Management of Neuroendocrine Tumors: Current and Future Therapies

Kjell E Öberg

Disclosures

Expert Rev Endocrinol Metab. 2011;6(1):49-62. 

In This Article

Management of NETs: Surgery

The primary treatment goal for patients with NETs should be curative (i.e., complete resection of tumor), with symptom control and the limitation of tumor progression as secondary goals. Challenges specific to patients with NETs include determining the extent of local and distant tumors, identifying synchronous non-NETs and detection of cardiac abnormalities; the treatment plan should be modified accordingly.[6] Surgery to remove the primary malignancy and/or local lymph nodes (if affected) is currently the only possible cure so represents traditional first-line therapy. However, curative surgery is often not feasible since most patients present with metastases at diagnosis. In these patients, the extent of resection is dependent on the tumor characteristics, including its location and involvement of surrounding tissues. It is commonly accepted that resection of at least 70–90% of the tumor is required to achieve symptom control.[29–31] Approximately 60% of patients will experience symptom recurrence post surgery and the 5-year survival rate for localized and regional metastases is 35–80%.[29,32] During palliative surgery, the primary tumor should also be removed, if possible. Tumor debulking may also render medical therapy more effective by decreasing the secretion of bioactive substances as well as tumor masses.

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