologie Digestive, CHU de Tours, Tours, France
| | - Marine Perrier
- Service d'Hépato-Gastro-Entérologie et de Cancérologie Digestive, CHU de Reims, Reims, France
| | - Come Lepage
- Service d'Hépato-Gastro-Entérologie et de Cancérologie Digestive, CHU Dijon Bourgogne, Dijon, France
| | | | - Bernard Goichot
- Service d'Endocrinologie, Diabétologie et Nutrition, CHU de Strasbourg, Strasbourg, France
| | - Boumediene Lachachi
- Service de Médecine Nucléaire, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France; and
| | - Thomas Walter
- Service d'Oncologie Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France;
- Gastroenterology and Technologies for Health, Research Unit, INSERM-UMR1052-CNRS-UMR-5286, Cancer Research Center of Lyon, Lyon, France
| | - Alice Durand
- Service d'Oncologie Médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
3
|
Panzuto F, Partelli S, Campana D, de Braud F, Spada F, Cives M, Tafuto S, Bertuzzi A, Gelsomino F, Bergamo F, Marcucci S, Mastrangelo L, Massironi S, Appetecchia M, Filice A, Badalamenti G, Bartolomei M, Amoroso V, Landoni L, Rodriquenz MG, Valente M, Colao A, Isidori A, Fanciulli G, Bollina R, Ciola M, Butturini G, Marconcini R, Arvat E, Cinieri S, Berardi R, Baldari S, Riccardi F, Spoto C, Giuffrida D, Gattuso D, Ferone D, Rinzivillo M, Bertani E, Versari A, Zerbi A, Lamberti G, Lauricella E, Pusceddu S, Fazio N, Dell'Unto E, Marini M, Falconi M. Epidemiology of gastroenteropancreatic neuroendocrine neoplasms: a review and protocol presentation for bridging tumor registry data with the Italian association for neuroendocrine tumors (Itanet) national database. Endocrine 2024; 84:42-47. [PMID: 38175391 PMCID: PMC10987336 DOI: 10.1007/s12020-023-03649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
Neuroendocrine neoplasms (NENs) are rare tumors with diverse clinical behaviors. Large databases like the Surveillance, Epidemiology, and End Results (SEER) program and national NEN registries have provided significant epidemiological knowledge, but they have limitations given the recent advancements in NEN diagnostics and treatments. For instance, newer imaging techniques and therapies have revolutionized NEN management, rendering older data less representative. Additionally, crucial parameters, like the Ki67 index, are missing from many databases. Acknowledging these gaps, the Italian Association for Neuroendocrine Tumors (Itanet) initiated a national multicenter prospective database in 2019, aiming to gather data on newly-diagnosed gastroenteropancreatic neuroendocrine (GEP) NENs. This observational study, coordinated by Itanet, includes patients from 37 Italian centers. The database, which is rigorously maintained and updated, focuses on diverse parameters including age, diagnostic techniques, tumor stage, treatments, and survival metrics. As of October 2023, data from 1,600 patients have been recorded, with an anticipation of reaching 3600 by the end of 2025. This study aims at understanding the epidemiology, clinical attributes, and treatment strategies for GEP-NENs in Italy, and to introduce the Itanet database project. Once comprehensive follow-up data will be acquired, the goal will be to discern predictors of treatment outcomes and disease prognosis. The Itanet database will offer an unparalleled, updated perspective on GEP-NENs, addressing the limitations of older databases and aiding in optimizing patient care. STUDY REGISTRATION: This protocol was registered in clinicaltriasl.gov (NCT04282083).
Collapse
Affiliation(s)
- Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy.
