From the Guidelines
Kemoterapi untuk tumor neuroendokrin rektal biasanya melibatkan penggunaan temozolomide dan capecitabine, dengan tingkat respons objektif sebesar 70% dan waktu bertahan bebas progresi median 18 bulan, seperti yang dilaporkan pada penelitian terbaru 1. Pengobatan tumor neuroendokrin rektal tergantung pada tingkat diferensiasi tumor, stadium, dan faktor pasien. Untuk tumor neuroendokrin rektal yang terdiferensiasi baik (G1/G2), kemoterapi biasanya disimpan untuk penyakit metastatik dan dapat melibatkan regimen seperti capecitabine plus temozolomide, atau kombinasi streptozocin dengan 5-fluorouracil. Beberapa pilihan kemoterapi yang dapat digunakan adalah:
- Temozolomide dan capecitabine, dengan tingkat respons objektif sebesar 70% dan waktu bertahan bebas progresi median 18 bulan 1
- Streptozocin dan doxorubicin, dengan tingkat respons objektif sebesar 39% 1
- 5-FU, doxorubicin, dan streptozocin, dengan tingkat respons objektif sebesar 39% 1 Pengobatan harus dilakukan oleh tim multidisiplin yang mempertimbangkan status kinerja pasien, komorbiditas, dan karakteristik tumor.
From the Research
Diagnosis and Treatment of Rectal Neuroendocrine Tumors
- Rectal neuroendocrine tumors (NETs) are increasingly identified at endoscopy, possibly due to bowel cancer screening programs 2.
- The incidence of rectal NETs is approximately 1 per 100,000 population per year, with the majority (80-90%) being <1 cm and localized to the submucosa 2.
- Metastatic disease is infrequent (<20%) with risk factors including size, atypical appearance, grade, and depth of invasion 2.
Management of Rectal Neuroendocrine Tumors
- Device-assisted endoscopic mucosal resection and endoscopic submucosal dissection are used to resect localized rectal NETs <2 cm 2.
- Transanal surgery is also used to resect localized 1-2 cm rectal NETs 2.
- Oncological surgical resection is used for rectal NETs that are >2 cm or with invasion and regional disease 2.
- The treatment of advanced disease is multimodal, and referral to neuroendocrine tumor centers for patients with locally advanced disease or metastatic disease is recommended 2.
Imaging and Surveillance
- Imaging of rectal NETs includes two primary categories: anatomic/morphologic imaging and functional/molecular imaging 3.
- Low-risk local rectal NETs can be resected endoscopically, and high-risk or locally advanced neoplasms can be treated with radical surgery and lymphadenectomy and/or chemoradiation 3.
- Surveillance is recommended after removal of rectal NETs, but the indications for surveillance are scarce and poorly codified by international guidelines 4.
Effectiveness of Endoscopic Resection
- Endoscopic resection is more effective than biopsy or endoscopic ultrasound (EUS) to detect residual rectal neuroendocrine tumor 5.
- Salvage endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) of the prior resection site can be considered if an advanced resection is not performed initially 5.