MODERN APPROACHES AND RECENT ADVANCES IN NEUROENDOCRINE TUMORS

Modern Approaches and Recent Advances in Neuroendocrine Tumors-kapak

FOLLOW-UP AFTER SURGICAL AND SYSTEMIC THERAPY IN NEUROENDOCRINE TUMORS

Fırat Mülküt1 Sena Çağla Özden2

1Şehit Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, Department of General Surgery, İstanbul, Türkiye
2Haseki Training and Research Hospital, Department of General Surgery, İstanbul, Türkiye

Mülküt F, Özden SÇ. Follow-up After Surgical and Systemic Therapy in Neuroendocrine Tumors. In: Gönüllü E, Karaman K, editors. Modern Approaches and Recent Advances in Neuroendocrine Tumors. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.191-199.

ABSTRACT

This review provides a comprehensive overview of follow-up strategies for patients receiving systemic therapy for neuroendocrine tumors (NETs). Due to the heterogeneous nature of these tumors, an individualized, risk-based approach to follow-up is essential for optimal patient management. The article outlines key components of patient monitoring including follow-up frequency, physical examination protocols, laboratory testing, radiological evaluation, and side effect management. Follow-up frequency should be tailored according to tumor grade, with more frequent evaluations recommended during the initial treatment period and for higher-grade tumors. Grade 1 tumors may require assessment every 3-4 months, while Grade 3 tumors warrant closer monitoring at 6-8 week intervals. Physical examination and clinical history remain fundamental for assessing treatment response and detecting complications, particularly for functional NETs with hormonal syndromes. The laboratory follow-up section details both general tests (complete blood count, liver and renal function) and disease-specific markers such as Chromogranin A and 5-HIAA. Radiological follow-up employs both conventional imaging (contrast-enhanced CT, MRI) and functional modalities like Ga-68/Cu-64 DOTATATE PET/CT, with RECIST 1.1 criteria serving as the standard for response evaluation. The high-risk patient population is characterized by Grade 2-3 tumors with Ki-67 >10%, extensive metastatic disease, uncontrolled hormonal syndromes, rapid progression, and significant organ dysfunction. These patients require more intensive monitoring protocols. Side effect management is addressed for various treatment modalities including somatostatin analogs, targeted therapies (everolimus, sunitinib), chemotherapy, and peptide receptor radionuclide therapy (PRRT). Early detection and appropriate management of these adverse effects are critical for treatment adherence and success. This systematic approach to follow-up care improves treatment outcomes while preserving quality of life through early detection of disease progression and complications in NET patients receiving systemic therapy.

Keywords: Neuroendocrine tumors; Follow-up studies

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