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Background <p>Neuroendocrine neoplasms (NEN) with peritoneal metastases (PM) represent a complex clinical challenge due to low incidence and heterogeneous phenotypes. This manuscript describes the results of a national consensus aimed at addressing clinical management of patients with NEN-PM.</p> Methods <p>An update of the 2018 Chicago consensus guidelines was conducted using a modified Delphi technique, encompassing two rounds of voting. The levels of agreement for various pathway blocks were assessed. Key systemic therapy concepts were summarized by content experts. Supporting evidence was evaluated via a rapid literature review. </p> Results <p>Overall, the level of evidence for the management of PM in this disease was universally low. In total, 107 participants responded in the first round, with 88/107 (82%) participating in the second round. Strong consensus (&gt; 90%) was achieved in 5/7 (71%) and 7/7 (100%) blocks in rounds I and II respectively. A multidisciplinary approach including psychosocial and wellness assessments received a strong positive recommendation. Management of NENs with PM was organized according to disease grade and symptom profiles. In grade 1 and 2 well-differentiated NENs, cytoreductive surgery (CRS) received strong support (&gt;95%) following the management of functional syndromes (if present). For grade 3 well-differentiated NENs, systemic therapy is the primary recommendation, with surgical resection considered in select cases.</p> Conclusion <p>Given limited evidence, the consensus-driven clinical pathway offers vital clinical guidance for the management on NENs with PM. The need for high-quality evidence remains critical to the field</p>

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Consensus Guideline for the Management of Peritoneal Metastases from Neuroendocrine Neoplasms

  • 期刊论文

  • 发表日期：

    2025年6月25日

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  • David G. Su,
  • Leanne M. Brown,
  • Varun V. Bansal,
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  • Craig Gunderson,
  • Emily Bergsland,
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  • Al B. Benson III,
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  • Alexander Loftus,
  • Alexander S. Thomas,
  • Alicia Greene,
  • Alissa Greenbaum,
  • Amanda Arrington,
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  • Anai Kothari,
  • Anand Govindarajan,
  • Andreana N. Holowatyj,
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  • Andres Abreu,
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  • Anwaar Saeed,
  • Armando Sardi,
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  • Darryl Outlaw,
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  • Devon Freudenberger,
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  • Elizabeth Godfrey,
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  • Georgios Georgakis,
  • Georgios Karagkounis,
  • Gilbert Murimwa,
  • Giorgos Karakousis,
  • Grace Zee Mak,
  • Hallbera Gudmundsdottir,
  • Hanlin L. Wang,
  • Hanna Sanoff,
  • Harveshp Mogal,
  • Heloisa Prado Soares,
  • Hunter Witmer,
  • Ian Solsky,
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  • Ira Leeds,
  • J. Randolph Hecht,
  • Jackson Baril,
  • James Cusack Campbell Jr,
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  • Jane Wang,
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  • Mazin Al-Kasspooles,
  • Mecker Moller,
  • Mehraneh D Jafari,
  • Melanie Ongchin,
  • Michael Foote,
  • Michael D. Kluger,
  • Michael Soulen,
  • Michael Wach,
  • Mikaël Soucisse,
  • Mio Kitano,
  • Mohamed Adam,
  • Mohammad Haroon Asif Choudry,
  • Mohammed Suraju,
  • Mojgan Hosseini,
  • Mustafa Raoof,
  • Nabil Wasif,
  • Nadège Fackche,
  • Nader Hanna,
  • Namrata Vijayvergia,
  • Neal Bhutiani,
  • Niraj J. Gusani,
  • Oliver Eng,
  • Olivier Glehen,
  • Pathik Aravind,
  • Patricio Polanco,
  • Patrick Wagner,
  • Paul Helft,
  • Paul Sugarbaker,
  • Prakash Pandalai,
  • Quan P Ly,
  • Rachel Kim,
  • Rachyl Shanker,
  • Raed Al-Rajabi,
  • Raghav Sundar,
  • Rebecca Wiatrek,
  • Ricardo Bello,
  • Richard Alexander,
  • Richard Hoehn,
  • Rifat Mannan,
  • Riom Kwakman,
  • Rita Akumuo,
  • Robert Ramirez,
  • Robert Sticca,
  • Rupen Shah,
  • Ryan Merkow,
  • Sabha Ganai,
  • Sam George Pappas,
  • Samantha Ruff,
  • Sameer Patel,
  • Samer Naffouje,
  • Samuel Butensky,
  • Sanjay Bagaria,
  • Sara Daniel,
  • Sarah Wilkins,
  • Scott Sherman,
  • Shannon Radomski,
  • Sherif Abdel-Misih,
  • Stephanie Greco,
  • Steven Libutti,
  • Susan Campbell,
  • TClark Gamblin,
  • Taylor Jaraczewski,
  • Thinzar Lwin,
  • Thomas Hope,
  • Travis Grotz,
  • Ugwuji Maduekwe,
  • Umut Sarpel,
  • Uqba Khan,
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摘要

Background

Neuroendocrine neoplasms (NEN) with peritoneal metastases (PM) represent a complex clinical challenge due to low incidence and heterogeneous phenotypes. This manuscript describes the results of a national consensus aimed at addressing clinical management of patients with NEN-PM.

Methods

An update of the 2018 Chicago consensus guidelines was conducted using a modified Delphi technique, encompassing two rounds of voting. The levels of agreement for various pathway blocks were assessed. Key systemic therapy concepts were summarized by content experts. Supporting evidence was evaluated via a rapid literature review.

Results

Overall, the level of evidence for the management of PM in this disease was universally low. In total, 107 participants responded in the first round, with 88/107 (82%) participating in the second round. Strong consensus (> 90%) was achieved in 5/7 (71%) and 7/7 (100%) blocks in rounds I and II respectively. A multidisciplinary approach including psychosocial and wellness assessments received a strong positive recommendation. Management of NENs with PM was organized according to disease grade and symptom profiles. In grade 1 and 2 well-differentiated NENs, cytoreductive surgery (CRS) received strong support (>95%) following the management of functional syndromes (if present). For grade 3 well-differentiated NENs, systemic therapy is the primary recommendation, with surgical resection considered in select cases.

Conclusion

Given limited evidence, the consensus-driven clinical pathway offers vital clinical guidance for the management on NENs with PM. The need for high-quality evidence remains critical to the field