NANETS Treatment Guidelines Well-Differentiated Neuroendocrine Tumors of the Stomach and Pancreas

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston MA 02115, USA.
Pancreas (Impact Factor: 2.96). 08/2010; 39(6):735-52. DOI: 10.1097/MPA.0b013e3181ebb168
Source: PubMed


Well-differentiated neuroendocrine tumors (NETs) of the stomach and pancreas represent 2 major subtypes of gastrointestinal NETs. Historically, there has been little consensus on the classification and management of patients with these tumor subtypes. We provide an overview of well-differentiated NETs of the stomach and pancreas and describe consensus guidelines for the treatment of patients with these malignancies.

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    • "Dans la plupart des séries de carcinomes neuroendocrines bien différenciés, la survie à 5 ans des patients opérés (donc sélectionnés car candidats à la chirurgie) est supérieure à 70 %. Les recommandations américaines discutent la transplantation hépatique chez les sujets jeunes, non contrôlés sur le plan sécrétoire et ayant une extension tumorale hépatique exclusive [5]. Hors métastases hépatiques, la chirurgie palliative s'applique aux métastases ganglionnaires abdominales, péritonéales et osseuses en cas de risque neurologique. "
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    La Presse Médicale 05/2014; 43(6). DOI:10.1016/j.lpm.2013.08.007 · 1.08 Impact Factor
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    • "Alacsony proliferációs index esetén kemoterápiától nem várhatunk érdemi daganatellenes hatást [30]. Kemoterápia javasolható , ha 1. a szomatosztatinanalóg, illetve interferonkezelés (már) nem eredményes, 2. a daganat gyorsan növekszik, 3. nagy a tumortömeg, és a beteg ezzel összefüggésbe hozhatóan panaszos, 4. a klinikai jelek rossz prognózist sugallnak (csont-, illetve egyéb extrahepaticus áttétek mutathatók ki) [9] [12] [31] [32], továbbá, ha 5. a Ki-67-index >10% [33]. Kemoterápia indokolt továbbá minden neuroendokrin carcinomás (G3) beteg esetében, az első választandó kezelés a ciszplatin-etopozid kombináció [12]. "
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    ABSTRACT: The author aims to review the established medical treatment options of neuroendocrine tumours, which have expanded greatly in recent years and present the most important aspects to be considered in planning patients' management. Medical treatment is usually considered in advanced stages of these tumours, as well as in cases of hormone overproduction. Somatostatin analogues have been known to be effective in alleviating hormone excess syndromes, especially carcinoid syndrome for the past 25 years. There is a convincing evidence that the somatostatin analogue octreotide is useful as an antitumor agent, at least in well-differentiated small intestinal neuroendocrine tumours and probably also in those of pancreatic origin. Interferons may be also used and the indications for their use may be almost the same. Optimal patient selection is mandatory for the use of cytotoxic chemotherapy. Streptozotocin- and, recently, temozolomide-based chemotherapies should be considered in progressive phases of well differentiated (G1/G2) pancreatic neuroendocrine tumours. A cisplatin-etoposide combination is the first choice for the treatment of G3 neuroendocrine carcinomas of any origin. Recently, the mammalian target of rapamycin inhibitor everolimus and the combined tyrosine kinase inhibitor sunitinib were registered for the treatment of G1/G2 pancreatic neuroendocrine tumours. The most recent drug treatment recommendations and therapeutic algorithms to improve systemic therapy in patients with neuroendocrine tumours are summarized and novel drug candidates with particular potential for future management of these tumours are outlined. Orv. Hetil., 2013, 154, 1556-1564.
    Orvosi Hetilap 09/2013; 154(39):1556-64. DOI:10.1556/OH.2013.29718
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    • "Long-term follow-up of patients having undergone surgical treatment for nonfunctioning PNETs is essential as there is a risk of late recurrence [34]. There have recently been published several international consensus guidelines on the management of patients with PNETs [113–116], which also include guidelines on follow-up of patients with functioning PNETs [113], nonfunctioning PNETs [114] and NECs [48]. The follow-up of patients with PNETs should be managed by specialized centers with a multidisciplinary approach [16, 57, 72, 117, 118]. "
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    ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. They are clinically diverse and divided into functioning and nonfunctioning disease, depending on their ability to produce symptoms due to hormone production. Surgical resection is the only curative treatment and remains the cornerstone therapy for this patient group, even in patients with advanced disease. Over the last decade there has been a noticeable trend towards more aggressive surgery as well as more minimally invasive surgery in patients with PNETs. This has resulted in improved long-term survival in patients with locally advanced and metastatic disease treated aggressively, as well as shorter hospital stays and comparable long-term outcomes in patients with limited disease treated minimally invasively. There are still controversies related to issues of surgical treatment of PNETs, such as to what extent enucleation, lymph node sampling, and vascular reconstruction are beneficial for the oncologic outcome. Histopathologic tumor classification is of high clinical importance for treatment planning and prognostic evaluation of patients with PNETs. A constant challenge, which relates to the treatment of PNETs, is the lack of an internationally accepted histopathological classification system. This paper reviews current issues on the surgical treatment of sporadic PNETs with specific focus on surgical approaches and tumor classification.
    The Scientific World Journal 12/2012; 2012(1):357475. DOI:10.1100/2012/357475 · 1.73 Impact Factor
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