New guidelines for neuroendocrine tumors urge less-frequent, longer follow-up

Last Updated: 2018-08-03

By David Douglas

NEW YORK (Reuters Health) - New guidelines from an international expert panel suggest less-frequent follow-up in the short term, but longer follow-up periods overall, for completely resected gastroenteropancreatic neuroendocrine tumors (NETs).

Dr. Eva Segelov, co-founder of the Commonwealth Neuroendocrine Tumour Collaboration, explained in an email to Reuters Health that the guidelines "address an area of need for patients and health systems, making recommendations about appropriate follow-up using current best evidence, in the absence of level 1 evidence in an uncommon cancer, neuroendocrine tumours. Unlike most cancers, these tumours recur much later yet follow-up tends to be based on that recommended for more common cancers such as colorectal cancer."

Dr. Segelov, of Monash University, in Clayton, Australia, and colleagues did a real-world practice survey which revealed "that current guidelines were not useful and that compliance with existing guidelines is poor."

In a systematic review of available data, they identified six relevant studies; they supplemented these by recurrence data from two large patient series. A 22-member multidisciplinary panel gave scores to delineate how appropriate various follow-up schedules and investigations were.

As Dr. Segelov pointed out, "These guidelines based on expert consensus using a RAND/UCLA Appropriateness Method differ significantly from previous recommendations, particularly recommending less frequent follow-up visits and investigations within the first five years after resection, extending follow-up to and even beyond 10 years and importantly, defining a subgroup who have such a low risk of recurrence that no routine surveillance for recurrence is recommended."

For example, for pancreatic NETs, the team says that follow-up consultation with CT or MRI imaging should be performed every year for the first three years and then every year or two for a total of 10 years.

Patients with any positive lymph nodes or a Ki-67 index greater than 5% should be followed-up more frequently and for at least 10 years, the team writes in JAMA Oncology, online July 26. However, patients with grade 1, node-negative tumors smaller than 2 cm are among those considered at sufficiently low clinical risk to warrant no follow-up.

The researchers conclude, "These recommendations stratify follow-up strategies based on evidence-based prognostic factors that allow for a more individualized patient-centered approach to this complex and heterogeneous malignant neoplasm."

The guidelines, Dr. Segelov added, "afford the opportunity to harmonise follow-up globally and streamline resource use and patient experience."

Dr. Arvind Dasari of the University of Texas MD Anderson Cancer Center, in Houston, told Reuters Health by email, "The authors should be congratulated on trying to address an acute need in the field."

Dr. Dasari, who is co-chair of the MD Anderson multi-disciplinary neuroendocrine tumor board, added, "Frequency of surveillance depends on the clinical risk of recurrence." This is determined by a number of factors, but certain neuroendocrine tumors "are at risk of recurrence for 10 years or even more post resection and this is reflected in the duration of recommended surveillance for at least 10 years," he added.

SOURCE: https://bit.ly/2OEwT3O

JAMA Oncol 2018.