Midgut Neuroendocrine Tumors with Liver-only Metastases: Benefit of Primary Tumor Resection

Gangi, Alexandra; Manguso, Nicholas; Gong, Jun; Crystal, Jessica S.; Paski, Shirley; Hendifar, Andrew Eugene; Tuli, Richard

doi:10.1245/s10434-020-08510-w

Cited by 16 publications

(9 citation statements)

References 28 publications

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“…This result is due to a patient selection bias (eg lack of primary staging examinations or investigations for unknown primary). On the other hand, oligo‐metastatic patients or patients with liver‐only metastatic disease may benefit of a potential curative surgery 13,14 . In these cases, an accurate presurgical staging, allowing precise metastatic cartography, is crucial and with potential therapeutic consequences.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, simultaneous resection of si-NETs with synchronous liver metastases is associated with considerable long-term survival even in the presence of bilobar disease. 13,14 At present, the question of which tracer should be preferred to obtain the best accurate metastatic cartography in patients with ileal NETs remains without a definitive response due to the lack of dedicated studies involving homogeneous series of patients. Head-to-head evaluation between 68 Ga-DOTA-peptides and 18 F-FDOPA PET/CT have been performed in only three studies, assembling 11 cases of ileal NETs, showing similar patient-based results.…”

Section: Nowadaysmentioning

confidence: 99%

“…On the other hand, oligo-metastatic patients or patients with liver-only metastatic disease may benefit of a potential curative surgery. 13,14 In these cases, an accurate presurgical staging, allowing precise metastatic cartography, is crucial and with potential therapeutic consequences. That was the case in a patient who presented a liver-only metastatic disease with only two lesions detected by 68 Ga-DOTATOC PET/CT but 5 lesions with 18 F-FDOPA PET/CT (Figure 2).…”

Section: Ta B L E 4 [18f]fdopa Vs [68ga]dotatoc Pet/ct Detection Ratementioning

confidence: 99%

“…The definition of metastatic burden is of capital importance in patients with ileal NETs because complete tumour and lymph nodes removal could decrease local recurrence. Furthermore, simultaneous resection of si‐NETs with synchronous liver metastases is associated with considerable long‐term survival even in the presence of bilobar disease 13,14 . At present, the question of which tracer should be preferred to obtain the best accurate metastatic cartography in patients with ileal NETs remains without a definitive response due to the lack of dedicated studies involving homogeneous series of patients.…”

Section: Introductionmentioning

confidence: 99%

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Intraindividual comparison of ¹⁸F‐FDOPA and ⁶⁸Ga‐DOTATOC PET/CT detection rate for metastatic assessment in patients with ileal neuroendocrine tumours

Ouvrard

Chevalier

Addeo

et al. 2020

Clinical Endocrinology

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Introduction: In patients with ileal neuroendocrine tumours (ileal NETs), headto-head evaluation of diagnostic performances of 68 Ga-DOTA-peptides and 18 F-fluorodihydroxyphenylalanine (18 F-FDOPA) positron emission tomography/computed tomography (PET/CT) has been performed in only few small patients' cohorts. The aim of this retrospective study was to compare 68 Ga-DOTATOC and 18 F-FDOPA PET/CT for metastatic disease assessment in a homogeneous large series of patients with well-differentiated ileal NETs. Methods: All patients with ileal NETs who underwent both 18 F-FDOPA and 68 Ga-DOTATOC PET/CT within a 3-month period and no therapeutic change between the two studies were retrospectively included. The detection rates of both modalities were calculated using per-patient, per-region and per-lesion analyses. Results: Forty one patients with ileal NETs were evaluated. 18 F-FDOPA and 68 Ga-DOTATOC showed similar detection rates according to per-patient (97% for both) and per-region analyses (94% for 18 F-FDOPA vs 88% for 68 Ga-DOTATOC, P = .35). For a total of 605 positive lesions, 458 (76%) were detected by both modalities, 122 (20%) exclusively by 18 F-FDOPA PET/CT, and 25 (4%) by 68 Ga-DOTATOC PET/CT only. In a per-lesion analysis, 18 F-FDOPA PET/CT performed better than 68 Ga-DOTATOC PET/ CT (overall detection rates of 96% vs 80%; P < .001). 18 F-FDOPA PET/CT detected significantly more metastases than 68 Ga-DOTATOC PET/CT in the liver, peritoneum, abdominal and supra-diaphragmatic lymph nodes. Conclusion: 18 F-FDOPA PET/CT seems not inferior than 68 Ga-DOTATOC PET/ CT for the delineation of metastatic spread of ileal NETs. Therefore, according to local expertise and technical availability, 18 F-FDOPA should be considered as a valid clinical diagnostic option for exhaustive metastatic assessment in patients with ileal NETs. Obviously, 68 Ga-DOTATOC PET/CT remains mandatory for PRRT assessment. Further comparative studies are needed to determine the optimal approach in various clinical scenarios such as preoperative staging and primary tumour detection.

