Clinical guidelines for diagnostic and treatment of patients with small intestinal neuroendocrine tumors
Summary. Neuroendocrine tumors (NETs) comprise a broad group of tumors which are distinguished by biological diversity and heterogeneity. According to the WHO data there has been an increase in the incidence of the NETs up to 3.65 per 100 thousands of population over the last decades in particular. The stage and grade of the gastrointestinal NETs are crucial factors in the prognosis of the disease. The use of modern diagnostic methods such as computed tomography, magnetic resonance imaging, scintigraphy, positron emission tomography — computed tomography and immunohistochemistry of the biological material play a key role in the detection of NETs of the gastrointestinal tract. The basic principles of surgical treatment combine following approaches as the adequate volume of lymph nodes dissection, removal of all visible primary palpable tumors, relapse and metastases. Systemic treatment of the patients with gastrointestinal NETs in the IV stage of the disease depends on the grade (G), indexes of proliferation (Ki-67) and mitotic activity and consists of the use of prolonged octreotide, immunotherapy, systemic chemotherapy, and locoregional therapy. Median overall survival of patients with gastrointestinal NETs in the III stage after adequate treatment is 112–170 months, stage III — 70–105 months and stage IV — 13–60 months, respectively. The recommendations for diagnosis and treatment of the patients with gastrointestinal NETs are based on the recommendations of ENETS 2016, NCCN 03/2017, which data were updated according to the literature review using the PubMed search resource over the period 2015–2016.
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