Clinical guidelines for the diagnostic and treatment of the metastatic gastrointestinal neuroendocrine tumors
Summary. The incidence of the metastases (Mts) of the gastrointestinal neuroendocrine tumors (NET) is quite high in comparison with other localizations of NET. Mts are most often found in the liver and lymph nodes, rarely in bones and other organs. New modern diagnostic methods such as MRI, CT, PET-CT and Octreoscan are revealed as the most sensitive and accurate enough in the efficient detection either the Mts and the primary tumors which is recently used to be the main problem. The surgery is the most effective method to use in the treatment of Mts of NET significantly increasing survival of the patients. The aim of the surgical treatment is to remove primary tumor and detectable metastases from other organs (liver, peritoneum, lungs etc). Locoregional and ablative therapies are also found as effective methods in the treatment of Mts of NET. Other type of therapy such as systemic chemotherapy, hormone therapy with somatostatin analogs and target agents have been approved for antiproliferative therapy, local control and symptomatic control of the carcinoid syndrome in patients with metastatic NET. The goal of this research was to analyze literature data published over the last decade and revealed the most recent modern approaches in the diagnostic and treatment of Mts of NET. Taking into account the variety of treatment options, the heterogeneity of NET and the individual disease complexity it is strongly recommended to discuss patients with Mts of NET after accurate imaging and pathology review in a multidisciplinary tumor board for appropriate decision of the further therapeutic options. The presented recommendations are based on the data of ENETS 2016, NCCN 3 edition 2017 and literature review from 2010 to 2017 using PubMed and own data from National Cancer Register of Ukraine of the patients with Mts of NET underwent different therapy over the period from 1997 till 2017.
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