| Theme |
Benign to Low-malignant Pancreatobiliary Lesionst |
| Title |
Pancreatic Neuroendocrine Tumors |
| Author |
Nao Fujimori |
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University |
| Author |
Tetsuhide Ito |
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University |
| Author |
Hisato Igarashi |
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University |
| Author |
Yusuke Niina |
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University |
| Author |
Takamasa Oono |
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University |
| Author |
Ryoichi Takayanagi |
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University |
| [ Summary ] |
Pancreatic neuroendocrine tumors (PNETs) are classified as functioning or non-functioning tumors and are considered to be relatively rare. Recently, the WHO classification of the histopathology of PNETs has been outlined. According to a Japanese nationwide survey of PNETs, nonfunctioning tumors constituted 47.7 % of PNETs. Next in frequency were insulinoma (31.7 %)and gastrinoma (8.6 %). To manage PNETs, precise diagnosis of disease existence and tumor localization are important. Serum chromogranin A tests and somatostatin receptor scintigraphy are useful diagnostic tools. However, those modalities are not covered by the public health insurance system in Japan. Surgery is the only modality offering a possible cure. These surgical techniques include enucleation, distal pancreatectomy, and pancreatico-duodenectomy. Medical management should be considered for patients who are unable to undergo curative surgical resection. Treatment with a combination of other procedures, such as somatostatin analogs, arterial embolization, chemoembolization, radiofrequency ablation and systemic chemotherapy, has been developed. Somatostatin analogs such as octreotide are highly effective in controlling symptoms related to hormonal hypersecretion. Furthermore, octreotide has also demonstrated an anti-tumor effect with stabilization of tumor growth. Recently, several clinical trials of new molecular targeted agents, such as RAD001 (everolimus) or sunitinib for the treatment of PNETs have been carried out. These novel antitumor agents alone or in combination with other agents can be good therapeutic options for PNET treatment in the future. |