MODERN APPROACHES AND RECENT ADVANCES IN NEUROENDOCRINE TUMORS

Modern Approaches and Recent Advances in Neuroendocrine Tumors-kapak

GENERAL CHARACTERISTICS AND MANAGEMENT OF PANCREATIC NEUROENDOCRINE TUMORS

Onur İlhan1 Kerem Karaman2

1Sakarya University Training and Research Hospital, Department of Gastroenterology Surgery, Sakarya, Türkiye
2Sakarya University, Faculty of Medicine, Department of Gastroenterology Surgery, Sakarya, Türkiye

İlhan O, Karaman K. General Characteristics and Management of Pancreatic Neuroendocrine Tumors. In: Gönüllü E, Karaman K, editors. Modern Approaches and Recent Advances in Neuroendocrine Tumors. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.115-131.

ABSTRACT

Although pancreatic neuroendocrine tumors (PNETs) are among the rare neoplasms of the pancreas, they have become more frequently detected in recent years thanks to improved diagnostic and therapeutic methods. Their clinical course ranges from low-grade, slow-growing tumors to aggressive and metastatic diseases.

Biochemical markers, advanced imaging modalities,and histopathological evaluation are critical in the diagnostic process. Targeted imaging techniques such as Ga-68 DOTATATE PET-CT have revolutionized the accurate localization and metastatic spread of PNETs.

Treatment strategies are determined depending on the size, functional status, metastatic spread and histological grade of the tumor. Surgery is the most effective treatment method for localized and lowgrade PNETs and is also preferred for symptom control in functional tumors. Systemic approaches such as somatostatin analogs, targeted therapies (everolimus, sunitinib), Peptide Receptor Radiopeptide Therapy (PRRT), and immunotherapy are used in metastatic or inoperable patients.

The prognosis of PNETs depends on factors such as grading, staging and metastatic status. While longterm survival rates are high in low-grade and localized tumors, the prognosis is worse in poorly differentiated neuroendocrine carcinomas (NEC G3) and metastatic disease. Regular follow-up protocols are critical to detect early disease recurrence and determine appropriate treatment strategies.

In the future, with the development of personalized medicine applications, genetic and molecular targeted therapies are expected to come to the forefront. Immunotherapy, next-generation PRRT agents, CAR-T cell therapies and multi-omic approaches may play an important role in the management of PNETs. Clinical trials will allow us to better understand the biology of these tumors and develop patient-specific treatment options.

In conclusion, PNETs are a heterogeneous tumor group and require a multidisciplinary approach. The prognosis of patients is gradually improving thanks to early diagnosis, appropriate surgical intervention, and integration of targeted therapies. Future scientific and technological advances will allow more effective management of these rare tumors.

Keywords: Pancreatic neoplasms; Neuroendocrine tumors; Insulinoma; Gastrinoma

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