Management of Small Bowel Neuroendocrine Tumours: 10 Years’ Experience at a Tertiary Referral Centre
Clift AK., Drymousis P., von Roon A., Humphries A., Goldin R., Bomanji J., Leaman S., Wasan H., Habib N., Frilling A.
Background: Neuroendocrine tumours (NET) arising from the small bowel are clinically challenging and are often diagnosed at advanced stages. Disease control with surgery alone can be demanding. Multimodal treatment concepts integrating surgery and non-surgical modalities could be of benefit. Method: Retrospective review of consecutive adult patients with SB NET treated at Imperial College Healthcare NHS Trust between 1 January 2010 and 31 December 2019. Data regarding clinicopathological characteristics, treatments, and disease trajectory were extracted and summarised. Overall and progression/recurrence-free survival were estimated at 5 and 10 years. Results: 154 patients were identified, with a median age of 64 years (range 33–87); 135/154 (87.7%) had stage III/IV disease at diagnosis. Surgery was used in 125 individuals (81.2%), typically with either segmental small bowel resection (60.8%) or right hemicolectomy (33.6%) and mesenteric lymphadenectomy for the primary tumour. Systemic and/or liver-directed therapies were used in 126 (81.8%); 60 (47.6%) had more than one line of non-surgical treatment. Median follow-up was 67.2 months (range 3.1–310.4); overall survival at 5 and 10 years was 91.0% (95% CI: 84.9–94.7%) and 82.5% (95% CI: 72.9–88.9%), respectively. Imaging-based median progression-free survival was 42.7 months (95% CI: 24.7 to 72.4); 5-year progression-free survival was 63.4% (95% CI: 55.0–70.6%); 10-year progression-free survival was 18.7% (95% CI: 12.4–26.1). Nineteen patients (12.3%) reached 10 years follow-up without disease recurrence and therefore were considered cured. Conclusions: Most patients with SB NET present in a metastasised stage. Multimodal treatment concepts may be associated with excellent clinical outcomes. Future work should explore optimal approaches to treatment sequencing and patient selection.