| | - Stefano Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Campana
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Filippo de Braud
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Milan, Italy
| | - Francesca Spada
- Gastrointestinal and Neuroendocrine Tumors Oncology Unit - ENETS Center of Excellence, European Institute of Oncology (IEO) - IRCCS, Milan, Italy
| | - Mauro Cives
- Dipartimento Interdisciplinare di Medicina, Università di Bari "Aldo Moro", Bari, Italy
| | - Salvatore Tafuto
- S.C. Sarcomi e Tumori Rari, Istituto Nazionale Tumori, I.R.C.C.S. - Fondazione "G. Pascale", ENETS Center of Excellence, Napoli, Italy
| | - Alexia Bertuzzi
- Sezione Sarcomi/NET e Oncologia del Giovane Adulto (AYA-Adolescent Young Adult) Humanitas Research Hospital-IRCCS Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Fabio Gelsomino
- Department of Oncology and Hematology, Division of Oncology, University Hospital of Modena, Modena, Italy
| | | | - Stefano Marcucci
- Department of Surgery & Hepato-Biliary and Pancreatic Unit Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Laura Mastrangelo
- UO Chirurgia Generale e d'Urgenza IRCCS Azienda Ospedaliera Universitaria Sant'Orsola Malpighi c/o Ospedale Maggiore, Bologna, Italy
| | - Sara Massironi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, and University of Milano-Bicocca, School of Medicine, Monza, Italy
| | - Marialuisa Appetecchia
- Oncological Endocrinology Unit, Regina Elena National Cancer Institutre - IFO IRCCS, Roma, Italy
| | - Angelina Filice
- Servizio di Medicina Nucleare, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Badalamenti
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Mirco Bartolomei
- Nuclear Medicine Unit, Azienda Ospedaliera Universitaria-Ferrara, Ferrara, Italy
| | - Vito Amoroso
- Medical Oncology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia at Spedali Civili Hospital, Brescia, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, ENETS Center of Excellence, Verona, Italy
| | - Maria Grazia Rodriquenz
- Oncology Unit - Ospedale IRCCS Casa Sollievo della Sofferenza - San Giovanni Rotondo, Foggia, Italy
| | - Monica Valente
- Center for Immuno-Oncology, Oncology Department, University Hospital of Siena, Siena, Italy
| | - Annamaria Colao
- Department of Endocrinology University of Naples, Azienda Ospedaliera Universitaria "Federico II", ENETS CEnter of Excellence, Napoli, Italy
| | - Andrea Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Fanciulli
- Endocrine Oncology Program, Endocrine Unit, University Hospital (AOU) of Sassari, Sassari, Italy
| | | | | | | | - Riccardo Marconcini
- Medical Oncology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences University of Turin, Turin, Italy
| | | | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti Delle Marche, Ancona, Italy
| | - Sergio Baldari
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Chiara Spoto
- Medical Oncology, Santa Maria Goretti Hospital, Latina, Italy
| | - Dario Giuffrida
- Medical Oncology Department, Istituto Oncologico del Mediterraneo, Viagrande, Catania, Italy
| | | | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine & Medical Specialties (DiMI), IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Maria Rinzivillo
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Emilio Bertani
- Digestive Surgery, European Institute of Oncology IRCCS, ENETS Center of Excellence, Milan, Italy
| | - Annibale Versari
- Servizio di Medicina Nucleare, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandro Zerbi
- Humanitas Research Hospital -IRCCS, Pancreatic Surgery Unit, Rozzano, and Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy
| | - Giuseppe Lamberti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum - University of Bologna, Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eleonora Lauricella
- Dipartimento Interdisciplinare di Medicina, Università di Bari "Aldo Moro", Bari, Italy
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, ENETS Center of Excellence, Milan, Italy
| | - Nicola Fazio
- Gastrointestinal and Neuroendocrine Tumors Oncology Unit - ENETS Center of Excellence, European Institute of Oncology (IEO) - IRCCS, Milan, Italy
| | - Elisabetta Dell'Unto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Marco Marini
