Therapy for Metastatic Disease: Stomach/Duodenum, Colon/Rectum

Neuroendocrine tumors (NET), especially those of the pancreas and gastrointestinal tract, are frequently metastatic at the time of initial diagnosis. Because of a better knowledge of the molecular and cell-biological aspects as well as the clear pathological characterization of this tumor entity, a worldwide overall increase of these neuroendocrine tumors is reported. Therapeutic approaches for management of metastatic disease include surgical, medical, radiological, and nuclear medicine strategies. We present our experiences of management of three clinical cases of ileum, rectum, and gastric metastatic neuroendocrine tumors treated at the ENETS Center for Neuroendocrine Tumors of Naples, Italy. In the case of ileum-NET, we demonstrate the potent antiproliferative effect of SSA and the decisive role of the multidisciplinary approach which is able by itself to impact on survival. Then, in the case of gastric NET, we stress such awful consequences; a late and misunderstood diagnosis may have on prognosis and on the quality of life of a young patient. The role of a center of excellence devoted to NETs becomes crucial in these situations. Regarding the last case, it is a patient with G2 rectum NET. His clinical history, characterized by successive progressions of disease, is a paradigm of the G2 metastatic neuroendocrine tumors treatment. Three lines of therapy (SSA, chemotherapy, and PRRT) have followed ensuring a prolongation of survival of the patient and a good quality of life. The patient is in follow-up and maintains additional therapeutic chance.