European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours

Abstract

This ENETS guidance paper, developed by a multidisciplinary working group, provides an update on the previous colorectal guidance paper in a different format. Guided by key clinical questions practical advice on the diagnosis and management of neuroendocrine tumours (NET) of the caecum, colon, and rectum is provided. Although covered in one guidance paper colorectal NET comprises a heterogeneous group of neoplasms. The most common rectal NET are often small G1 tumours that can be treated by adequate endoscopic resection techniques. Evidence from prospective clinical trials on the treatment of metastatic colorectal NET is limited and discussion of patients in experienced multidisciplinary tumour boards strongly recommended.Neuroendocrine carcinomas (NEC) and mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are discussed in a separate guidance paper.

Comparing surgical and endoscopic resection approaches for colorectal neuroendocrine tumors within the diameter range of 10-20mm: an inverse probability weighting analysis based on the SEER database

“…This study further lowered the clinical decision threshold for tumor diameter to 11.5mm, highlighting the need for cautious selection of diagnostic and treatment strategies for CRNET patients with tumor diameters of 10-20mm. Additionally, ENETS guidelines explicitly recommend baseline local staging through pelvic MRI for all rectal NETs larger than 10mm and chest CT, abdominal CT/MRI, and 68Ga-SSR-PET/CT evaluations for assessing distant metastasis ( 32 ).Considering these reasons, we strongly recommend that patients undergo thorough preoperative local and systemic examinations, including endoscopy under ultrasound guidance and relevant imaging evaluations, to select more accurate treatment approaches based on comprehensive assessments.…”

Advances in Radionuclide Therapies for Patients with Neuro-endocrine Tumors

“…Additionally, patients should have ECOG performance status < 2 and sufficient bone marrow, renal, and liver function in order to safely receive four cycles of PRRT [ 6 ]. More details on clinical implementation of the treatment can be found in the recent guidelines [ 1 , 23 ].…”

“…Surgical resection of the primary tumor and regional lymph nodes is still the only curative treatment; however, more than 40% of patients initially present with metastatic and advanced disease. At this stage, the disease is considered non-curative, so treatment focusses on controlling tumor volume, reduce tumor related side-effects, improve quality of live (QoL), and prolong survival [ 1 , 2 ]. In patients with advanced well-differentiated somatostatin-receptor (SSTR) positive (functional) NETs, somatostatin analogs (SSA) are generally recommended as first-line treatment.…”

Genetics-guided therapy in neuroendocrine carcinoma: response to BRAF- and MEK-inhibitors

“…They may arise anywhere in the body, most commonly in the gastrointestinal and broncho-pulmonary tracts ( 1 ). Previously described as carcinoids ( 2 ), cancer-like, they are now classified as either neuroendocrine tumor (NET, well-differentiated) or neuroendocrine carcinoma (NEC, poorly differentiated) ( 2 – 4 ) ( Table 1 ). Though NETs often have an indolent presentation with a relatively slow growth rate, curable surgery is seldom possible since they tend to be metastasized at diagnosis ( 1 ).…”