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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -38 مورد

Initial management of locally advanced and metastatic well-differentiated low-grade (G1) and intermediate-grade (G2) gastrointestinal neuroendocrine tumors

Initial management of locally advanced and metastatic well-differentiated low-grade (G1) and intermediate-grade (G2) gastrointestinal neuroendocrine tumors
The initial management of locally advanced and metastatic well-differentiated G1 and G2 neuroendocrine tumors arising from sites in the gastrointestinal tract other than the pancreas is presented here. Listed treatments are preferred options, although alternate therapies that are not listed may also be effective. Clinical trial enrollment is encouraged, where available, given the rarity of these tumors. For further details and evidence, refer to UpToDate content on well-differentiated neuroendocrine tumors.

CT: computed tomography; G1: low-grade; G2: intermediate-grade; LAR: long-acting release; MRI: magnetic resonance imaging; PET: positron emission tomography; PRRT: peptide receptor radionuclide therapy; SSTR: somatostatin receptor.

* We obtain surveillance imaging of the abdomen and pelvis with either contrast-enhanced CT or gadolinium-enhanced MRI, along with a CT chest with or without contrast at 3 and 6 months. The frequency of subsequent imaging is based on the pace of disease progression (eg, every 6 months for slowly progressive disease).

¶ Tumor SSTR expression is determined using an SSTR PET-CT or PET-MRI. Only SSTR-positive tumors are likely to benefit from somatostatin analogs or PRRT.

Δ Some patients with tumors that lack uptake on SSTR imaging may still be candidates for a somatostatin analog for symptom control, if needed, but disease control is less certain.

◊ Eligibility criteria for PRRT include tumor SSTR expression, sufficient bone marrow reserve (grade 1 to 2 hematologic toxicity is usually acceptable), creatinine clearance >50 mL/minute, Karnofsky performance status >50, and expected survival greater than 3 months.

§ Somatostatin analog is continued during and after PRRT.

¥ Both agents are equally acceptable, effective therapies for well-differentiated NETs that can be administered with minimal patient discomfort. The cost of lanreotide can be higher than octreotide LAR.

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