Imaging-guided precision medicine in non-resectable gastro-entero-pancreatic neuroendocrine tumors: A step-by-step approach. Issue 122 (January 2020)

• Record Type: Journal Article
• Authors: Rozenblum, Laura; Mokrane, Fatima-Zohra; Yeh, Randy; Sinigaglia, Mathieu; Besson, Florent L.; Seban, Romain-David; Zadro, Charline; Dierickx, Lawrence; Chougnet, Cecile N; Partouche, Ephraim; Revel-Mouroz, Paul; Zhao, Binsheng; Otal, Philippe; Schwartz, Lawrence H.; Dercle, Laurent
• Is Part Of: European journal of radiology. Issue 122(2020)
• Publication Date: 2020-01
• Subjects: ADC Apparent diffusion coefficient -- CEUS Contrast enhanced ultra sound examination -- CT Computed tomography -- DEB Drug-eluting beads -- DOPA Dihydroxyphenylalanine -- DOTATOC DOTA0-Phe1-Tyr3 octreotide -- ECL Enterochromaffin-like -- ENETs European Neuroendocrine Tumor Society -- EUS Endoscopic ultra sound examination -- 18F-FDG 18Fluoro-Fluorodeoxyglucose -- 68Ga Gallium-68 -- GEP Gastroenteropancreatic -- giNET Gastro-intestinal neuroendocrine tumors -- IACIG Intra-arterial injection of calcium -- ICM Immune-checkpoint modulators -- Ifα Interferon α -- IOUS Intra operative ultra sound examination -- MRI Magnetic resonance imaging -- NET Neuroendocrine tumors -- OS Overall survival -- PD-L1 Programmed death-ligand 1 -- PET Positron emission tomography -- PERCIST PET Response Criteria in Solid Tumors -- PFS Progression-free survival -- pNET Pancreatic neuroendocrine tumor -- PRRT Peptide receptor radionuclide therapy -- RECIST Response Evaluation Criteria in Solid Tumors -- SIRT Selective internal radiotherapy -- SSA Somatostatin analogs -- SSTR Somatostatin receptor -- SSTR-PET Somatostatin receptor PET -- SSTR scintigraphy Somatostatin receptor scintigraphy -- SUV Standard uptake value -- TAE Transarterial embolization -- TACE Transarterial chemoembolization -- WHO World Health Organization -- Y-90 Yttrium-90; Neuroendocrine tumors -- Unresectability -- PET-CT -- Theranostics -- Somatostatin receptors; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2019.108743
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Medical imaging is pivotal for risk stratification and treatment planning. Imaging assesses non-invasively tumor spatial and temporal heterogeneity. The diagnostic accuracy of medical imaging varies with tumor type and metastatic site. There are several interventional approaches in non-resectable patients. Response assessments should be tailored to the type of systemic treatments. Abstract: The majority of gastroenteropancreatic (GEP) neuroendocrine tumors (NETs) are diagnosed at a non-resectable stage due to non-specific clinical syndromes, late manifestations from mass effects, or incidental detection of a clinically silent disease. Management strategies include curative or cytoreduction surgery, imaging-guided intervention, chemotherapy, immunotherapy, and radionuclide therapies. In this step-by-step review, we provide a structured approach for standardized reading and reporting of medical imaging studies covering content and terminology. This review explains which imaging studies should be used for different NETs and what should be reported when interpreting these studies. This standardized data collection guide should enable precision medicine for the management of patients with GEP-NETs of neuroectodermal origin: gastrointestinal-NETs (giNETs) and pancreatic NETs (pNETs). To improve outcomes from GEP-NETs, it contains a comprehensive evaluation of imaging aids for determining surgical non-resectability, and serves as a surrogate measure for tumor differentiation and proliferation, assessing the spatial and temporal heterogeneity of the tumor sites with prognostic and therapeutic implications.