Nordic guidelines 2021 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

Janson, Eva Tiensuu; Knigge, Ulrich; Dam, Gitte; Federspiel, Birgitte; Grønbæk, Henning; Stålberg, Peter; Langer, Seppo W.; Kjær, Andreas; Arola, Johanna; Schalin‐Jäntti, Camilla; Sundín, Anders; Welin, Staffan; Thiis‐Evensen, Espen; Sørbye, Halfdan

doi:10.1080/0284186x.2021.1921262

Cited by 37 publications

(51 citation statements)

References 68 publications

(84 reference statements)

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“…Peptide receptor radionuclide therapy (PRRT) using somatostatin analogues labelled with radionuclides has become an established option for treatment of somatostatin receptor positive neuroendocrine tumors (NETs) [1][2][3][4], and PRRT is now recommended as second-line treatment for gastro-intestinal NETs [5]. For several years, the standard treatment schedule using the isotope 177 Lu has been four fractions of 7.4 GBq [ 177 Lu] Lu-DOTATATE [6] or to lesser extent [ 177 Lu]Lu-DOTATOC [7,8], but in recent years personalized treatments allowing for an increase of cumulated activity, in anticipation of improved treatment effect, have attracted much attention [9][10][11], and controlled clinical trials are ongoing [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Practical kidney dosimetry in peptide receptor radionuclide therapy using [177Lu]Lu-DOTATOC and [177Lu]Lu-DOTATATE with focus on uncertainty estimates

et al. 2021

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Background Kidney dosimetry after peptide receptor radionuclide therapy using 177Lu-labelled somatostatin analogues is a procedure with multiple steps. We present the SPECT/CT-based implementation at Aarhus University Hospital and evaluate the uncertainty of the various steps in order to estimate the total uncertainty and to identify the major sources of uncertainty. Absorbed dose data from 115 treatment fractions are reported. Results The total absorbed dose with uncertainty is presented for 59 treatments with [177Lu]Lu-DOTATOC and 56 treatments with [177Lu]Lu-DOTATATE. For [177Lu]Lu-DOTATOC the mean and median specific absorbed dose (dose per injected activity) is 0.37 Gy/GBq and 0.38 Gy/GBq, respectively, while for [177Lu]Lu-DOTATATE the median and mean are 0.47 Gy/GBq and 0.46 Gy/GBq, respectively. The uncertainty of the procedure is estimated to be about 13% for a single treatment fraction, where the absorbed dose calculation is based on three SPECT/CT scans 1, 4 and 7 days post-injection, while it increases to about 19% if only a single SPECT/CT scan is performed 1 day post-injection. Conclusions The specific absorbed dose values obtained with the described procedure are comparable to those from other treatment sites for both [177Lu]Lu-DOTATOC and [177Lu]Lu-DOTATATE, but towards the lower end of the range of reported values. The estimated uncertainty is also comparable to that from other reports and judged acceptable for clinical and research use, thus proving the kidney dosimetry procedure a useful tool. The greatest reduction in uncertainty can be obtained by improved activity determination, partial volume correction and additional SPECT/CT scans.

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Section: Introductionmentioning

confidence: 99%

Practical kidney dosimetry in peptide receptor radionuclide therapy using [177Lu]Lu-DOTATOC and [177Lu]Lu-DOTATATE with focus on uncertainty estimates

et al. 2021

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“…The male:female ratio is about 1.1:1 and the mean age at diagnosis about 60 years. After diagnosis, obtained through pancolonscopy and/or endoscopic ultrasonography (particularly in rectal NETs), colorectal NETs are managed as those arising in other tissues [ 42 ]. In particular, standard contrasted total-body CT or MRI (magnetic resonance imaging) of the abdomen and pelvis are done for staging the disease.…”