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
4
|
Ünal Ç, Azizy A, Karabulut S, Taştekin D, Akyıldız A, Yaşar S, Yalçın Ş, Çoban E, Evrensel T, Kalkan Z, Oruç Z, Derin S, Turna ZH, Bayram D, Köş FT, Şendur MAN, Sever N, Ercelep Ö, Seyyar M, Kefeli U, Uygun K, Özçelik M, Ön S, Şanlı UA, Canaslan K, Ünek İT, Yücel KB, Özdemir N, Yazıcı O, Güzel HG, Salim DK, Göksu SS, Tatlı AM, Ordu Ç, Selvi O, Sakin A, Büyükbayram ME, Dursun B, Ürün Y, Arak H, Ağdaş G, Uğraklı M, Hendem E, Eryılmaz MK, Bilgin B, Topçu A, Şimşek M, Büyükşimşek M, Akay B, Erdal GŞ, Karataş F, Alan Ö, Çağlayan M, Kahvecioğlu FA, Demirci A, Paksoy N, Çetin B, Gümüş M, Ak N, Aydınalp Y, Paydaş S, Güven DC, Kılıçkap S, Sağlam S. Efficacy of Capecitabine and Temozolomide Regimen in Neuroendocrine Tumors: Data From the Turkish Oncology Group. Oncologist 2023; 28:875-884. [PMID: 37676712 PMCID: PMC10546829 DOI: 10.1093/oncolo/oyad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION This study aims to report the efficacy and safety of capecitabine plus temozolomide (CAPTEM) across different lines of treatment in patients with metastatic neuroendocrine tumors (NETs). METHODS We conducted a multicenter retrospective study analyzing the data of 308 patients with metastatic NETs treated with CAPTEM between 2010 and 2022 in 34 different hospitals across various regions of Turkey. RESULTS The median follow-up time was 41.0 months (range: 1.7-212.1), and the median age was 53 years (range: 22-79). Our results across the entire patient cohort showed a median progression-free survival (PFS) of 10.6 months and a median overall survival (OS) of 60.4 months. First-line CAPTEM treatment appeared more effective, with a median PFS of 16.1 months and a median OS of 105.8 months (median PFS 16.1, 7.9, and 9.6 months in first-, second- and ≥third-line respectively, P = .01; with median OS values of 105.8, 47.2, and 24.1 months, respectively, P = .003) In terms of ORR, the first-line treatment again performed better, resulting in an ORR of 54.7% compared to 33.3% and 30.0% in the second and third or higher lines, respectively (P < .001). Grade 3-4 side effects occurred only in 22.5% of the patients, leading to a discontinuation rate of 9.5%. Despite the differences in outcomes based on treatment line, we did not observe a significant difference in terms of side effects between the first and subsequent lines of treatment. CONCLUSIONS AND RELEVANCE The substantial superior outcomes in patients receiving first-line CAPTEM treatment highlight its potential as an effective treatment strategy for patients with metastatic NET.
Collapse
Affiliation(s)
- Çağlar Ünal
- Division of Medical Oncology, Department of Internal Medicine, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
| | - Abdulmunir Azizy
- Division of Medical Oncology, Department of Internal Medicine, İstanbul University Institute of Oncology, İstanbul, Turkey
| | - Senem Karabulut
- Division of Medical Oncology, Department of Internal Medicine, İstanbul University Institute of Oncology, İstanbul, Turkey
| | - Didem Taştekin
- Division of Medical Oncology, Department of Internal Medicine, İstanbul University Institute of Oncology, İstanbul, Turkey
| | - Arif Akyıldız
- Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Serkan Yaşar
- Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Şuayib Yalçın
- Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Eyüp Çoban
- Division of Medical Oncology, Department of Internal Medicine, Uludağ University Hospital, Bursa, Turkey
| | - Türkkan Evrensel
- Division of Medical Oncology, Department of Internal Medicine, Uludağ University Hospital, Bursa, Turkey
| | - Ziya Kalkan
- Division of Medical Oncology, Department of Internal Medicine, Dicle University Hospital, Diyarbakır, Turkey
| | - Zeynep Oruç
- Division of Medical Oncology, Department of Internal Medicine, Dicle University Hospital, Diyarbakır, Turkey
| | - Sümeyra Derin
- Division of Medical Oncology, Department of Internal Medicine, Cerrahpaşa University Hospital, İstanbul, Turkey
| | - Zeynep Hande Turna
- Division of Medical Oncology, Department of Internal Medicine, Cerrahpaşa University Hospital, İstanbul, Turkey
| | - Doğan Bayram
- Division of Medical Oncology, Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Fahriye Tuğba Köş
