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
References