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Pancreatic neuroendocrine tumours: proactive approach shows benefits

Takeaway

  • A proactive interventional multimodal management approach that concentrates on early cytoreductive strategies early shows prognostic benefit in patients with advanced pancreatic neuroendocrine tumours (PNET).

Why this matters

  • Survival benefits from individual treatments for PNETs have been well reported but the combined outcome from multimodal treatments has not been well described.
  • Sequencing of multimodal therapy continues to be a challenge in PNET treatment.
  • The authors of this study suggest first-line treatment in grade 1-2 tumours should be cytoreductive strategies alongside somatostatin analogues.
  • Systemic therapy and peptide receptor radiotherapy (PRRT) should be reserved for disease progression. 

Key results

  • 106 patients with histologically proven PNETs were analysed.
  • 51 had stage I-III disease and 55 had stage V.
  • 99 surgeries were performed in 80 (75.5%) patients.
  • 54.2% underwent resection of the primary tumour.
  • 14.2% had pancreatic and liver resection.
  • 4.7% had liver resection alone.
  • 39 of 106 patients received locoregional treatment.
  • Average number of locoregional treatment episodes was 2.9.
  • 97 patients received systemic treatment of which 8.5% had PRRT, 37.7% had somatostatin analogues, 17.9% had everolimus and 10.4% had sunitinib.
  • 9.4% received no active treatment.
  • Survival for all stages was 92.5% at 1 yr and 62% at 5 yrs.
  • 5-yr survival was 90% in patients with stage I-III disease.
  • In patients with stage IV disease, median survival in patients with stage IV disease was 51 months and 5-yr survival was 40%. 

Study design

  • Analysis of a prospectively collected database of all patients referred with PNETs to the Southampton University Hospitals NHS Trust tertiary referral centre between January 2000 and December 2014, treated with a proactive multimodal management strategy.
  • Funding: no specific funding.

Limitations

  • Single centre.
  • Lack of data on quality of life.

References


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