- Division of Medical Oncology, Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Mehmet Ali Nihat Şendur
- Division of Medical Oncology, Department of Internal Medicine, Ankara City Hospital, Ankara, Turkey
| | - Nadiye Sever
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Özlem Ercelep
- Division of Medical Oncology, Department of Internal Medicine, Marmara University Hospital, İstanbul, Turkey
| | - Mustafa Seyyar
- Division of Medical Oncology, Department of Internal Medicine, Kocaeli University Hospital, Kocaeli, Turkey
| | - Umut Kefeli
- Division of Medical Oncology, Department of Internal Medicine, Kocaeli University Hospital, Kocaeli, Turkey
| | - Kazım Uygun
- Division of Medical Oncology, Department of Internal Medicine, Kocaeli University Hospital, Kocaeli, Turkey
| | - Melike Özçelik
- Division of Medical Oncology, Department of Internal Medicine, Ümraniye Research and Training Hospital, İstanbul, Turkey
| | - Sercan Ön
- Division of Medical Oncology, Department of Internal Medicine, Ege University Hospital, İzmir, Turkey
| | - Ulus Ali Şanlı
- Division of Medical Oncology, Department of Internal Medicine, Ege University Hospital, İzmir, Turkey
| | - Kübra Canaslan
- Division of Medical Oncology, Department of Internal Medicine, Dokuz Eylül University Hospital, İzmir, Turkey
| | - İlkay Tuba Ünek
- Division of Medical Oncology, Department of Internal Medicine, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Kadriye Bir Yücel
- Division of Medical Oncology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
| | - Nuriye Özdemir
- Division of Medical Oncology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
| | - Ozan Yazıcı
- Division of Medical Oncology, Department of Internal Medicine, Gazi University Hospital, Ankara, Turkey
| | - Halil Göksel Güzel
- Division of Medical Oncology, Department of Internal Medicine, Antalya Research and Training Hospital, Antalya, Turkey
| | - Derya Kıvrak Salim
- Division of Medical Oncology, Department of Internal Medicine, Antalya Research and Training Hospital, Antalya, Turkey
| | - Sema Sezgin Göksu
- Division of Medical Oncology, Department of Internal Medicine, Akdeniz University Hospital, Antalya, Turkey
| | - Ali Murat Tatlı
- Division of Medical Oncology, Department of Internal Medicine, Akdeniz University Hospital, Antalya, Turkey
| | - Çetin Ordu
- Division of Medical Oncology, Department of Internal Medicine, Gayrettepe Florence Nightinagle Hospital, İstanbul, Turkey
| | - Oğuzhan Selvi
- Division of Medical Oncology, Department of Internal Medicine, Okmeydanı Research and Training Hospital, İstanbul, Turkey
| | - Abdullah Sakin
- Division of Medical Oncology, Department of Internal Medicine, Bahçelievler Medipol Hospital, İstanbul, Turkey
| | - Mehmet Emin Büyükbayram
- Division of Medical Oncology, Department of Internal Medicine, Ataturk University Hospital, Erzurum, Turkey
| | - Bengü Dursun
- Division of Medical Oncology, Department of Internal Medicine, Ankara University Hospital, Ankara, Turkey
| | - Yüksel Ürün
- Division of Medical Oncology, Department of Internal Medicine, Ankara University Hospital, Ankara, Turkey
| | - Hacı Arak
- Division of Medical Oncology, Department of Internal Medicine, Gaziantep University Hospital, Gaziantep, Turkey
| | - Gözde Ağdaş
- Division of Medical Oncology, Department of Internal Medicine, Osmangazi University Hospital, Eskişehir, Turkey
| | - Muzaffer Uğraklı
- Division of Medical Oncology, Department of Internal Medicine, Konya Meram University Hospital, Konya, Turkey
| | - Engin Hendem
- Division of Medical Oncology, Department of Internal Medicine, Konya Meram University Hospital, Konya, Turkey
| | - Melek Karakurt Eryılmaz
- Division of Medical Oncology, Department of Internal Medicine, Konya Meram University Hospital, Konya, Turkey
| | - Burak Bilgin
- Division of Medical Oncology, Department of Internal Medicine, Konya City Hospital, Konya, Turkey
| | - Atakan Topçu
- Division of Medical Oncology, Department of Internal Medicine, Bezmialem Vakıf University Hospital, İstanbul, Turkey
| | - Melih Şimşek
- Division of Medical Oncology, Department of Internal Medicine, Bezmialem Vakıf University Hospital, İstanbul, Turkey
| | - Mahmut Büyükşimşek
- Division of Medical Oncology, Department of Internal Medicine, Adana Research and Training Hospital, Adana, Turkey
