Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Pavel, Marianne; Öberg, Kjell; Falconi, Massimo; Krenning, Eric P.; Sundín, Anders; Perren, Aurel; Berruti, Alfredo

doi:10.1016/j.annonc.2020.03.304

Cited by 713 publications

(1,048 citation statements)

References 102 publications

(112 reference statements)

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“…The liver is a frequent target for distant metastases from several tumors. Liver metastases (LM) are associated with poor prognosis and may occur early in gastrointestinal malignancies because of hematogenous spread through the portal venous system [ 1 , 2 , 3 , 4 , 5 ]. Selected patients with LM, mainly those with liver-only metastases, can be considered for aggressive systemic and loco-regional treatments to prolong survival expectancy and optimize quality of life.…”

Section: Introductionmentioning

confidence: 99%

Radiomics of Liver Metastases: A Systematic Review

Fiz

Viganò

Gennaro

et al. 2020

Cancers

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Multidisciplinary management of patients with liver metastases (LM) requires a precision medicine approach, based on adequate profiling of tumor biology and robust biomarkers. Radiomics, defined as the high-throughput identification, analysis, and translational applications of radiological textural features, could fulfill this need. The present review aims to elucidate the contribution of radiomic analyses to the management of patients with LM. We performed a systematic review of the literature through the most relevant databases and web sources. English language original articles published before June 2020 and concerning radiomics of LM extracted from CT, MRI, or PET-CT were considered. Thirty-two papers were identified. Baseline higher entropy and lower homogeneity of LM were associated with better survival and higher chemotherapy response rates. A decrease in entropy and an increase in homogeneity after chemotherapy correlated with radiological tumor response. Entropy and homogeneity were also highly predictive of tumor regression grade. In comparison with RECIST criteria, radiomic features provided an earlier prediction of response to chemotherapy. Lastly, texture analyses could differentiate LM from other liver tumors. The commonest limitations of studies were small sample size, retrospective design, lack of validation datasets, and unavailability of univocal cut-off values of radiomic features. In conclusion, radiomics can potentially contribute to the precision medicine approach to patients with LM, but interdisciplinarity, standardization, and adequate software tools are needed to translate the anticipated potentialities into clinical practice.

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Section: Introductionmentioning

confidence: 99%

Radiomics of Liver Metastases: A Systematic Review

Fiz

Viganò

Gennaro

et al. 2020

Cancers

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“…Chemotherapy options as a treatment algorithm for ANECs has primarily been based on platinum-derived agents (i.e. cisplatin), which is the recommended drug of choice according to the Swedish national guidelines and the European Society for Medical Oncology (ESMO)and was also the case for our patient [27]. This compound inhibits cell division by interference with DNA transcription and/or replication [12,28].…”

Section: Discussionmentioning

confidence: 99%

Highly proliferative anal neuroendocrine carcinoma: molecular and clinical features of a rare, recurrent case in complete remission

et al. 2020

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Background: Poorly differentiated anal neuroendocrine carcinomas (ANECs) are rare lesions with poor prognosis, and the molecular etiology is only partially understood. Case presentation: At our institution, we have treated and followed a patient with such a rare ANEC. He had primarily surgery followed by three rounds of repeated surgery for loco-regional recurrences. He also received three different combinations of chemotherapy and external beam radiation. At last follow-up 13 years since the primary diagnosis, the patient had been in complete remission for nine years. The patient's medical files were reexamined , including laboratory, radiology and clinical examinations. Histopathology was reassessed , and expanded immunohistochemistry was performed from tissue specimens from the four surgical procedures. In addition, the molecular genetic status was evaluated through next-generation sequencing. The initial tumor was consistent with a 59 mm small cell neuroendocrine cancer with a Ki-67 index of 80%. Regional lymph node metastases were evident, and immunohistochemistry supported a neuroendocrine origin. A PCR screening detected human papilloma virus type 45 DNA (high-risk subtype), and focused next-generation sequencing found a missense mutation in the Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit Alpha (PIK3CA) gene. In tissues representing subsequent recurrences, the Chromogranin A expression was lost, and the Ki-67 index increased to 90%. Conclusions: For the first time, we report the detection of HPV45 in a case of ANEC. To our belief, PIK3CA mutations have also not been previously demonstrated in this tumor entity. In highly malignant ANECs, cure can in rare cases be achieved. Although speculative, expression of HPV45 and/or the PIK3CA mutation may have contributed to the favorable outcome.

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“…9 Assessment by immunohistochemistry or functional imaging is an essential tool for diagnostic purpose and treatment eligibility and SSR imaging, at our centre preferably performed by 68 Ga-DOTA SSA positron emission tomography (PET)-CT is mandatory for staging of well-differentiated NETs. 10 As SSRs are usually homogeneously distributed, they constitute an optimal target for 'personalised' treatment. SSA targeting SSRs have been introduced already in the 1980s for symptomatic treatment of endocrine-active NETs and still constitute the treatment standard for these patients.…”

Section: Open Accessmentioning

confidence: 99%

How I treat neuroendocrine tumours

Kiesewetter

Raderer

2020

ESMO Open

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Neuroendocrine tumours (NETs) constitute a heterogeneous group of neoplasms characterised by variable endocrine activity and somatostatin receptor expression, with the latter allowing the use of targeted therapeutic concepts. Currently accepted treatment strategies for advanced well-differentiated NET include somatostatin analogues octreotide and lanreotide, peptide receptor radionuclide therapy using radiolabelled somatostatin analogues, mammalian target of Rapamycin inhibitor everolimus, tyrosine kinase inhibitor sunitinib, interferon alpha and classical cytostatic, such as streptozotocin-based and temozolomide-based treatment. Indication, use and approval of these treatments differ based on primary tumour origin, grading and symptomatic burden and require an optimised multidisciplinary cooperation of medical oncologists, endocrinologists and nuclear medicine specialists. Interestingly, hot topics in oncology including immunotherapy and use of next-generation-sequencing techniques currently play a minor role for the treatment of NETs. The recent revision of the WHO classification including the recognition of the novel NET G3 category allows for potentially more tailored treatment strategies in the near future. However, this new entity also poses a therapeutic challenge as only limited data are currently available. The present article aims to provide an overview on our personal treatment concepts for advanced NETs with a focus on tumours of gastroenteropancreatic origin.

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Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Cited by 713 publications

References 102 publications

Radiomics of Liver Metastases: A Systematic Review

Radiomics of Liver Metastases: A Systematic Review

Highly proliferative anal neuroendocrine carcinoma: molecular and clinical features of a rare, recurrent case in complete remission

How I treat neuroendocrine tumours

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