Less frequent, longer-term follow-up recommended for neuroendocrine tumours
Patients with completely resected gastroenteropancreatic neuroendocrine tumours (NETs) should undergo less frequent follow-up in the short term but have the overall follow-up duration extended to 10 years or more, an international panel of experts recommended.
Consensus is currently lacking on the optimal approach of follow-up for patients with completely resected gastroenteropancreatic NETs. While published guidelines emphasize closer surveillance in the first 3 years after resection, the experts, from the Commonwealth Neuroendocrine Tumour Collaboration (CommNETS) Follow-up Working Group, pointed out that NETs have a different pattern of recurrence and tend to recur much later than more common cancers. [JAMA Oncol 2018, doi: 10.1001/jamaoncol.2018.2428]
“As such, surveillance practice is diverse and compliance with current guidelines is poor, as shown in a multinational real-world survey conducted by our group,” they noted. “More practical and tailored follow-up is required for patients with completely resected gastroenteropancreatic NETs.”
Based on a systemic review of six relevant studies supplemented by recurrence data from two large patient series, the experts suggested that patients with completely resected pancreatic NETs should be monitored with CT or MRI annually for the first 3 years, followed by every 1–2 years thereafter for a total of 10 years.
More frequent follow-up (ie, every 6–12 months for 3 years, and every 1–2 years thereafter for at least 10 years) is warranted for patients with completely resected pancreatic NETs with a Ki-67 index above 5 percent and those with any positive lymph nodes due to their high risk of recurrence.
However, no follow-up is warranted for patients considered at sufficiently low clinical risk, namely those with grade 1 node-negative tumours smaller than 2 cm, and those with completely resected insulinomas of any size with either no suspected nodal activity or nodal activity formally classified as N0 based on nodes removed.
For patients with completely resected midgut or hindgut NETs, follow-up should be performed every 1–2 years for at least 10 years, the experts recommended. CT or MRI should be performed annually for the first 3 years for these patients, followed by every 1–2 years thereafter for at least 10 years in total.
Increased frequency of follow-up is recommended for patients with completely resected midgut or hindgut NETs who had a Ki-67 index above 10 percent, and those with a higher number or ratio of positive lymph nodes. Minimal or no follow-up is warranted for patients with incidental midgut NETs of grade 1, T1/T2 N0 (stage I).
No biomarkers are recommended for routine follow-up except for patients with functional pancreatic NETs, for whom serial assay of the relevant hormone may be useful in postresection surveillance.