| | - Büşra Akay
- Division of Medical Oncology, Department of Internal Medicine, Ankara Yurtaslan City Hospital, Ankara, Turkey
| | - Gülçin Şahingöz Erdal
- Division of Medical Oncology, Department of Internal Medicine, Bakırköy Sadi Konuk Research and Training Hospital, İstanbul, Turkey
| | - Fatih Karataş
- Division of Medical Oncology, Department of Internal Medicine, Karabük University Hospital, Karabük, Turkey
| | - Özkan Alan
- Division of Medical Oncology, Department of Internal Medicine, Koc University Hospital, İstanbul, Turkey
| | - Melek Çağlayan
- Division of Medical Oncology, Department of Internal Medicine, Konya Selçuk University Hospital, Konya, Turkey
| | - Fatma Akdağ Kahvecioğlu
- Division of Medical Oncology, Department of Internal Medicine, Sakarya Research and Training Hospital, Sakarya, Turkey
| | - Ayşe Demirci
- Division of Medical Oncology, Department of Internal Medicine, Sakarya Research and Training Hospital, Sakarya, Turkey
| | - Nail Paksoy
- Division of Medical Oncology, Department of Internal Medicine, Tekirdağ City Hospital, Tekirdağ, Turkey
| | - Bülent Çetin
- Division of Medical Oncology, Department of Internal Medicine, Ondokuz Mayıs University Hospital, Samsun, Turkey
| | - Mahmut Gümüş
- Division of Medical Oncology, Department of Internal Medicine, Göztepe Medeniyet University Hospital, İstanbul, Turkey
| | - Naziye Ak
- Division of Medical Oncology, Department of Internal Medicine, İstanbul Florence Nightinagle Hospital, İstanbul, Turkey
| | - Yasemin Aydınalp
- Division of Medical Oncology, Department of Internal Medicine, Adana Balcalı University Hospital, Adana, Turkey
| | - Semra Paydaş
- Division of Medical Oncology, Department of Internal Medicine, Adana Balcalı University Hospital, Adana, Turkey
| | - Deniz Can Güven
- Division of Medical Oncology, Department of Internal Medicine, Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Saadettin Kılıçkap
- Division of Medical Oncology, Department of Internal Medicine, Ankara Liv Hospital, Ankara, Turkey
| | - Sezer Sağlam
- Division of Medical Oncology, Department of Internal Medicine, Demiroglu Bilim University, İstanbul, Turkey
| |
Collapse
|
5
|
Grundmann N, Voigtländer S, Hakimhashemi A, Pape U, Meyer M, Müller‐Nordhorn J. Site-specific trends in gastroenteropancreatic neuroendocrine neoplasms in Bavaria, Germany. Cancer Med 2023; 12:19949-19958. [PMID: 37737059 PMCID: PMC10587981 DOI: 10.1002/cam4.6510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/20/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Neuroendocrine neoplasms (NEN) are rare and heterogeneous epithelial tumors, occurring throughout the body. For gastroenteropancreatic (GEP)-NEN, rising incidence rates were reported for the last decades, with underlying causes remaining largely unexplained. We evaluated NEN trends stratifying by their histologic subtypes. METHODS Incident cases of GEP-NEN diagnosed between 2005 and 2019 were retrieved from the prospective, population-based Bavarian Cancer Registry. GEP-NEN were divided in their histologic subtypes, that is, neuroendocrine tumors (NET) G1, NET G2/G3, other NET versus small-cell neuroendocrine carcinoma (NEC), large-cell NEC, and other NEC. We calculated annual age-standardized incidence rates (ASIRs) per 100,000 persons for the total of GEP-NEN, NEN histologic subtypes, and tumor sites. We used an annual percentage change (APC) approach including a joinpoint analysis to investigate NEN incidence trends. RESULTS ASIR of GEP-NEN rose from 2.2 in 2005 to 4.8 in 2019, characterized by a significant increase until 2012 (APC 2005-2012: 10.1%), followed by modest rise (APC 2012-2019: 1.5%). In the last decade, this increase was mainly driven by the rise of NET G1 and G2/G3, while incidence for NEC declined. Over the study period, ASIR increased significantly for all GEP-sites except the colon. APCs were largest for the stomach, the appendix, the pancreas, and the rectum. CONCLUSIONS This study found a significant increase in the incidence of GEP-NET. Though this development may partially be attributable to the increased use of advanced detection techniques and changes in NEN classification, further research should also focus on the identification of NEN risk factors.
