Management of neuroendocrine tumors depends on tumor size, grade, and location. Because of the complexity of these tumors, and the fact that there are so many therapeutic options available for patients with neuroendocrine tumors, the Neuroendocrine Tumor Program at Baylor St. Luke’s Medical Center adapted a multidisciplinary team approach for the management of these tumors to integrate the care of neuroendocrine tumor patients and improve outcomes. This team includes specialists such as surgeons, oncologists, endocrinologists, gastroenterologists, interventional radiologists, nuclear medicine experts, pathologists, and nurses.
Treatment is usually considered on a patient-by-patient basis. Among treatment options available at the neuroendocrine program at Baylor St. Luke’s Medical Center:
Surgery: Surgical removal of the primary tumor is the only curative option available for early neuroendocrine tumors. The aim is to keep the patient disease-free for as long as possible. Surgical debulking can be advocated in patients with advanced stages for relief of symptoms due to hormonal secretion by the tumor. There are a wide range of surgical procedures that can be performed by our surgeons at the Baylor St. Luke’s Medical Center Neuroendocrine Tumors Program including minimally invasive laparoscopic liver and pancreatic resection, radiofrequency ablation of liver metastasis, laparoscopic resection of lung neuroendocrine tumors, and liver transplantation.
Hepatic Artery Embolization (TAE, TACE, and SIRT): This procedure can be employed in cases where it is not possible to surgically remove the liver tumor. It involves placing a catheter into the artery that supplies the liver to deliver small particles to occlude the blood supply into the tumors. This can be preceded by injecting chemotherapeutic drugs directly into the tumor. Other technique of hepatic artery embolization involves using millions of tiny resin microshperes, called SIR-Spheres (the size of which are about one-third the diameter of a strand of hair) which contain a radioactive element Yttrium-90 that can deliver high-dose radiation directly into the tumors, sparing normal liver tissue. We have employed this technique in large number of patients at Baylor St. Luke’s Medical Center with excellent response rate. The procedure is usually performed as an outpatient procedure under local sedation in the radiology suite and lasts about one hour from beginning to end. Most patients are discharged within 24 hours. Patients should not have any serious side effects when SIR-Spheres are correctly administered. However, during the infusion, you may experience pain.
Radiofrequency Ablation (RFA): This approach can be used either alone or combined with surgical resection in carefully selected patients. It involves placing a probe within the tumor using ultrasound guidance to deliver high-frequency waves that heat up the tumor in an effort to destroy the tumor. It can be performed by a radiologist through the skin or surgically using a laporascopic or open surgical technique. We recently employed a new technique of irreversible electroporation using the nano-knife system to ablate liver tumors in close proximity to major introhepatic blood vessels or bile ducts that could not be ablated with standard RFA.
Peptide Receptor Radionuclide Therapy (PRRT): This new and innovative approach involves intravenous injection of high-dose radioactive somatostatin analog and MIBG therapy to target neuroendocrine tumors that overexpress the somatostatin receptor. Recently, the radiologists at Baylor St. Luke’s Medical Center in collaboration with Excel Diagnostics used a novel approach to deliver high concentration of PRRT via the hepatic artery with good results.
External Beam Radiotherapy using Cyberknife Technology: Is an image-guided robotic that precisely targets and destroys tumors with multiple beams of radiation. It offers a pain-free non-surgical option for patients with neuroendocrine tumors who seek an alternative to surgery.
Biotherapy: Somatostatin analogs both alone or in combination with interferon may stabilize the disease and delay its progression. In addition, they can be used for the control of hormonal symptoms.
New chemotherapeutic agents: Are emerging that show promising response in patients with advanced neuroendocrine tumors. These include mTOR inhibitors (everolimus) alone or in combination with somatostatin analogs. A number of targeted therapies, such as the monoclonal antibodies bevacizumab and Tyrosine kinas inhibitors, sunitinib and sorafenib, are currently investigational but demonstrated promising results in a few clinical trials.
Standard chemotherapy: The slow-growing neuroendocrine tumors respond poorly to standard chemotherapy. However, it may be considered in patients with advanced poorly differentiated tumors.