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Section: Discussionmentioning

confidence: 99%

Section: Nowadaysmentioning

confidence: 99%

Section: Ta B L E 4 [18f]fdopa Vs [68ga]dotatoc Pet/ct Detection Ratementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraindividual comparison of ¹⁸F‐FDOPA and ⁶⁸Ga‐DOTATOC PET/CT detection rate for metastatic assessment in patients with ileal neuroendocrine tumours

Ouvrard

Chevalier

Addeo

et al. 2020

Clinical Endocrinology

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“…In addition, the presence of many liver metastases is associated with a higher risk of developing carcinoid syndrome (e.g., flushing, diarrhoea and bronchoconstriction) due to the overproduction of serotonin 6 . Given that surgery with radical intent has a high impact on prognosis, even in the case of liver metastases, 7,8 accurate imaging procedures for staging are required, to select the most appropriate surgical approach.…”

Section: Introductionmentioning

confidence: 99%

Head‐to‐head comparison between ¹⁸F‐DOPA PET/CT and ⁶⁸Ga‐DOTA peptides PET/CT in detecting intestinal neuroendocrine tumours: A systematic review and meta‐analysis

Piccardo

Fiz

Bottoni

et al. 2021

Clinical Endocrinology

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Purpose The imaging of intestinal neuroendocrine tumours (NETs) relies on functional positron emission tomography (PET) tracers; these tumours can be studied by means of both 68Ga‐DOTA peptides and 18F‐fluorodihydroxyphenyl‐ l‐alanine (18F‐DOPA) PET/computed tomography (CT). As yet, it is unclear which of these two modalities offers the better sensitivity. We therefore conducted a meta‐analysis to assess the available data. Methods PubMed, CENTRAL, Scopus and Web of Science were searched for studies comparing the sensitivity of 68Ga‐DOTA peptides and 18F‐DOPA PET/CT; papers up to February 2021 were considered. In each study, we considered sensitivity in terms of patient‐based analysis (PBA), region‐based analysis (RBA) and lesion‐based analysis (LBA), and pooled the results yielded by each tracer. Multidisciplinary follow‐up served as the standard of truth. Results Of the 636 records identified, 6 articles published between 2008 and 2021 were finally selected, and 112 intestinal NETs patients were included. The pooled sensitivity of 18F‐DOPA PET/CT was 83%, 89% and 95% on PBA, RBA and LBA, respectively. 68Ga‐DOTA peptides PET/CT showed sensitivity of 88%, 92% and 82% on PBA, RBA and LBA, respectively. No significant differences were found between the two tracers on PBA and RBA. By contrast, a clear trend towards significance in favour of 18F‐DOPA PET/CT was identified on LBA. The presence of a significant difference in favour of 18F‐DOPA PET/CT was confirmed in a subgroup analysis conducted only on the most recent and largest studies. In all three analyses, mild‐to‐high heterogeneity was found; however, no publication bias was observed. Conclusion Both 18F‐DOPA PET/CT and 68Ga‐DOTA‐peptides PET/CT are reliable diagnostic procedures in patients with intestinal NETs. However, in terms of lesion detection, a non‐negligible difference in favour of 18F‐DOPA PET/CT was observed. Thus, the use of 18F‐DOPA PET/CT could be considered as a first‐line molecular procedure in intestinal NETs.