Collapse
Affiliation(s)
- Nina Grundmann
- Bavarian Cancer Registry, Bavarian Health and Food Safety AuthorityNurembergGermany
| | - Sven Voigtländer
- Bavarian Cancer Registry, Bavarian Health and Food Safety AuthorityNurembergGermany
| | - Amir Hakimhashemi
- Bavarian Cancer Registry, Bavarian Health and Food Safety AuthorityNurembergGermany
| | - Ulrich‐Frank Pape
- Department of Internal Medicine and Gastroenterology, Asklepios Tumour Centre Hamburg and Asklepios Hospital St. GeorgHamburgGermany
| | - Martin Meyer
- Bavarian Cancer Registry, Bavarian Health and Food Safety AuthorityNurembergGermany
| | | |
Collapse
|
6
|
Søreide K, Hallet J, Jamieson NB, Stättner S. Optimal surgical approach for digestive neuroendocrine neoplasia primaries: Oncological benefits versus short and long-term complications. Best Pract Res Clin Endocrinol Metab 2023; 37:101786. [PMID: 37328324 DOI: 10.1016/j.beem.2023.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The rising incidence and the accumulating prevalence of neuroendocrine neoplasia (NEN) in the population makes this a common, prevalent and a clinically relevant disease group. Surgical resection represents the only potentially curative treatment for digestive NENs. Thus, resection should in principle be considered for all patients with NEN, although taking the patients age, relevant comorbidity, and performance status into account for operability. Patients with insulinomas, NEN of the appendix and rectal NENs are usually cured by surgery alone. However, less than a third of patients are amendable to curative surgery alone at time of diagnosis. Furthermore, recurrence is common and may occur years after primary surgery, hence the long follow-up time recommended in most NENs (>10 years). As many patients with NENs present with locoregional or metastatic disease, there is considerable debate regarding the role of debulking surgery in these settings. However, good long-term survival can be achieved in a considerable proportion of patients, with 50-70% alive up to 10 years after surgery. Location and grade are the main determinants of long-term survival. Here we present considerations to surgery for primary neuroendocrine tumors in the digestive tract.
Collapse
Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Gastrointestinal Translational Research Group, Laboratory for Molecular Medicine, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Susan Leslie Clinic for Neuroendocrine Tumors - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nigel B Jamieson
- Wolfson Wohl Cancer Research Centre, School of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Vöcklabruck, Austria
| |
Collapse
|
7
|
de Mestier L, Resche-Rigon M, Dromain C, Lamarca A, La Salvia A, de Baker L, Fehrenbach U, Pusceddu S, Colao A, Borbath I, de Haas R, Rinzivillo M, Zerbi A, Funicelli L, de Herder WW, Selberherr A, Wagner AD, Manoharan P, De Cima A, Lybaert W, Jann H, Prinzi N, Faggiano A, Annet L, Walenkamp A, Panzuto F, Pedicini V, Pitoni MG, Siebenhuener A, Mayerhoefer ME, Ruszniewski P, Vullierme MP. Proposal of early CT morphological criteria for response of liver metastases to systemic treatments in gastroenteropancreatic neuroendocrine tumors: Alternatives to RECIST. J Neuroendocrinol 2023; 35:e13311. [PMID: 37345276 DOI: 10.1111/jne.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 06/23/2023]
Abstract
RECIST 1.1 criteria are commonly used with computed tomography (CT) to evaluate the efficacy of systemic treatments in patients with neuroendocrine tumors (NETs) and liver metastases (LMs), but their relevance is questioned in this setting. We aimed to explore alternative criteria using different numbers of measured LMs and thresholds of size and density variation. We retrospectively studied patients with advanced pancreatic or small intestine NETs with LMs, treated with systemic treatment in the first-and/or second-line, without early progression, in 14 European expert centers. We compared time to treatment failure (TTF) between responders and non-responders according to various criteria defined by 0%, 10%, 20% or 30% decrease in the sum of LM size, and/or by 10%, 15% or 20% decrease in LM density, measured on two, three or five LMs, on baseline (≤1 month before treatment initiation) and first revaluation (≤6 months) contrast-enhanced CT scans. Multivariable Cox proportional hazard models were performed to adjust the association between response criteria and TTF on prognostic factors. We included 129 systemic treatments (long-acting somatostatin analogs 41.9%, chemotherapy 26.4%, targeted therapies 31.8%), administered as first-line (53.5%) or second-line therapies (46.5%) in 91 patients. A decrease ≥10% in the size of three LMs was the response criterion that best predicted prolonged TTF, with significance at multivariable analysis (HR 1.90; 95% CI: 1.06-3.40; p = .03). Conversely, response defined by RECIST 1.1 did not predict prolonged TTF (p = .91), and neither did criteria based on changes in LM density. A ≥10% decrease in size of three LMs could be a more clinically relevant criterion than the current 30% threshold utilized by RECIST 1.1 for the evaluation of treatment efficacy in patients with advanced NETs. Its implementation in clinical trials is mandatory for prospective validation. Criteria based on changes in LM density were not predictive of treatment efficacy. CLINICAL TRIAL REGISTRATION: Registered at CNIL-CERB, Assistance publique hopitaux de Paris as "E-NETNET-L-E-CT" July 2018. No number was assigned. Approved by the Medical Ethics Review Board of University Medical Center Groningen.
