Management of Neuroendocrine Tumors - Episode 7
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In this segment the panelists describe surgical approaches available for patients with neuroendocrine tumors (NETs), which vary based on the primary site of the tumor. To start, Rodney F. Pommier, MD, provides an overview of current strategies in lung carcinoids, pancreatic NETs, and small bowel tumors.
The same standard oncologic operations used for non-small cell lung cancer can be applied to patients with lung carcinoids, Pommier notes. Moreover, these patients generally respond more favorably to surgery, since their cancer is less likely to be related to smoking. Additionally, the tumor may cause unusual syndromes, such as Cushing's syndrome, which are alleviated by resection.
Pommier categorizes pancreatic NETs into two categories based on tumor sizes. Small tumors are generally very small and not localized at the time of the surgery. Once they are found, they can generally be enucleated without major pancreatic resection. However, in larger tumors the feasibility of resection relies heavily on location.
In small bowel tumors, the size of the tumor is less important than the degree of nodal involvement, Pommier notes. In these patients, a wide lymph node resection is advised.
Pommier states that strict criteria exist regarding surgical resection in patients with metastatic disease; however, many of these guidelines may not apply for NETs. He adds that studies have shown that patients with multiple hepatic metastases with 70% to 90% of their disease debulked will have the same outcomes as patients who have a 100% resection. As a result, Pommier believes, achieving a complete resection with negative margins is not entirely necessary.
Panelists, James C. Yao, MD, and Pamela L. Kunz, MD, believe the treatment decision should be individualized and based on a multidisciplinary context. Yao notes that generally patients with a more indolent treatment course benefit from surgery for a longer duration. Kunz notes that other means, such as therapeutic intervention, are being examined to reduce the risk of recurrence following resection.