Subject: : Participation in survey “To Understand the Epidemiology and Management of Neuroendocrine Tumor in Indian Context”
Neuroendocrine tumors (NETs) encompass a heterogeneous group of tumors arising from amine‑producing neuroendocrine cells anywhere in the body. The incidence of NETs is 2 per lakh, and they account for 0.5% of all malignancies. Based on the ability to produce certain peptides, NETs are classified as being functional and nonfunctional. Based on histology, NENs can be divided into two major types: well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs).
Over the last decade, pathologic categorization, diagnostic techniques and therapeutic choices for NETs—both well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs)—have appreciably evolved. Diagnosis of NEN mostly follows a suspicion from clinical features or incidental imaging findings. Hormonal or non- hormonal biomarkers (like serum serotonin, urine 5-HIAA, gastrin and VIP) and histology of a suspected NEN is, therefore, critical for both confirmation of the diagnosis and classification as an NET or NEC.
The management of NENs has proven to be challenging because of their varied clinical presentations and response to therapy. The mainstay of treatment has been surgery, but with the evolution of pharmacotherapy in recent decades, the horizon of options has broadened. Most NETs express somatostatin receptors (SSTRs) leading to the first-line use of long-acting somatostatin analogs (SSAs) for symptomatic control. Other treatment options include everolimus, sunitinib, chemotherapy, interferon-α and PRRT, which is especially efficacious in SSTR-expressing NETs. Due to the variation in the biological behavior of these neoplasms, the combined use of nuclear imaging with and 18F-FDG-PET and 68Ga-DOTA-TOC/TATE/NOC- PET scans (dual-baseline scanning) prior to therapy with PRRT has been proposed in recent years. The detection of SSTR overexpression by 68Ga-DOTA-TOC/TATE/NOC-PET scans and the localization of foci with high glycolytic metabolism via 18F-FDG-PET scans can be used for personalization and the selection of patients for PRRT initiation. The treatment, prognosis and metastatic potential differ based on the location and histology of NET.
Multiple systemic therapies are approved for the management of NET and the treatment selection is based on the tumor histology, SSTR expression and location of the tumor.
Therefore, this multicentric survey is designed to understand the diagnostic/biomarker testing approaches and management of neuroendocrine tumors with somatostatin analogs (SSAs) and its combination in NET management in India.
If you agree to participate, you will be required to respond to questions of the enclosed questionnaire. We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this survey. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.
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