Abstract
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.
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References
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)
I.M. Modlin, K.D. Lye, M. Kidd, A 5-decade analysis of 13715 carcinoid tumors. Cancer 97, 934–959 (2003)
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)
U.F. Pape, M. Bohmig, U. Berndt, N. Tiling, B. Wiedenmann, U. Plockinger, Survival and clinical outcome of patients with neuroendocrine tumors of the gastroenteropancreatic tract in a German referral center. Ann. N. Y. Acad. Sci. 1014, 222–233 (2004)
P.D. Leotlela, A. Jauch, H. Holtgreve-Grez, R.V. Thakker, Genetics of neuroendocrine and carcinoid tumours. Endocr. Relat. Cancer 10, 437–450 (2003)
S.K. Helland, A.M. Prosch, A. Viste, Carcinoid tumours in the gastrointestinal tract: a population-based study from Western Norway. Scand. J. Surg. 95, 158–161 (2006)
B.G. Taal, M. Smits, Developments in diagnosis and treatment of metastatic midgut carcinoid tumors. A review. Minerva Gastroenterol. Dietol. 51, 335–344 (2005)
K. Oberg, Neuroendocrine tumors of the gastrointestinal tract: recent advances in molecular genetics, diagnosis, and treatment. Curr. Opin. Oncol. 17, 386–391 (2005)
ENETS Consensus guidelines for the management of patients with digestive neuroendocrine tumors. Neuroendocrinology. 84, 151–215 (2006)
ENETS Consensus guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumors. Neuroendocrinology. 87, 1–62 (2008)
K.I. Alexandraki, G. Kaltsas, Gastroenteropancreatic neuroendocrine tumors: new insights in the diagnosis and therapy. Endocrine 41, 40–52 (2012)
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)
W.W. de Herder, S.W. Lamberts, Somatostatin and somatostatin analogues: diagnostic and therapeutic uses. Curr. Opin. Oncol. 14, 53–57 (2002)
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)
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)
G.B. Turner, B.T. Johnston, D.R. McCance, A. McGinty, R.G. Watson, C.C. Patterson, J.E. Ardill, Circulating markers of prognosis and response to treatment in patients with midgut carcinoid tumours. Gut 55, 1586–1591 (2006)
U. Ploeckinger, G. Kloepp, B. Wiedenmann, R. Lohmann, representatives of 21 German NET Centers, The German NET-registry: an audit on the diagnosis and therapy of neuroendocrine tumors. Neuroendocrinology 90, 349–363 (2009)
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. 13–14
I.M. Modlin, M.D. Shapiro, M. Kidd, Carcinoid tumors and fibrosis: an association with no explanation. Am. J. Gastroenterol. 99, 2466–2478 (2004)
S. Bhattacharyya, J. Davar, G. Dreyfus, M.E. Caplin, Carcinoid heart disease. Circulation 116, 2860–2865 (2007)
S. Bhattacharyya, C. Toumpanakis, M.E. Caplin, J. Davar, Analysis of 150 patients with carcinoid syndrome seen in a single year at one institution in the first decade of the twenty-first century. Am. J. Cardiol. 101, 378–381 (2008)
M.R. Druce, N. Bharwani, S.A. Akker, W.M. Drake, A. Rockall, A.B. Grossman, Intra-abdominal fibrosis in a recent cohort of patients with neuroendocrine (“carcinoid”) tumours of the small bowel. QJM 103, 177–185 (2010)
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)
K. Oberg, Gallium-68 somatostatin receptor PET/CT: is it time to replace (111)Indium DTPA octreotide for patients with neuroendocrine tumors? Endocrine 42, 3–4 (2012)
G. Treglia, P. Castaldi, G. Rindi, A. Giordano, V. Rufini, Diagnostic performance of Gallium-68 somatostatin receptor PET and PET/CT in patients with thoracic and gastroenteropancreatic neuroendocrine tumours: a metaanalysis. Endocrine 42, 80–87 (2012)
K.L. Yim, Role of biological targeted therapies in gastroenteropancreatic neuroendocrine tumours. Endocrine 40, 181–186 (2011)
S. Singh, C. Law, Multidisciplinary reference centers: the care of neuroendocrine tumors. J. Oncol. Pract. 6, e11–e16 (2010)
D.C. Metz, J. Choi, J. Strosberg, A.P. Heaney, C.W. Howden, D. Klimstra, J.C. Yao, A rationale for multidisciplinary care in treating neuroendocrine tumours. Curr. Opin. Endocrinol. Diabetes Obes. 19, 306–313 (2012)
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Tamagno, G., Sheahan, K., Skehan, S.J. et al. Initial impact of a systematic multidisciplinary approach on the management of patients with gastroenteropancreatic neuroendocrine tumor. Endocrine 44, 504–509 (2013). https://doi.org/10.1007/s12020-013-9910-5
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DOI: https://doi.org/10.1007/s12020-013-9910-5
Keywords
- Neuroendocrine tumor
- Multidisciplinary team
- Chromogranin A
- Ki-67
- Somatostatin analogs