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Outcomes after primary tumor resection of metastatic pancreatic neuroendocrine tumors: An analysis of the National Cancer Database

Kaslow

Hani

Cohen

et al. 2023

Journal of Surgical Oncology

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Introduction: There is no consensus regarding the role of primary tumor resection for patients with metastatic pancreatic neuroendocrine tumors (panNET). We assessed surgical treatment patterns and evaluated the survival impact of primary tumor resection in patients with metastatic panNET.Methods: Patients with synchronous metastatic nonfunctional panNET in the National Cancer Database (2004Database ( −2016 were categorized based on whether they underwent primary tumor resection. We used logistic regressions to assess associations with primary tumor resection. We performed survival analyses with Kaplan−Meier survival functions, log-rank test, and Cox proportional hazard regression within a propensity score matched cohort.Results: In the overall cohort of 2613 patients, 68% (n = 839) underwent primary tumor resection. The proportion of patients who underwent primary tumor resection decreased over time from 36% (2004) to 16% (2016, p < 0.001).After propensity score matching on age at diagnosis, median income quartile, tumor grade, size, liver metastasis, and hospital type, primary tumor resection was associated with longer median overall survival (OS) (65 vs. 24 months; p < 0.001) and was associated with lower hazard of mortality (HR: 0.39, p < 0.001). Conclusion:Primary tumor resection was significantly associated with improved OS, suggesting that, if feasible, surgical resection can be considered for well-selected patients with panNET and synchronous metastasis. | INTRODUCTIONPancreatic neuroendocrine tumors (panNETs) are a rare, but increasingly prevalent, set of neoplasms that may be associated with functional hormonal syndromes, multiple endocrine neoplasia type I, and von-Hippel−Lindau syndrome, among others. 1,2 Among pan-NETs, nonfunctional tumors are not only more prevalent but also diagnosed at more advanced stage, with more than half of patients presenting with metastasis at diagnosis. 3 Patients with distant metastases at diagnosis experience significantly shorter overall

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Midgut Neuroendocrine Tumors with Liver-only Metastases: Benefit of Primary Tumor Resection

Cited by 16 publications

References 28 publications

Intraindividual comparison of ¹⁸F‐FDOPA and ⁶⁸Ga‐DOTATOC PET/CT detection rate for metastatic assessment in patients with ileal neuroendocrine tumours

Intraindividual comparison of ¹⁸F‐FDOPA and ⁶⁸Ga‐DOTATOC PET/CT detection rate for metastatic assessment in patients with ileal neuroendocrine tumours

Head‐to‐head comparison between ¹⁸F‐DOPA PET/CT and ⁶⁸Ga‐DOTA peptides PET/CT in detecting intestinal neuroendocrine tumours: A systematic review and meta‐analysis

Outcomes after primary tumor resection of metastatic pancreatic neuroendocrine tumors: An analysis of the National Cancer Database

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Midgut Neuroendocrine Tumors with Liver-only Metastases: Benefit of Primary Tumor Resection

Cited by 16 publications

References 28 publications

Intraindividual comparison of 18F‐FDOPA and 68Ga‐DOTATOC PET/CT detection rate for metastatic assessment in patients with ileal neuroendocrine tumours

Intraindividual comparison of 18F‐FDOPA and 68Ga‐DOTATOC PET/CT detection rate for metastatic assessment in patients with ileal neuroendocrine tumours

Head‐to‐head comparison between 18F‐DOPA PET/CT and 68Ga‐DOTA peptides PET/CT in detecting intestinal neuroendocrine tumours: A systematic review and meta‐analysis

Outcomes after primary tumor resection of metastatic pancreatic neuroendocrine tumors: An analysis of the National Cancer Database

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Intraindividual comparison of ¹⁸F‐FDOPA and ⁶⁸Ga‐DOTATOC PET/CT detection rate for metastatic assessment in patients with ileal neuroendocrine tumours

Intraindividual comparison of ¹⁸F‐FDOPA and ⁶⁸Ga‐DOTATOC PET/CT detection rate for metastatic assessment in patients with ileal neuroendocrine tumours

Head‐to‐head comparison between ¹⁸F‐DOPA PET/CT and ⁶⁸Ga‐DOTA peptides PET/CT in detecting intestinal neuroendocrine tumours: A systematic review and meta‐analysis