Multidisciplinary Symposium—neuroendocrine Tumours

Neuroendocrine tumours (NETs) are very rare diseases characterised by a high degree of histological and clinical heterogeneity. They can be silent (even producing some hormones) or clinically evident as a result of local growth and/or hormonal production. The diagnostic and therapeutic approach to patients with NETs should be multidisciplinary. A medical oncologist should coordinate a group of experts, including a radiologist, surgeon, nuclear medicine specialist, pathologist, clinical pathologist, gastroenterologist, endocrinologist and radiotherapist, who should discuss all of the cases and define therapeutic strategies rather than single therapy indications. The therapeutic programme depends on a profound knowledge of the disease and the patient. It should begin with appropriate staging using an octreoscan, computed tomography or magnetic resonance, with ultrasound and bone scan if indicated, and serum chromogranin-A assays. Secondly, the biological characteristics of the tumour (particularly its proliferation index) should be known. If possible, the disease should be reassessed after 1 or 2 months without anti-tumoral therapy in order to evaluate the growth rate. In well-differentiated NETs with a high density of somatostatin 2 and 5 receptors, we are studying the feasibility and efficacy of a multimodal strategy including debulking with hepatic chemoembolisation and/or surgery for primary tumours or metastases, combined with systemic treatment with a somatostatin analogue and interferon, and followed by targeted radiotherapy with 90Y-DOTATOC or 177Lu-DOTATATE. About 40 patients have been treated in this way, 15 of whom received a combination of surgery, chemoembolisation, 90Y-DOTATOC and hormonal therapy in various sequences. The preliminary results indicate that an increasing number of patients with NETs can avoid potentially toxic treatment such as chemotherapy.