From the Research
Primary malignant neuroendocrine tumors of the duodenum should be treated with surgical resection as the primary approach, with the extent of surgery depending on tumor size, location, and stage, as this approach has been shown to improve morbidity, mortality, and quality of life outcomes 1.
Treatment Approach
The treatment of primary malignant neuroendocrine tumors of the duodenum typically involves surgical resection, with the goal of removing the tumor and any affected tissue.
- For small tumors (<1 cm) without invasion, endoscopic resection may be sufficient, as it is a less invasive procedure with fewer complications 2.
- Larger tumors or those with invasion often require pancreaticoduodenectomy (Whipple procedure), which is a more extensive surgery that involves removing the tumor, the duodenum, and part of the pancreas and bile duct 3.
Medical Management
For metastatic disease, medical management is often necessary to control symptoms and slow tumor growth.
- Somatostatin analogs like octreotide LAR (20-30 mg intramuscularly every 4 weeks) or lanreotide (90-120 mg subcutaneously every 4 weeks) are recommended to control symptoms and potentially slow tumor growth 4.
- Peptide receptor radionuclide therapy (PRRT) with lutetium-177 dotatate may be used for progressive disease, as it has been shown to improve symptoms and quality of life 4.
Surveillance and Follow-up
Regular surveillance with imaging and biomarkers like chromogranin A is necessary post-treatment to monitor for recurrence, as early detection and treatment of recurrence can improve outcomes 5.
Key Considerations
When treating primary malignant neuroendocrine tumors of the duodenum, it is essential to consider the tumor size, location, and stage, as well as the patient's overall health and quality of life, to determine the best course of treatment 1.