Nonfunctioning Incidental Pancreatic Neuroendocrine Tumors

Gorelik, M.L.; Ahmad, Mahmoud S.; Grossman, David C.; Grossman, Martin B.; Cooperman, Avram M.

doi:10.1016/j.suc.2017.09.014

Cited by 20 publications

(16 citation statements)

References 59 publications

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“…Up to 90% of pNETs are hormonally silent . Nonfunctioning tumors seem to have worse prognosis compared with functioning neoplasms, probably as result of late diagnosis.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Up to 90% of pNETs are hormonally silent. 54 Nonfunctioning tumors seem to have worse prognosis compared with functioning neoplasms, probably as result of late diagnosis. Increasing numbers of nonfunctioning pNETs are diagnosed incidentally, and the optimal management of small (<2 cm), asymptomatic, incidentally detected tumors is controversial.…”

Section: Pancreatic Netsmentioning

confidence: 99%

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Gastroenteropancreatic Neuroendocrine Tumors

Cives

Strosberg

2018

CA A Cancer J Clinicians

460

411

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Neuroendocrine tumors (NETs) are heterogeneous malignancies arising from the diffuse neuroendocrine system. They frequently originate in the gastroenteropancreatic (GEP) tract and the bronchopulmonary tree, and their incidence has steadily increased in the last 3 decades. Fundamental biologic and genomic differences underlie the clinical heterogeneity of NETs, and distinct molecular features characterize NETs of different grades and different primary sites. Although surgery remains the cornerstone of treatment for localized tumors, systemic treatment options for patients with metastatic NETs have expanded considerably. Somatostatin analogs have demonstrated both antisecretory and antitumor efficacy. Peptide receptor radionuclide therapy with lutetium‐177 dotatate (177Lu‐DOTATATE) has been approved for advanced GEP‐NETs. The antitumor activity of everolimus has been demonstrated across a wide spectrum of NETs, and the antiangiogenic agent sunitinib has been approved for pancreatic NETs (pNETs). Chemotherapy with temozolomide and capecitabine has recently demonstrated an unprecedented prolongation of progression‐free survival in a randomized trial of pNETs. Multiple retrospective series have reported the efficacy of liver‐directed therapies both for palliating symptoms of hormone excess and for controlling tumor growth. Telotristat, an oral inhibitor of tryptophan hydroxylase, has been shown to reduce diarrhea in patients with carcinoid syndrome. Defining the therapeutic algorithm and identifying biomarkers predictive of response to treatments are among the main priorities for the next decade of research in the NET field.

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“…Up to 90% of pNETs are hormonally silent . Nonfunctioning tumors seem to have worse prognosis compared with functioning neoplasms, probably as result of late diagnosis.…”

Section: Clinical Presentationmentioning

confidence: 99%

Section: Pancreatic Netsmentioning

confidence: 99%

Gastroenteropancreatic Neuroendocrine Tumors

Cives

Strosberg

2018

CA A Cancer J Clinicians

460

411

View full text Add to dashboard Cite

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“…[35] Moreover, although the cutoff level of ≤2 cm has been widely adopted, other studies have found that larger NF-PanNENs size up to 3 cm did not correlate with behavior, and factors other than size are important. [36] Jiang et al [37] found a correlation between radiologic diameter of 2.5 cm, high tumor grade, symptoms, and lymph nodes metastases. Salinen et al [34] stratified NF-PanNENs into three groups: <2 cm, between 2 and 4 cm, and >4 cm and noted that size alone did not predict behavior.…”

Section: Radiofrequency Ablation For Pannens and Conclusionmentioning

confidence: 99%

EUS-guided radiofrequency ablation as an alternative to surgery for pancreatic neuroendocrine neoplasms: Who should we treat?

et al. 2019

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Pancreatic neuroendocrine neoplasms (PanNENs) are rare tumors, but their incidental diagnosis has significantly increased due to the widespread use of imaging studies. Therefore, most PanNENs are now diagnosed when completely asymptomatic and in early stages. PanNENs are classified according to their grade (Ki-67 index) and can be functional (F-) or nonfunctional (NF-) depending on the presence or absence of a clinical, hormonal hypersecretion syndrome. The mainstay treatment of PanNENs is a surgery that is mostly curative but also associated with significant short- and long-term adverse events. Therefore, less invasive alternative locoregional treatment modalities are warranted. Recently, few case reports and two case series have described EUS-guided radiofrequency ablation (EUS-RFA) for the treatment of patients with both F-PanNENs and NF-PanNENs. If for F-PanNENs EUS-RFA can very easily become the standard of care, for NF-PanNENEs it is still controversial how to select patients for EUS-RFA. A balance between overtreatment ( i.e. , RFA/surgery in patients who will not progress) and undertreatment (locoregional treatments in patients with undetected metastases) needs to be found based on solid data. The decision should also take into account patients’ comorbidity and risk of postoperative death, life expectancy, tumor location, risk of postoperative fistula and postoperative morbidity, and risk of long-term exocrine and/or endocrine insufficiency. To answer the important question on which a patient should be treated with EUS-RFA, properly designed studies to evaluate the efficacy of this treatment in large cohorts of patients with NF-PanNENs and to establish prognostic factors associated with treatment response are urgently needed.

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“…They are often diagnosed during radiographic screening for unrelated issues or nonspecific abdominal complaints. NF-PNETs do not have a specific clinical syndrome but between 60–100% of NF-PNETs secrete a number of peptides that can help with diagnosis, including: chromogranin A, neuron-specific enolase, pancreatic polypeptide, ghrelin, neurotensin, motilin, or human gonadotrophin (20).…”

Section: Clinical Features Of Specific Pnetsmentioning

confidence: 99%

“…30 patients) (22). Decisions regarding treatment of NF- PNETs are multifactorial and often based on size and grade, combined with consideration of patient comorbidities and risks (20).…”

Section: Clinical Features Of Specific Pnetsmentioning

confidence: 99%

Insights into the biology and treatment strategies of pancreatic neuroendocrine tumors

Buicko¹,

Finnerty²,

Zhang³

et al. 2019

Ann Pancreat Cancer

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Pancreatic neuroendocrine tumors (PNETs) are the second most common primary pancreatic neoplasms after pancreatic ductal adenocarcinoma. PNETs present with widely various clinical manifestation and unfavorable survival rate. The recent advances in next generation sequencing have significantly increased our understanding of the molecular landscape of PNETs and help guide the development of targeted therapies. This review intends to outline a holistic picture of the tumors by discussing current understanding of clinical presentations, up-to-date treatment strategies, novel mouse models, and molecular biology of PNETs. Furthermore, we will provide insight into the future development of more effective targeted therapies that are necessary to manage PNETs.

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Nonfunctioning Incidental Pancreatic Neuroendocrine Tumors

Cited by 20 publications

References 59 publications

Gastroenteropancreatic Neuroendocrine Tumors

Gastroenteropancreatic Neuroendocrine Tumors

EUS-guided radiofrequency ablation as an alternative to surgery for pancreatic neuroendocrine neoplasms: Who should we treat?

Insights into the biology and treatment strategies of pancreatic neuroendocrine tumors

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