Section: Rare Tumors Of Colon and Rectummentioning

confidence: 99%

“…Tumors larger than 2 cm or those localized in other sites of the colon need to be treated with surgical excision similarly to adenocarcinomas [ 45 ]. The medical treatment of poly-metastatic disease overlaps with that of other gastrointestinal high-grade NETs [ 42 ]. The latter, also called neuroendocrine carcinoma, occurs very rarely in colon and rectum compared to well-differentiated NETs, they include small-cell and large-cell neuroendocrine carcinomas.…”

Section: Rare Tumors Of Colon and Rectummentioning

confidence: 99%

Clinical and Molecular Characteristics of Rare Malignant Tumors of Colon and Rectum

Ottaiano

Santorsola

Perri

et al. 2022

Biology

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The most frequent form of colorectal cancer is represented by adenocarcinoma being about 98% of tumor histological types. However, other rare histotypes can be found in colon and rectum (adenosquamous, goblet cell adenocarcinoma, lymphoma, medullary carcinoma, melanoma, mesenchymal, neuroendocrine, plasmacytoma, signet ring, squamous tumors). Altogether, these forms account for less than 2% of colorectal tumors. There are no specific diagnostic or therapeutic recommended approaches and most of the information available from literature derives from small and retrospective clinical series. In the present study, we provide a paramount and updated view on clinical and biologic characteristics of rare colorectal tumors.

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“…GEP-NENs are often slow-growing and indolent, so they can go undetected for years prior to diagnosis[ 4 ]. Though GEP-NENs were previously considered rare, the incidence has dramatically increased over the years as awareness of GEP-NENs grew and diagnostic modalities improved[ 1 , 4 - 7 ]. GEP-NENs are currently the second most prevalent gastrointestinal neoplasm, second only to colorectal adenocarcinoma[ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, their clinical presentation may mimic other classes of neoplasms, leading to inappropriate treatment and delays in appropriate therapy. Due to delays in diagnosis, metastases are present in 21% to 69% of patients at the time of diagnosis[ 6 , 7 ]. Therefore, it is imperative to come to an accurate diagnosis in a timely manner.…”

Section: Introductionmentioning

confidence: 99%

An update on the diagnosis of gastroenteropancreatic neuroendocrine neoplasms

Fang¹,

Li²,

Shi³

2022

WJG

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Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) arise from neuroendocrine cells found throughout the gastrointestinal tract and islet cells of the pancreas. The incidence and prevalence of GEP-NENs have been increasing each year due to higher awareness, improved diagnostic modalities, and increased incidental detection on cross-sectional imaging and endoscopy for cancer screening and other conditions and symptoms. GEP-NENs are a heterogeneous group of tumors and have a wide range in clinical presentation, histopathologic features, and molecular biology. Clinical presentation most commonly depends on whether the GEP-NEN secretes an active hormone. The World Health Organization recently updated the classification of GEP-NENs to introduce a distinction between high-grade neuroendocrine tumors and neuroendocrine carcinomas, which can be identified using histology and molecular studies and are more aggressive with a worse prognosis compared to high-grade neuroendocrine tumors. As our understanding of the biology of GEP-NENs has grown, new and improved diagnostic modalities can be developed and optimized. Here, we discuss clinical features and updates in diagnosis, including histopathological analysis, biomarkers, molecular techniques, and radiology of GEP-NENs. We review established diagnostic tests and discuss promising novel diagnostic tests that are currently in development or require further investigation and validation prior to broad utilization in patient care.

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Nordic guidelines 2021 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

Cited by 37 publications

References 68 publications

Practical kidney dosimetry in peptide receptor radionuclide therapy using [177Lu]Lu-DOTATOC and [177Lu]Lu-DOTATATE with focus on uncertainty estimates

Practical kidney dosimetry in peptide receptor radionuclide therapy using [177Lu]Lu-DOTATOC and [177Lu]Lu-DOTATATE with focus on uncertainty estimates

Clinical and Molecular Characteristics of Rare Malignant Tumors of Colon and Rectum

An update on the diagnosis of gastroenteropancreatic neuroendocrine neoplasms

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