Initial impact of a systematic multidisciplinary approach on the management of patients with gastroenteropancreatic neuroendocrine tumor
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According to the international guidelines, a multidisciplinary approach is currently advised for the optimal care of patients with a gastroenteropancreatic neuroendocrine tumor (GEP NET). In our institution (tertiary care center), a systematic multidisciplinary approach was established in May 2007. In this study, we have aimed to assess the initial impact of establishing a systematic multidisciplinary approach to the management of GEP NET patients. We have collected and compared the biochemical, imaging, and pathological data and the therapeutic strategies in GEP NET patients diagnosed, treated, or followed-up from January 1993 to April 2007 versus GEP NET patients attending our institution after the multidisciplinary approach starting, from May 2007 to October 2008. Data of 91 patients before and 42 patients after the establishment of the multidisciplinary approach (total: 133 consecutive GEP NET patients) have been finally collected and analyzed. Before the establishment of the multidisciplinary approach, a lack of consistency in the biochemical, imaging, and pathological findings before treatment initiation as well as during follow-up of GEP NET patients was identified. These inconsistencies have been reduced by the systematic multidisciplinary approach. In addition, the therapeutic management of GEP NET patients has been altered by the multidisciplinary approach and became more consistent with recommended guidelines. We think that a systematic multidisciplinary approach significantly impacts on GEP NET patient care and should be established in all centers dealing with these tumors.
KeywordsNeuroendocrine tumor Multidisciplinary team Chromogranin A Ki-67 Somatostatin analogs
Conflict of interest
No conflicts of interest or funding sources affect this manuscript.
- 1.I.M. Modlin, K. Oberg, D.C. Chung, R.T. Jensen, W.W. de Herder, R.V. Thakker, M. Caplin, G. Delle Fave, G.A. Kaltsas, E.P. Krenning, S.F. Moss, O. Nilsson, G. Rindi, R. Salazar, P. Ruszniewski, A. Sundin, Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol. 9, 61–72 (2008)PubMedCrossRefGoogle Scholar
- 3.R. Garcia-Carbonero, J. Capdevila, G. Crespo-Herrero, J.A. Díaz-Pérez, M.P. Martínez Del Prado, V. Alonso Orduña, I. Sevilla-García, C. Villabona-Artero, A. Beguiristain-Gómez, M. Llanos-Muñoz, M. Marazuela, C. Alvarez-Escola, D. Castellano, E. Vilar, P. Jiménez-Fonseca, A. Teulé, J. Sastre-Valera, M. Benavent-Viñuelas, A. Monleon, R. Salazar, Incidence, patterns of care and prognostic factors for outcome of gastroenteropancreatic neuroendocrine tumors (GEP-NETs): results from the National Cancer Registry of Spain (RGETNE). Ann. Oncol. 21, 1794–1803 (2010)PubMedCrossRefGoogle Scholar
- 9.ENETS Consensus guidelines for the management of patients with digestive neuroendocrine tumors. Neuroendocrinology. 84, 151–215 (2006)Google Scholar
- 10.ENETS Consensus guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumors. Neuroendocrinology. 87, 1–62 (2008)Google Scholar
- 12.D. O’Toole, M. Ducreux, G. Bommelaer, J.L. Wemeau, O. Bouché, F. Catus, J. Blumberg, P. Ruszniewski, Treatment of carcinoid syndrome: a prospective crossover evaluation of lanreotide versus octreotide in terms of efficacy, patient acceptability, and tolerance. Cancer 88, 770–776 (2000)PubMedCrossRefGoogle Scholar
- 14.Proceedings of the 3rd ENETS Consensus conference on guidelines for the standard of care in neuroendocrine tumors, Palma de Mallorca, Spain, 2007. Neuroendocrinology. 90, 155–234 (2009)Google Scholar
- 15.J.K. Ramage, A. Ahmed, J. Ardill, N. Bax, D.J. Breen, M.E. Caplin, P. Corrie, J. Davar, A.H. Davies, V. Lewington, T. Meyer, J. Newell-Price, G. Poston, N. Reed, A. Rockall, W. Steward, R.V. Thakker, C. Toubanakis, J. Valle, C. Verbeke, A.B. Grossman, UK and Ireland Neuroendocrine Tumour Society, Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs). Gut. 61, 6–32 (2012)PubMedCrossRefGoogle Scholar
- 18.G. Rindi, R. Arnold, F.T. Bosman, C. Capella, D.S. Klimstra, G. Klöppel, P. Komminoth, E. Solcia, Nomenclature and classification of neuroendocrine neoplasms of the digestive system, in WHO Classification of Tumours of the Digestive System, ed. by F.T. Bosman, F. Carneiro, R.H. Hruban, N. Theise (IARC, Lyon, 2010), pp. 13–14Google Scholar
- 23.A. Rinke, H.H. Müller, C. Schade-Brittinger, K.J. Klose, P. Barth, M. Wied, C. Mayer, B. Aminossadati, U.F. Pape, M. Bläker, J. Harder, C. Arnold, T. Gress, R. Arnold, PROMID Study Group, Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J. Clin. Oncol. 27, 4656–4663 (2009)PubMedCrossRefGoogle Scholar