From the Guidelines
For a patient with a neuroendocrine tumor of the colon with metastatic disease, the next imaging test that should be performed is a somatostatin receptor imaging study, preferably a Gallium-68 DOTATATE PET/CT scan, as it has the highest sensitivity for detecting neuroendocrine tumors, with a sensitivity of 87-96% 1. This specialized nuclear medicine scan is superior to conventional imaging for detecting neuroendocrine tumors because these tumors typically express somatostatin receptors that bind to the radiotracer.
Key Considerations
- The Gallium-68 DOTATATE PET/CT scan is the preferred imaging modality due to its high sensitivity and specificity for neuroendocrine tumors 1.
- If Gallium-68 DOTATATE is unavailable, an Indium-111 octreotide scan (Octreoscan) can be used as an alternative, though it has lower sensitivity.
- The patient should be referred to a medical oncologist who specializes in neuroendocrine tumors, ideally at a center with a multidisciplinary neuroendocrine tumor program, as early specialized care is crucial for optimal management 1.
Specialized Care
- A multidisciplinary team approach is essential for the management of neuroendocrine tumors, including gastroenterologists, surgeons, oncologists, endocrinologists, radiologists, nuclear medicine specialists, and histopathologists 1.
- The medical oncologist should have experience with the unique biology and treatment approaches for these relatively rare tumors, including considerations for somatostatin analogs (octreotide or lanreotide), targeted therapies, peptide receptor radionuclide therapy (PRRT), and cytotoxic chemotherapy depending on tumor grade and other characteristics 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Next Steps in Imaging and Special PET Tests
- For a patient with a neuroendocrine tumor of the colon with metastatic disease, the next imaging test or special PET test that needs to be performed is the 68Gallium-DOTATATE positron emission tomography-computed tomography (PET CT) 2, 3, 4.
- This imaging modality has shown superior accuracy in detecting grade 1 and 2 neuroendocrine tumors and is frequently associated with changes in management 2.
- 68Gallium-DOTATATE PET CT can noninvasively assess tumor heterogeneity, especially in G2 and G3 NETs, for personalized management of patients 3.
Special Oncology Referral
- Given the complexity of neuroendocrine tumors, a referral to a specialized oncology team or a neuroendocrine tumor center is recommended 5, 6.
- The team should include experts in medical oncology, surgical oncology, and radiation oncology to provide comprehensive care for the patient.
- The referral should be made to discuss treatment options, including surgery, chemotherapy, and targeted therapy, and to develop a personalized treatment plan.
Treatment Considerations
- For patients with metastatic disease, treatment options may include chemotherapy, targeted therapy, and palliative care 5, 6.
- The choice of treatment will depend on the tumor grade, size, location, and the patient's overall health status.
- A multidisciplinary approach to care is essential to ensure that all treatment options are considered and that the patient receives the best possible care.