The Chicago Consensus on peritoneal surface malignancies: Management of neuroendocrine tumors

Schuitevoerder, Darryl; Plana, Alejandro; Izquierdo, Francisco J.; Lambert, Laura; Keutgen, Xavier M.; Deneve, Jeremiah L.; Ahrendt, Steven A.; Al‐kasspooles, Mazin F.; Amersi, Farin; Bowne, Wilbur B.; Brown, Charles K.; Hayes‐Jordan, Andrea; Kane, John M.; Kelly, Kaitlyn J.; Kennedy, Timothy J.; Maduekwe, Ugwuji N.; Mak, Grace Z.; Melis, Marcovalerio; Royal, Richard E.; Abbott, Daniel E.; Abdel‐Misih, Sherif; Alpert, Lindsay; Arrington, Amanda K.; Badgwell, Brian D.; Barone, Robert M.; Baumgartner, Joel M.; Berri, Richard N.; Bijelić, Lana; Blazer, Dan G.; Catenacci, Daniel V.T.; Chan, Carlos; Cho, Clifford S.; Choudry, M. Haroon A.; Clarke, Callisia N.; Cusack, James C.; Dachman, Abraham H.; Dineen, Seán; Eng, Oliver S.; Fernandez, Leopoldo; Fleshman, James W.; Gamblin, T. Clark; Gangi, Alexandra; Georgakis, Georgios V.; Gilbert, Erin W.; Goodman, Martin; Govindarajan, Anand; Grotz, Travis E.; Gushchin, Vadim; Hanna, Nader; Harmath, Carla; Husain, Aliya N.; Idrees, Kamran; Ihemelandu, Chukwuemeka; In, Haejin; Jiang, David; Johnston, Fabian M.; Karakousis, Giorgos C.; Kindler, Hedy L.; Kluger, Michael D.; Lee, Byrne; Liao, Chih‐Yi; Mack, Lloyd A.; Mammen, Joshua M.V.; Mathew, Melvy Sarah; Melnitchouk, Nelya; Merkow, Ryan P.; Mogal, Harveshp; Möller, Mecker G.; Oto, Aytekin; Pameijer, Colette R.; Pappas, Sam G.; Polanco, Patricio M.; Polite, Blasé N.; Reddy, Sanjay S.; Salti, George I.; Sardi, Armando; Senthil, Maheswari; Setia, Namrata; Sherman, Scott K.; Sidéris, Lucas; Skitzki, Joseph J.; Tun, Sandy; Veerapong, Jula; Votanopoulos, Konstantinos I.; White, Michael G.; Winer, Joshua H.; Xiao, Shu‐Yuan; Yantiss, Rhonda K.; Ahuja, Nita; Lowy, Andrew M.; Alexander, H. Richard; Esquivel, Jesús; Foster, Jason M.; Labow, Daniel M.; Levine, Edward A.; Staley, Charles A.; Sugarbaker, Paul H.; Bartlett, David L.; Turaga, Kiran K.

doi:10.1002/cncr.32865

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…Complete CRS is the best option for patients with metastatic GEP-NETs and appears to improve patient outcomes [ 144 , 145 , 146 , 147 , 148 , 149 , 150 ]. Therefore, primary tumor resection should be performed during CRS [ 145 , 151 ].…”

Section: Surgical Options For Psm From Gastroenteropancreatic Neuroen...mentioning

confidence: 99%

Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies—A Comprehensive Review

2023

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The peritoneum is a common site for the dissemination of digestive malignancies, particularly gastric, colorectal, appendix, or pancreatic cancer. Other tumors such as cholangiocarcinomas, digestive neuroendocrine tumors, or gastrointestinal stromal tumors (GIST) may also associate with peritoneal surface metastases (PSM). Peritoneal dissemination is proven to worsen the prognosis of these patients. Cytoreductive surgery (CRS), along with systemic chemotherapy, have been shown to constitute a survival benefit in selected patients with PSM. Furthermore, the association of CRS with hyperthermic intraperitoneal chemotherapy (HIPEC) seems to significantly improve the prognosis of patients with certain types of digestive malignancies associated with PSM. However, the benefit of CRS with HIPEC is still controversial, especially due to the significant morbidity associated with this procedure. According to the results of the PRODIGE 7 trial, CRS for PSM from colorectal cancer (CRC) achieved overall survival (OS) rates higher than 40 months, but the addition of oxaliplatin-based HIPEC failed to improve the long-term outcomes. Furthermore, the PROPHYLOCHIP and COLOPEC trials failed to demonstrate the effectiveness of oxaliplatin-based HIPEC for preventing peritoneal metastases development in high-risk patients operated for CRC. In this review, we discuss the limitations of these studies and the reasons why these results are not sufficient to refute this technique, until future well-designed trials evaluate the impact of different HIPEC regimens. In contrast, in pseudomyxoma peritonei, CRS plus HIPEC represents the gold standard therapy, which is able to achieve 10-year OS rates ranging between 70 and 80%. For patients with PSM from gastric carcinoma, CRS plus HIPEC achieved median OS rates higher than 40 months after complete cytoreduction in patients with a peritoneal cancer index (PCI) ≤6. However, the data have not yet been validated in randomized clinical trials. In this review, we discuss the controversies regarding the most efficient drugs that should be used for HIPEC and the duration of the procedure. We also discuss the current evidence and controversies related to the benefit of CRS (and HIPEC) in patients with PSM from other digestive malignancies. Although it is a palliative treatment, pressurized intraperitoneal aerosolized chemotherapy (PIPAC) significantly increases OS in patients with unresectable PSM from gastric cancer and represents a promising approach for patients with PSM from other digestive cancers.

