1. ΝΕΤ MasterClass 2015 ΙΩΑΝΝΗΣ ΠΙΛΠΙΛΙΔΗΣ, MD, FEBGH
ΓΑΣΤΡΕΝΤΕΡΟΛΟΓΙΚΟ – ΟΓΚΟΛΟΓΙΚΟ ΤΜΗΜΑ
ΑΝΘ «ΘΕΑΓΕΝΕΙΟ»
Dr ΧΑΡΑΛΑΜΠΟΣ ΑΝΔΡΕΑΔΗΣ
Γ’ ΤΜΗΜΑ ΚΛΙΝΙΚΗΣ ΟΓΚΟΛΟΓΙΑΣ
ΑΝΘ «ΘΕΑΓΕΝΕΙΟ»

2. Case Presentation 52 year-old man, good health
Dyspepsia (epigastric pain): 06/2012
Upper GI Endosccopy: Duodenal ulcer
Jaudice: 07/2012
Abdominal CT: tumor within the head of the
pancreas (no mesenteric vessel involvement)

3. Question (1) Biopsy Surgery (pancreatectomy) Stenting and biopsy
Stenting and surgery
Stenting and chemotherapy

5. 7/11 G1 (64%) – 4 ασθενείς μεγαλύτερο G
Karoumpalis I, Salla Ch, Kontogeorgos G
7/11 G1 (64%) – 4 ασθενείς μεγαλύτερο G
5/13 G2 (38%) – 8 ασθενείς μικρότερο G

9. Case Presentation The patient underwent typical Whipple’s procedure
( ). R0 resection.
Pathology report: (well/poorly) differentiated NET,
ki-67 about 20%. T3, N1, M1 (metastatic nodules
intraperitoneal?). CK, Chr A, synaptophysin (+),
CD34 (+).
2nd consultation: (well/poorly) differentiated NEC
(NET), ki-67 54%

11. Epidemiology of Neuroendocrine Tumors in France: The PRONET Study
Scoazek J-Y , et al.
Results
31% of tumors were metastatic at diagnosis
Among GEP-NET: 57% were G1; 29% G2; and 14% G3
Conclusions
The relative distribution of NETs between GI and pulmonary sites in French patients is comparable to that observed in other countries
20% G3 WDNET

13. Case Presentation RESTAGING on 2-10-2012: Octreoscan: (-)
Abdominal MR imaging: (-)
Chromogranin A, NSE: (-)

14. Question (2) Wait and watch – (PET-CT scan?)
Adjuvant chemotherapy (IA/ΙΒ)
“Adjuvant” somatostatin analogues (CLARINET)
“Adjuvant” everolimus (ΙΑ)
“Adjuvant” sunitinib (ΙΑ)

17. Case Presentation The patient had received 4 cycles
chemotherapy with the combination cisplatin
+ etoposide, from 8/10/2012 –
Restaging on : multiple secondary
liver lesions (>9)
Scintigraphy on : Octreoscan: (-)

18. G1/G2

19. Question (3) PET-CT scan? 2nd line chemotherapy Chemoembolization
RFAs (>9 lesions)
Surgery
PRRTs
Everolimus - Sunitinib
PET-CT scan?

21. Elias D, Goere D, Leroux G, et al. Eur J Surg Oncol 2009; 35: 1092–97.
PET-CT scan?
Liver only disease
Liver predominant disease
Liver predominantly progression of disease
Elias D, Goere D, Leroux G, et al. Eur J Surg Oncol 2009; 35: 1092–97.

25. 10% infections, if enterobiliary anastomosis
Gillams A, Cassoni A, Conway G, Lees W, Abdom Imaging. 2005; 30: 435–41.

26. Question (4)
2nd line chemotherapy
PRRTs
Everolimus

28. 71% disease-control

32. Case Presentation Disease progression following 3 cycles of
chemotherapy with the combination
(TEM + CAP + BEV).

33. Question (5)
3nd line chemotherapy
Everolimus
PRRTs (Octreoscan: -)

39. Case Presentation 131I-MIBG (on 11/4/2013): (+) uptake
On : therapeutic dose (150 mCi 131I
MIBG)
Addition of everolimus!!!
Clinical deterioration: 6/2013, CT scan +
7/2013: 68GA-Pet/CT scan: (-)

41. Case Presentation 5-8-2013: died because of liver failure.
Surgery: R0 resection
1st line chemo (cis-etoposide)
2nd line chemo (TEM – Cap – Bev)
PRRTs + Biologic (everolimus)

42. Case Presentation Pathology report (preop biopsy)
Imaging (preoperatively)
MDT discussion (many options, many specialties)
Overtreatment!!!