Endocrine Abstracts

Introduction: Accurate survival data for patients with neuroendocrine tumours (NETs) across the UK has been difficult to capture. Individual centres often report good survival rates, however, national data has not previously been available. Pulmonary neuroendocrine tumours (NETs) cover a spectrum of histological disease, including typical carcinoid, atypical carcinoid and large cell neuroendocrine carcinoma. Surgical resection with curative intent is advocated in the majority of cases provided the patient is fit enough to tolerate lung resection. There is little consensus between key international groups on the most appropriate post-surgical follow up guidelines for pulmonary NETs. Based upon evidence available, existing guidelines and individual clinical experience, we have developed the Glenfield Pulmonary NETs Guidelines which we present for discussion. The majority of NET recurrences occur in the first couple of years, but recurrence may occur at 10 years, or more, after initial resection. Whilst ‘longer-term follow up’ of these patients is widely recommended there is no consensus on the precise duration of this follow up, nor the frequency of clinical review or repeat imaging/investigations. Our regional guidelines cover initial assessment of each patient and advocate consideration of surgical resection in the majority of cases, even in N2-positive disease (given the normally slow progression of NETs). Most cases will initially be discussed in the local lung cancer multidisciplinary meeting (MDT). However, it is advised that biopsy-proven cases are discussed in the regional, specialist, neuroendocrine MDT. The key considerations with regard to post-surgical follow-up are its duration, as well as repeat imaging modality and frequency. Initial follow up reflects our local lung cancer protocol (3 monthly clinic for 2 years then yearly with repeat CT chest at 6 months, 12 months, 2 years and 5 years) but this annual clinic review is then extended for a total of 20 years follow up. Contrast CT is accepted as the gold-standard imaging and this is recommended every 3 years after the initial 5 year follow up period. In contrast to the European Neuroendocrine tumour society guidelines, repeat octreotide scans and bronchoscopies are not recommended in the majority of cases. Our guidelines involve less frequent imaging than the European groups may advocate, however, we feel these guidelines are appropriate and safe, whilst considering wider factors such as patient preferences and health service funding.