MULTIDISCIPLINARY MANAGEMENT OF METASTATIC NEUROENDOCRINE TUMOURS
Abstract
A 65-year-old man presented to his GP with right upper quadrant abdominal pain and weight loss. Abdominal ultrasound showed multiple gallstones and some ill-defined liver lesions. Computer tomography scan diagnosed a terminal ileal lesion causing cicatrisation of the terminal small bowel but does liver abnormality. The patient was worked up with serum gut hormone profile and magnetic resonance imaging of the liver which demonstrated multiple liver lesions and biochemical suspicion of neuroendocrine tumour (NET). The patient underwent a right hemicolectomy and excision/ ablation of 44 liver metastases. He made a good post-operative recovery and remains disease free after 18 months. We also present a brief literature review regarding advances in the management of metastatic NET.
Key words: Neuroendocrine tumours, Hepatic metastases, Radiofrequency ablation, Computer tomography, Magnetic
resonance imaging
References
Kulke MH, Mayer RJ. Carcinoid tumors. N Engl J Med 1999;340:858-68.
Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: Epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008;26:3063-72.
Perez EA, Koniaris LG, Snell SE, et al. 7201 carcinoids: Increasing incidence overall and disproportionate mortalityin the elderly. World J Surg 2007;31:1022-30.
Modlin IM, Oberg K, Chung DC, et al. Gastroenteropancreatic
neuroendocrine tumours. Lancet Oncol 2008;9:61-72.
Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97:934-59.
Santhanam P, Chandramahanti S, Kroiss A, et al. Nuclear imaging of neuroendocrine tumors with unknown primary: Why, when and how? Eur J Nucl Med Mol Imaging2015;42:1144-55.
Bhosale P, Shah A, Wei W, et al. Carcinoid tumours: Predicting the location of the primary neoplasm based on the sites of metastases. Eur Radiol 2013;23:400-7.
Ramage JK, Ahmed A, Ardill J, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs). Gut 2012;61:6-32.
Bacchetti S, Bertozzi S, Londero AP, et al. Surgical treatment and survival in patients with liver metastases from neuroendocrine tumors: A meta-analysis of observational studies. Int J Hepatol 2013;2013:235040.
Pavel M, Baudin E, Couvelard A, et al. ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology 2012;95:157-76.
Søreide O, Berstad T, Bakka A, et al. Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors. Surgery 1992;111:48-54.
Maxwell JE, Sherman SK, O’Dorisio TM, et al. Liverdirected surgery of neuroendocrine metastases: What is the optimal strategy? Surgery 2016;159:320-33.
Boudreaux JP, Klimstra DS, Hassan MM, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: Well-differentiated neuroendocrine tumors of the jejunum, ileum, appendix, andcecum. Pancreas 2010;39:753-66.
Shi W, Johnston CF, Buchanan KD, et al. Localization of neuroendocrine tumours with [111In] DTPA-octreotide scintigraphy (Octreoscan): A comparative study with CT and MR imaging. QJM 1998;91:295-301.
Chambers AJ, Pasieka JL, Dixon E, et al. Role of imaging in the preoperative staging of small bowel neuroendocrine tumors. J Am Coll Surg 2010;211:620-7.
Orlefors H, Sundin A, Garske U, et al. Whole-body (11)C-5-hydroxytryptophan positron emission tomography as a universal imaging technique for neuroendocrine tumors: Comparison with somatostatin receptor scintigraphy and computed tomography. J Clin Endocrinol Metab
;90:3392-400.
Hofmann M, Maecke H, Börner R, et al. Biokinetics and imaging with the somatostatin receptor PET radioligand (68)Ga-DOTATOC: Preliminary data. Eur J Nucl Med2001;28:1751-7.
Kowalski J, Henze M, Schuhmacher J, et al. Evaluation of positron emission tomography imaging using [68Ga]-DOTA-D phe(1)-tyr(3)-octreotide in comparison to [111In]-DTPAOC SPECT. First results in patients withneuroendocrine tumors. Mol Imaging Biol 2003;5:42-8.
Gabriel M, Decristoforo C, Kendler D, et al 68Ga-DOTAtyr3-octreotide PET in neuroendocrine tumors: Comparison with somatostatin receptor scintigraphy and CT. J Nucl Med2007;48:508-18.
Naswa N, Sharma P, Kumar A, et al. Gallium-68-DOTANOC PET/CT of patients with gastroenteropancreatic neuroendocrine tumors: A prospective single-center study. AJR Am J Roentgenol 2011;197:1221-8.
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