Collapse
Affiliation(s)
- Louis de Mestier
- Department of Pancreatology and Digestive Oncology, Université Paris-Cité, INSERM U1149, Beaujon University Hospital, Clichy, France
| | - Matthieu Resche-Rigon
- Department of Epidemiology and Biostatistics, Université Paris-Cité, Saint-Louis Hospital, Paris, France
| | - Clarisse Dromain
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Angela Lamarca
- Department of Medical Oncology, The Christie Hospital, Manchester, UK
| | - Anna La Salvia
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lesley de Baker
- Department of Radiology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sara Pusceddu
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Università Federico II di Napoli, Naples, Italy
- Endocrinology Unit, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea Hospital, ENETS Center of Excellence, Rome, Italy
| | - Ivan Borbath
- Department of Hepatology and Gastroenterology, University Hospital St Luc/UCLouvain, Woluwe, Belgium
| | - Robbert de Haas
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Rinzivillo
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
| | - Alessandro Zerbi
- Pancreatic Surgery, Humanitas Clinical and Research Center, Rozzano-, Milano, Italy
| | - Luigi Funicelli
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Wouter W de Herder
- Department of Internal Medicine, Erasmus MC and Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Andreas Selberherr
- Division of General Surgery, Department of Surgery, Medical University, Vienna, Austria
- Department of General and Visceral Surgery, Evangelisches Krankenhaus Wien, Vienna, Austria
| | - Anna Dorothea Wagner
- Department of Medical Oncology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Prakash Manoharan
- Department of Radiology and Nuclear Medicine, The Christie, Manchester, UK
| | - Andrea De Cima
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Willem Lybaert
- Department of Medical Oncology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Henning Jann
- Department of Hepatology and Gastroenterology, Charité-University, Charité-Universitätsmedizin, Berlin, Germany
| | - Natalie Prinzi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Antongiulio Faggiano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, Università Federico II di Napoli, Naples, Italy
| | - Laurence Annet
- Department of Radiology, Cliniques Universitaires Saint-Luc/UCLouvain, Brussels, Belgium
| | - Annemiek Walenkamp
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Francesco Panzuto
- Digestive Disease Unit, Sant'Andrea University Hospital, ENETS Center of Excellence, Rome, Italy
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, ENETS Center of Excellence, Rome, Italy
| | - Vittorio Pedicini
- Department of Radiology, Humanitas Clinical and Research Center, Rozzano-Milano, Italy
| | | | - Alexander Siebenhuener
- Department of Gastroenterology and Hepatology, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Marius E Mayerhoefer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Philippe Ruszniewski
- Department of Pancreatology and Digestive Oncology, Université Paris-Cité, INSERM U1149, Beaujon University Hospital, Clichy, France
| | | |
Collapse
|
8
|
Massironi S, Gallo C, Laffusa A, Ciuffini C, Conti CB, Barbaro F, Boskoski I, Dinelli ME, Invernizzi P. Endoscopic techniques for gastric neuroendocrine tumors: An update. World J Gastrointest Endosc 2023; 15:103-113. [PMID: 37034968 PMCID: PMC10080559 DOI: 10.4253/wjge.v15.i3.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/11/2023] [Accepted: 02/08/2023] [Indexed: 03/16/2023] Open
Abstract
Gastric neuroendocrine neoplasms (gNENs) are a rare type of gastric neoplasm, even if their frequency is increasing according to the latest epidemiologic revisions of the main registries worldwide. They are divided into three main subtypes, with different pathogeneses, biological behaviors, and clinical characteristics. GNEN heterogeneity poses challenges, therefore these neoplasms require different management strategies. Update the knowledge on the endoscopic treatment options to manage g-NENs. This manuscript is a narrative review of the literature. In recent years, many advances have been made not only in the knowledge of both the pathogenesis and the molecular profiling of gNENs but also in the endoscopic expertise towards innovative treatment options, which proved to be less aggressive without losing the capability of being radical. The endoscopic approach is increasingly applied in the field of gastrointestinal (GI) luminal neoplasms, and this is true not only for adenocarcinomas but also for gNENs. In particular, different techniques have been described for the endoscopic removal of suspected lesions, ranging from classical polypectomy (cold or hot snare) to endoscopic mucosal resection (both with “en bloc” or piecemeal technique), endoscopic submucosal dissection, and endoscopic full-thickness resection. GNENs comprise different subtypes of neoplasms with distinct management and prognosis. New endoscopic techniques offer a wide variety of approaches for GI localized neoplasms, which demonstrated to be appropriate and effective also in the case of gNENs. Correct evaluation of size, site, morphology, and clinical context allows the choice of tailored therapy in order to guarantee a definitive treatment.
