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Summary of recommendations from expert groups for follow-up surveillance after resection of a well-differentiated gastroenteropancreatic neuroendocrine tumor

Summary of recommendations from expert groups for follow-up surveillance after resection of a well-differentiated gastroenteropancreatic neuroendocrine tumor
Organization Recommendations for SBNET Recommendations for panNET Groups not requiring follow-up
NCCN[1] Clinical review at 3 to 12 months with biomarkers and CT or MRI as clinically indicated; then review every 6 to 12 months for maximum of 10 years. Clinical review at 3 to 12 months with biomarkers and CT or MRI as clinically indicated; then review every 6 to 12 months for maximum of 10 years. Appendiceal NET <2 cm completely resected by appendicectomy "as clinically indicated"; rectal NET <1 cm with negative margins.
ENETS[2,3]

Grade 1: US, CT, or MRI at 6 and 12 months, then yearly or longer; octreoscan (or gallium-68-based PET) at baseline and every 2 years.

Grade 2-3: US, CT, or MRI every 3 months indefinitely; octreoscan (or gallium-68-based PET) at 3 months and yearly.

Grade 1: US, CT, or MRI at 6 and 12 months, then yearly or longer; octreoscan (or gallium-68-based PET) at baseline and every 2 years.

Grades 2-3: US, CT, or MRI every 3 months indefinitely; octreoscan (or gallium-68-based PET) at 3 months and yearly. 		Appendiceal NET <1 cm completely resected by appendicectomy; appendiceal NET >1 cm completely resected by right hemicolectomy without LN involvement; completely resected rectal NETs <1 cm.
ESMO[4]

Grades 1-2: Biochemistry and CT or MRI every 3 to 6 months.

Grade 3: Every 2 to 3 months. Octreoscan after 18 to 24 months if SRS positive.

Grades 1-2: Biochemistry and CT or MRI every 3 to 6 months.

Grade 3: Every 2 to 3 months. Octreoscan after 18 to 24 months if SSTR positive. 		Not listed.
NANETS[5,6] Stages I-III: Long-term surveillance (at least 10 years); imaging every 6 months transitioning to annual imaging over time. No routine SSTR imaging required. CT or MRI 3 to 6 months after resection, then every 6 to 12 months for at least 7 years. Consider CgA or hormone markers if elevated levels at baseline, and nuclear imaging for suspected recurrence. Stage I rectal NETs.
CommNETs Grade 1: CT every 12 months for 3 years, then every 1 to 2 years for total of at least 10 years; no biochemistry. Grade 1: CT every 12 months for 3 years, then every 1 to 2 years for 10 years; no biochemistry. Midgut: Incidental grade 1, stage I tumors; pancreas: grade 1, node-negative, <2 cm tumors; rectal: grade 1, node-negative, T1 tumors; appendix: grade 1, <1 cm tumors.
NET: neuroendocrine tumor; SBNET: small bowel NET; panNET: pancreatic NET; NCCN: National Comprehensive Cancer Network; CT: computed tomography; MRI: magnetic resonance imaging; ENETS: European Neuroendocrine Tumor Society; US: ultrasound; PET: positron emission tomography; LN: lymph node; ESMO: European Society for Medical Oncology; SRS: somatostatin receptor scintigraphy; SSTR: somatostatin receptor; NANETS: North American Neuroendocrine Tumor Society; CgA: chromogranin A; CommNETs: Commonwealth Neuroendocrine Tumour Collaboration.
Reproduced with permission from: Singh S, Moody L, Chan DL, et al. Follow-up Recommendations for Completely Resected Gastroenteropancreatic Neuroendocrine Tumors. JAMA Oncol 2018; 4(11):1597-1604. Copyright © 2018 American Medical Association. All rights reserved.
  1. ​Dasari A, Shen C, Halperin D, et al. Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 2017; 3:1335.
  2. Hallet J, Law CHL, Cukier M, et al. Exploring the rising incidence of neuroendocrine tumors: a population-based analysis of epidemiology, metastatic presentation, and outcomes. Cancer 2015; 121:589.
  3. Pape U-F, Niederle B, Costa F, et al; Vienna Consensus Conference participants. ENETS consensus guidelines for neuroendocrine neoplasms of the appendix (excluding goblet cell carcinomas). Neuroendocrinology 2016; 103:144.
  4. Meyerhardt JA, Mangu PB, Flynn PJ, et al; American Society of Clinical Oncology. Follow-up care, surveillance protocol, and secondary prevention measures for survivors of colorectal cancer: American Society of Clinical Oncology clinical practice guideline endorsement. J Clin Oncol 2013; 31:4465.
  5. Kunz PL, Reidy-Lagunes D, Anthony LB, et al; North American Neuroendocrine Tumor Society. Consensus guidelines for the management and treatment of neuroendocrine tumors. Pancreas 2013; 42:557.
  6. Strosberg JR, Halfdanarson TR, Bellizzi AM, et al. The North American Neuroendocrine Tumor Society consensus guidelines for surveillance and medical management of midgut neuroendocrine tumors. Pancreas 2017; 46:707.
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