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Special Communication
November 2018

Follow-up Recommendations for Completely Resected Gastroenteropancreatic Neuroendocrine Tumors

Author Affiliations
  • 1Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  • 3Perelman School of Medicine, Department of Gastroenterology, University of Pennsylvania, Philadelphia
  • 4Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Centre, Tampa, Florida
  • 5Department of Internal Medicine, University of Ottawa, Ottawa, Ontario, Canada
  • 6Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
  • 7Department of Medical Oncology, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco
  • 8North American Neuroendocrine Tumor Society, Albany, New York
  • 9Department of Endocrinology, Wellington Regional Hospital, Wellington, New Zealand
  • 10Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
  • 11Department of Gastroenterology, Mount Sinai Hospital, New York, New York
  • 12Department of Nuclear Medicine, Peter MacCullum Cancer Centre, Melbourne, Australia
  • 13Department of Surgery, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 14Department of Medical Oncology, Auckland Hospital, Auckland, New Zealand
  • 15Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
  • 16Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  • 17Department of Medical Oncology, Peter MacCullum Cancer Centre, Melbourne, Australia
  • 18Department of Surgery, Tom Baker Cancer Centre, Calgary, Alberta, Canada
  • 19Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
  • 20Department of Surgery, Oregon Health & Science University, Portland
  • 21Perelman School of Medicine, Department of Medical Imaging, University of Pennsylvania, Philadelphia
  • 22Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Queensland, Australia.
  • 23Department of Medical Oncology, Monash University, Clayton, Australia
JAMA Oncol. 2018;4(11):1597-1604. doi:10.1001/jamaoncol.2018.2428
Abstract

There is no consensus on optimal follow-up for completely resected gastroenteropancreatic neuroendocrine tumors. Published guidelines for follow-up are complex and emphasize closer surveillance in the first 3 years after resection. Neuroendocrine tumors have a different pattern and timescale of recurrence, and thus require more practical and tailored follow-up. The Commonwealth Neuroendocrine Tumour Collaboration convened an international multidisciplinary expert panel, in collaboration with the North American Neuroendocrine Tumor Society, to create patient-centered follow-up recommendations for completely resected gastroenteropancreatic neuroendocrine tumors. This panel used the RAND/UCLA (University of California, Los Angeles) Appropriateness Method to generate recommendations. A large international survey was conducted outlining current the surveillance practice of neuroendocrine tumor practitioners and shortcomings of the current guidelines. A systematic review of available data to date was supplemented by recurrence data from 2 large patient series. The resultant guidelines suggest follow-up for at least 10 years for fully resected small-bowel and pancreatic neuroendocrine tumors and also identify clinical situations in which no follow-up is required. 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.

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