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Treatments and Therapies

Neuroendocrine Tumours (NETs) are diverse and complex, and therefore the treatments given depend on several factors including type and grade of NET.

Somatostatin Analogues

Patients with advanced or metastatic low or middle grade NETs will often commence monthly somatostatin analogue injections (Octreotide or Lanreotide) to control growth of tumours and, in some cases, to manage symptoms caused by hormonal secretion by the NET. These are administered by the homecare service after an initial injection by a CNS but can be also be occasionally undertaken in a GP practice.

Radionuclide therapy

PRRT (Peptide Receptor Radionuclide Therapy) is a targeted therapy used to inhibit tumour growth and reduce associated symptoms, when there has been some progression after previous therapies. It is not suitable for every patient with a NET. Currently, this therapy is given in London, in four cycles over one year but there are plans to offer this service in South Wales.

Surgery

If possible, surgery is performed with the intention of removing the tumour in the hope of a cure. Sometimes "debulking" surgery is performed in order to remove as much tumour as possible so that other treatments have less tumour to treat. Depending on where the tumours are, this could involve surgery in the bowel in a local hospital or specialised liver, pancreas or lung surgery in Cardiff or Swansea.

Chemotherapy and Other systemic treatments

Patients with higher grade NETs or ‘poorly differentiated’ neuroendocrine carcinomas often need traditional oncology treatments such as chemotherapy or radiotherapy in Velindre or South West Wales Cancer Centres. Sunitinib or Everolimus are oral medications which are options in certain situations in NETs.

Peptide Receptor Radionuclide Therapy (PRRT)

Radionuclide therapy may be of benefit in patients who have positive scans, ie patients who have positive I-123 mIBG scans may benefit from therapeutic I-131 mIBG therapy. Similarly, patients who have positive Octreotide scans or Ga68 Octreotate PET scans may benefit from agents such as Yttrium-90 DOTA Octreotide / octreotate Lutetium-177 DOTA octreotate.

In the NHS, PRRT with Lutetium-177 has recently been approved by NICE for treatment of gastroenteropancreatic (GEP) NETs. For those non-GEP NETs outside of the funded NHSE agreement for PRRT we have only been able to treat such non-GEP NET patients (i.e. bronchial NETs, paraganglioma, phaeochromocytoma, medullary thyroid cancer and those requiring retreatment, which are not funded by NHSE) within a limited prospective audit and registry of such patients. At present further inclusion of such patients beyond those currently agreed is on hold. Future treatment for such patients has yet to be defined, however if it becomes possible, it will remain limited and within the need for prospective audit the decision for PRRT if it becomes available for non-GEP NET patients will be via the Royal Free NET MDT.

Liver Embolisation

Liver embolisation, that is, cutting off the blood supply to tumours in the liver with or without the addition of chemotherapy (chemoembolization), is useful for a small group of patients with predominantly liver disease. 

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