Current practice in approaching controversial diagnostic and therapeutic topics in gastroenteropancreatic neuroendocrine neoplasm management. Belgian multidisciplinary expert discussion based on a modified Delphi method
| Journal | Volume 83 - 2020 |
| Issue | Fasc.4 - Expert Point of View |
| Author(s) | P.-J. Cuyle 1, K. Geboes 2, S. Carton 1, V. Casneuf 3, J. Decaestecker 4, M. De Man 2, G. Demolin 5, C. M. Deroose 6, C. De Vleeschouwer 7, P. Flamen 8, A. Hendlisz 9, A. Hoorens 10, J. Janssens 11, I. Karfis 8, W. Lybaert 12, G. Machiels 9, E. Monsaert 13, I. Sinapi 14, E. Van Cutsem 15, T. Vandamme 16, I. Borbath 17, C. Verslype 15 |
| Full article |
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Affiliations: (1) Gastroenterology/Digestive Oncology, Imelda General Hospital, Bonheiden, Belgium
(2) Gastroenterology, Digestive Oncology, Ghent University Hospital, Ghent, Belgium (3) Gastroenterology/Digestive Oncology, OLV Hospital, Aalst, Belgium (4) Gastroenterology/Digestive Oncology, AZ Delta Hospital, Roeselare, Belgium (5) Gastroenterology/Digestive Oncology, Centre Hospitalier Chrétien St-Joseph, Liège, Belgium (6) Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium (7) Gastroenterology/Digestive Oncology, Mariaziekenhuis Noord-Limburg, Pelt, Belgium (8) Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (9) Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium (10) Pathology, Ghent University Hospital, Ghent, Belgium (11) Gastroenterology/Digestive Oncology, AZ Turnhout, Turnhout, Belgium (12) Medical Oncology, AZ Nikolaas, Sint-Niklaas, Belgium (13) Gastroenterology/Digestive Oncology, AZ Maria Middelares, Ghent, Belgium (14) Medical Oncology, Grand Hôpital de Charleroi, Charleroi, Belgium (15) Digestive Oncology, University Hospitals Leuven, Leuven, Belgium (16) NETwerk, Antwerp University Hospital, Edegem, Belgium (17) Gastroenterology/Digestive Oncology, Cliniques Universitaires Saint- Luc, Brussels, Belgium |
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Background and study aims: Neuroendocrine neoplasms (NENs) are relatively rare, with marked clinical and biological heterogeneity. Consequently, many controversial areas remain in diagnosis and optimal treatment stratification for NEN patients. We wanted to describe current clinical practice regarding controversial NEN topics and stimulate critical thinking and mutual learning among a Belgian multidisciplinary expert panel Patients and methods: A 3-round, Delphi method based project, coordinated by a steering committee (SC), was applied to a predefined multidisciplinary NEN expert panel studying the following controversial topics : factors guiding therapeutic decision making, the use of somatostatin analogues (SSA) in adjuvant setting, the interference between non-radioactive and radioactive SSAs, challenging small intestine neuroendocrine tumor (NET) cases, the approach of the carcinoid syndrome, the role of chemotherapy in well differentiated NET, the relevance of NET G3 and neuroendocrine carcinoma subclassification and the role of imaging techniques in NEN management. Results: A high level of consensus exists regarding the necessary diagnostic work-up, use of imaging techniques and interference between non-radioactive and radioactive SSAs. However, the prognostic impact of tumor functionality might be overrated and adequate diarrhea differential diagnostic work-up in these patients is underused. Significant differences are seen between individual experts and centers regarding treatment preferences both on the treatment modality level, as well as the choice of specific drugs (e.g. chemotherapy regimen). Conclusions: A Delphi-like multi-round expert discussion proves useful to boost critical thinking and discussion among experts of different background, as well as to describe cur- rent clinical practice and stimulate mutual learning in the absence of high-level scientific guidance. Keywords: neuro-endocrine tumor, neuroendocrine carcinoma, multidisciplinary team (MDT). |
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© Acta Gastro-Enterologica Belgica. PMID 33321023 |
