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Pancreas. 2017 Jul;46(6):707-714. doi: 10.1097/MPA.0000000000000850.

The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Medical Management of Midgut Neuroendocrine Tumors.

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From the *Department of GI Oncology, H. Lee Moffitt Cancer Center, Tampa FL; †Division of Medical Oncology, Mayo Clinic, Rochester, MN; ‡Department of Pathology, University of Iowa, Iowa City, IA; §Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; ∥Department of Medicine, University of Iowa, Iowa City, IA; ¶Departments of Medicine and Neurosurgery, University of California Los Angeles, Los Angeles; and #Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA; **Department of Radiology, Northwestern University, Chicago IL; ††Department of Oncology, Monash University and Monash Health, Melbourne, Victoria, Australia; ‡‡Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA; §§Oregon Health & Science University and ∥∥North American Neuroendocrine Tumor Society, Portland, OR; ¶¶Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA; ##Sunnybrook Hospital, Toronto, Canada; ***Department of Radiology, University of Pennsylvania, Philadelphia, PA; †††Memorial Sloan Kettering University and ‡‡‡Division of Cardiology, Mount Sinai Hospital, New York, NY; §§§Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston TX; and ∥∥∥Department of Medicine, University of California San Francisco, San Francisco, CA.


There have been significant developments in diagnostic and therapeutic options for patients with neuroendocrine tumors (NETs). Key phase 3 studies include the CLARINET trial, which evaluated lanreotide in patients with nonfunctioning enteropancreatic NETs; the RADIANT-2 and RADIANT-4 studies, which evaluated everolimus in functioning and nonfunctioning NETs of the gastrointestinal tract and lungs; the TELESTAR study, which evaluated telotristat ethyl in patients with refractory carcinoid syndrome; and the NETTER-1 trial, which evaluated Lu-DOTATATE in NETs of the small intestine and proximal colon (midgut). Based on these and other advances, the North American Neuroendocrine Tumor Society convened a multidisciplinary panel of experts with the goal of updating consensus-based guidelines for evaluation and treatment of midgut NETs. The medical aspects of these guidelines (focusing on systemic treatment, nonsurgical liver-directed therapy, and postoperative surveillance) are summarized in this article. Surgical guidelines are described in a companion article.

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