Collapse
Affiliation(s)
- Sara Massironi
- Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB) 20900, Italy
| | - Camilla Gallo
- Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB) 20900, Italy
| | - Alice Laffusa
- Interventional Endoscopy Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB) 20900, Italy
| | - Cristina Ciuffini
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Roma 00168, Italy
| | - Clara Benedetta Conti
- Interventional Endoscopy Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB) 20900, Italy
| | - Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Roma 00168, Italy
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore di Roma, Center for Endoscopic Research Therapeutics and Training (CERTT), Roma 00168, Italy
| | - Marco Emilio Dinelli
- Interventional Endoscopy Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB) 20900, Italy
| | - Pietro Invernizzi
- Gastroenterology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza (MB) 20900, Italy
| |
Collapse
|
9
|
Perrier M, Scoazec JY, Walter T. A practical proposal on treatment sequencing of metastatic well-differentiated neuroendocrine tumours. Ther Adv Med Oncol 2023; 15:17588359231171041. [PMID: 37152421 PMCID: PMC10155015 DOI: 10.1177/17588359231171041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
According to the neuroendocrine tumour (NET) characteristics, 3 to 7 different treatment options are available, corresponding to 6 to 5,040 theoretical different sequences. Even though each patient is unique and despite a large heterogeneity in NET characteristics, the present review aims to discuss the main sequences and addresses how one can propose the best sequence to treat metastatic NET (mNET) on a case-by-case basis. Each treatment must be discussed during dedicated multi-disciplinary meetings, and inclusions in clinical trials should be favoured. After a thorough characterization of patients and their mNET, and taking into account the availability of drugs, the first-line treatment should be chosen according to the treatment aim. The latter is determined based on three main topics (efficacy, safety, and patient preferences) that do not necessarily converge and must be defined a priori. At baseline, physicians should design an a priori full therapeutic sequence, which may evolve at each step depending on the response to previous treatment, the occurrence of chronic toxicities, and the patients' perception of the prior treatment. To improve knowledge in terms of effectiveness and risk of cumulative toxicities regarding the different sequences, real-world data using long follow-up durations are necessary; such issues will not be resolved by randomized clinical trials.
Collapse
Affiliation(s)
- Marine Perrier
- Université Reims Champagne-Ardenne, Department
of Gastroenterology and Digestive Oncology, Reims University Hospital,
Reims, France
| | - Jean-Yves Scoazec
- Department of Surgical and Molecular Pathology,
Gustave Roussy, Villejuif, France
| | | |
Collapse
|
10
|
Surgery, Liver Directed Therapy and Peptide Receptor Radionuclide Therapy for Pancreatic Neuroendocrine Tumor Liver Metastases. Cancers (Basel) 2022; 14:cancers14205103. [PMID: 36291892 PMCID: PMC9599940 DOI: 10.3390/cancers14205103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/19/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Pancreatic neuroendocrine tumors (PNETs) are described by the World Health Organization (WHO) classification by grade (1–3) and degree of differentiation. Grade 1 and 2; well differentiated PNETs are often characterized as relatively “indolent” tumors for which locoregional therapies have been shown to be effective for palliation of symptom control and prolongation of survival even in the setting of advanced disease. The treatment of liver metastases includes surgical and non-surgical modalities with varying degrees of invasiveness; efficacy; and risk. Most of these modalities have not been prospectively compared. This paper reviews literature that has been published on treatment of pancreatic neuroendocrine liver metastases using surgery; liver directed embolization and peptide receptor radionuclide therapy (PRRT). Surgery is associated with the longest survival in patients with resectable disease burden. Liver-directed (hepatic artery) therapies can sometimes convert patients with borderline disease into candidates for surgery. Among the three embolization modalities; the preponderance of data suggests chemoembolization offers superior radiographic response compared to bland embolization and radioembolization; but all have similar survival. PRRT was initially approved as salvage therapy in patients with advanced disease that was not amenable to resection or embolization; though the role of PRRT is evolving rapidly
Collapse
|