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Section: Surgical Options For Psm From Gastroenteropancreatic Neuroen...mentioning

confidence: 99%

Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies—A Comprehensive Review

2023

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“…Peritoneal metastases, present in 20% of SINETs patients [ 65 ], and mesenteric masses found in >50% [ 66 ], may provide a specific resistance challenge to the activity of 177Lu-DOTATATE. Almost 40% of patients with diffuse GEP-NET peritoneal metastases showed peritoneal progression during PRRT with 177 Lu-DOTATATE [ 67 ].…”

Section: Resistance To Sstr-targeted Therapymentioning

confidence: 99%

Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine Tumors

Shi

Morse

2022

Cancers

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Gastroenteropancreatic neuroendocrine tumors (GEP-NETs), although curable when localized, frequently metastasize and require management with systemic therapies, including somatostatin analogues, peptide receptor radiotherapy, small-molecule targeted therapies, and chemotherapy. Although effective for disease control, these therapies eventually fail as a result of primary or secondary resistance. For small-molecule targeted therapies, the feedback activation of the targeted signaling pathways and activation of alternative pathways are prominent mechanisms, whereas the acquisition of additional genetic alterations only rarely occurs. For somatostatin receptor (SSTR)-targeted therapy, the heterogeneity of tumor SSTR expression and dedifferentiation with a downregulated expression of SSTR likely predominate. Hypoxia in the tumor microenvironment and stromal constituents contribute to resistance to all modalities. Current studies on mechanisms underlying therapeutic resistance and options for management in human GEP-NETs are scant; however, preclinical and early-phase human studies have suggested that combination therapy targeting multiple pathways or novel tyrosine kinase inhibitors with broader kinase inhibition may be promising.

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Performances of 18F-FDOPA PET/CT in the Preoperative Evaluation of the Peritoneal Cancer Index in Small Intestine Neuroendocrine Tumors

et al. 2022

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Purpose: Peritoneal carcinomatosis (PC) concerns up to 30% of patients with a neuroendocrine tumor (NET), especially of the small intestine. Aggressive management of carcinomatosis seems to be justified, especially with regard to possible mechanical complications. 18 F-FDOPA PET/CT is known to be the most sensitive imaging modality for the detection of small bowel NET metastases, yet its performance in the detection of PC is not well studied. The main objective of our study is to evaluate the performances of preoperative 18 F-FDOPA PET/CT in the prediction of surgical peritoneal cancer index. Methods: All patients referred to our center for an 18 F-FDOPA PET/CT from October 2017 to January 2021 were retrospectively screened. Images were analyzed by a blinded nuclear medicine physician, and peritoneal abnormalities were reported to comply with the surgical peritoneal cancer index standard. Per patient analysis and per region analysis were then conducted. Results: Thirty-three patients were included; 6 patients (35 regions) presented a peritoneal carcinosis. Peritoneal Carcinomatosis Index (PCI) estimated on 18 F-FDOPA PET/CT was significantly and strongly correlated to surgical PCI (r = 0.96, P < 0.001). Patient-based sensitivity, specificity, negative predictive value, and positive predictive value for 18 F-FDOPA PET/CT were 100%, 93%, 100%, and 75%, respectively. The agreement between 18 F-FDOPA and surgery regarding PC was excellent (Cohen κ = 0.82 on per patient analysis, 0.74 on per region analysis). Conclusions: A preoperative estimation of PCI is achievable based on 18 F-FDOPA PET/CT for small intestine NET and could allow to optimize surgical procedures and patient selection.

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The Chicago Consensus on peritoneal surface malignancies: Management of neuroendocrine tumors

Cited by 4 publications

References 16 publications

Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies—A Comprehensive Review

Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies—A Comprehensive Review

Mechanisms of Resistance in Gastroenteropancreatic Neuroendocrine Tumors

Performances of 18F-FDOPA PET/CT in the Preoperative Evaluation of the Peritoneal Cancer Index in Small Intestine Neuroendocrine Tumors

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