Modern opportunities and problematic aspects of diagnostics and treatment of patients with neuroendocrine tumors

Abstract

Objective. To study modern diagnostic capabilities and identify available ways to improve the results of treatment of patients with NET of the digestive organs. Neuroendocrine tumors (NET) are neoplasms difficult to diagnose and treat, which are localized mainly in the digestive tract.

Materials and methods. The results of observation of 325 patients with NET were studied: gastrointestinal tract – in 189 (58.1 %) persons, pancreas – in 125 (38.5 %), without established localization – in 11 (3.4 %). NET of various malignancy prevailed – 92.3 %. Laboratory diagnostics included tumor markers (CGA, serotonin, 5-HIAA, etc.), instrumental – endoscopic (FGS, FCS), radiation (US, CT, MRI), radioisotope (PET-CT with 18-FDG, 68-Ga-peptides) and morphological (histology, immunohistochemistry) research.

Results. Nonspecific symptoms were noted in 38–48 % of patients, asymptomatic course – in 20–25 %. The sensitivity of CGA was 54 %, serotonin and 5- HIAA – depended on the presence of carcinoid syndrome and the prevalence of the tumor. Multiphase CT is the main method of diagnosis of small intestinal NET, which allows you to differentiate pancreatic NET by the degree of malignancy. The surgical intervention provides the best results in the treatment of patients with non-metastatic NET, but in case of generalized tumors, its combination with antitumor therapy prolongs the duration of life in patients by 2 times.

Conclusions. Personalized therapeutic and diagnostic tactics, taking into account the clinical and morphological features of NET, ensures optimal detection and treatment, improves survival and quality of life among patients.

Keywords

neuroendocrine tumor / neuroendocrine carcinoma / chromogranin-A / carcinoid syndrome / surgical treatment / cytoreduction / biotherapy

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