Management of asymptomatic sporadic non-functioning pancreatic neuroendocrine neoplasms no larger than 2 cm: interim analysis of prospective ASPEN trial

Translate
Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 19,911 other subscribers.

One of the most controversial subjects in Neuroendocrine Neoplasms is the management of small non-functional (asymptomatic) pancreatic NETs (NF-PanNEN).  In the most general terms, surgery is not recommended in tumours less than 2cm.  Allowances are made for those who are functional (i.e. symptomatic with one of several syndrome possibilities) or where the tumour is threatening important vessels (i.e. pre-emptive surgery).  Normally watching and waiting is recommended.  I wrote more detail in an earlier blog – Pancreatic Neuroendocrine Tumours – to cut or not to cut

Some patients opt (or push for) a non-guideline surgery regardless and as one other patient advocate put it, “they will surgeon shop until they find one who will do it”. 

While the guidelines are just that (guidelines), decisions on surgery in such cases must be carefully considered given that pancreatic surgery can come with considerable morbidity and the risk of mortality is there. 

One of the issues is the lack of solid data to base such decisions on.  There is also no test available with sufficient sensitivity to indicate the likelihood of particular individuals remaining localised and manageable or going on to develop growth of the primary, locally advanced scenarios and distant metastases.  Work on molecular markers is not yet advanced but it is a work in progress.  It is likely these markers would help decision-making.  There are also some suggestions in the US that the guidelines should be amended to make the threshold less than 1cm. 

Thus why I was very interested to see the Management of asymptomatic sporadic non-functioning pancreatic neuroendocrine neoplasms no larger than 2 cm: interim analysis of prospective ASPEN trial which concludes “….. active surveillance is the preferred approach for sporadic, asymptomatic, NF-PanNENs no larger than 2 cm. An active surveillance strategy seems safe, but the measurable risk of distant metastases, as well as the presence of histological characteristics of aggressiveness in almost one-fifth of operated tumours, necessitates personalized management for lesions larger than 1 cm as well as for young patients and in the presence of measurable growth of the nodule. Moreover, surgery is always mandatory for small NF-PanNENs with a dilated MPD (author insert: main pancreatic duct). According to the protocol, the study will be concluded 1 year after the enrolment of the last patient. Nevertheless, as these preliminary results showed only a very low rate of patients with tumour growth after a median follow-up of 2 years, longer follow-up is probably needed for definitive conclusions to be reached.

I have cited the study output below – click the link in blue. 

Study citation

Stefano Partelli, Sara Massironi, Alessandro Zerbi, Patricia Niccoli, Wooil Kwon, Luca Landoni, Francesco Panzuto, Ales Tomazic, Alberto Bongiovanni, Gregory Kaltsas, Alain Sauvanet, Emilio Bertani, Vincenzo Mazzaferro, Martyn Caplin, Thomas Armstrong, Martin O Weickert, John Ramage, Eva Segelov, Giovanni Butturini, Stefan Staettner, Mauro Cives, Andrea Frilling, Carol Anne Moulton, Jin He, Florian Boesch, Andreas Selberheer, Orit Twito, Antonio Castaldi, Claudio G De Angelis, Sebastien Gaujoux, Katharina Holzer, Colin H Wilson, Hussein Almeamar, Emanuel Vigia, Francesca Muffatti, Martina Lucà, Andrea Lania, Jacques Ewald, Hongbeom Kim, Roberto Salvia, Maria Rinzivillo, Alojz Smid, Andrea Gardini, Marina Tsoli, Olivia Hentic, Samuele Colombo, Davide Citterio, Christos Toumpanakis, Emma Ramsey, Harpal S Randeva, Ray Srirajaskanthan, Daniel Croagh, Paolo Regi, Silvia Gasteiger, Pietro Invernizzi, Cristina Ridolfi, Marc Giovannini, Jin Young Jang, Claudio Bassi, Massimo Falconi, Management of asymptomatic sporadic non-functioning pancreatic neuroendocrine neoplasms no larger than 2 cm: interim analysis of prospective ASPEN trial, British Journal of Surgery, 2022;, znac267, https://doi.org/10.1093/bjs/znac267

Disclaimer

I am not a doctor or any form of medical professional, practitioner or counsellor. None of the information on my website, or linked to my website(s), or conveyed by me on any social media or presentation, should be interpreted as medical advice given or advised by me. 

Neither should any post or comment made by a follower or member of my private group be assumed to be medical advice, even if that person is a healthcare professional.   

Please also note that mention of a clinical service, trial/study or therapy does not constitute an endorsement of that service, trial/study or therapy by Ronny Allan, the information is provided for education and awareness purposes and/or related to Ronny Allan’s own patient experience. This element of the disclaimer includes any complementary medicine, non-prescription over the counter drugs and supplements such as vitamins and minerals.

Click picture to subscribe

Thanks for reading.

Ronny

I’m also active on Facebook. Like this page.
I’m also active on this Facebook page. Follow this page.
Also like this awareness page on Facebook. 

Sign up for my newsletters – Click Here

Disclaimer

My Diagnosis and Treatment History

Follow me on twitter

Check out my online presentations

Check out my WEGO Health Awards

Like my new awareness page – click here or on the photo.  (Like rather than follow please!)

Check out my Glossary of Terms – click here

patients included

Please Share this post for Neuroendocrine Cancer awareness and to help another patient

 
 
 
Facebook
Twitter
Pinterest
WhatsApp
Email

A spotlight on Chromogranin A

What is Chromogranin A? Chromogranin A (CgA) is an acidic protein released along with catecholamines from chromaffin cells and nerve terminals. This statement alone might

Read More »

Neuroendocrine Cancer: Catch them early, not late!

Diagnosing Neuroendocrine Neoplasms (NENs). It’s no secret that Neuroendocrine Neoplasms (NENs) can be difficult to diagnose, particularly well differentiated slow growing types (NETs) which can

Read More »

A spotlight on Rectal Neuroendocrine Neoplasms

What are Rectal NENs Rectal Neuroendocrine Neoplasms (NENs) (rNENs) account for approximately 1-2% of all primary cancers in the rectum.  The other main cancer types

Read More »
Clinical Trial

Clinical Trial: Novel Somatostatin Receptor Subtype 2 Antagonist Labelled With Terbium-161 (161Tb-DOTA-LM3) (Beta plus)

A new clinical trial post. What is Terbium-161 (161Tb-DOTA-LM3) (Beta plus). Terbium-161 is a radioactive substance.  DOTA-LM3 is a novel somatostatin antagonist targeted using somatostatin

Read More »

Repeat after me: Maria Menounos has Neuroendocrine Cancer

Like many people from outside USA, I don’t really know anything about Maria Menounos.  For those in the same boat, let me confirm she is

Read More »

Summary of April 2023 on RonnyAllan.NET

Summary of RonnyAllan.NET website activity in April 2023 The top 10 most read posts in April are included below as the main product of this summary

Read More »

A spotlight on 5-HIAA

Background. It’s important to note that not every type of Neuroendocrine Neoplasm will get the same tests due to the heterogenous nature of this cancer type.

Read More »

The NET Detectives

The NET Detectives is an awareness post. Detecting NETs In general, it’s probably true to say that Neuroendocrine Tumours (NETs) are difficult to diagnose. Some

Read More »

Low FODMAPs – The NET Effect

Background Many people with NET have had issues prior to diagnosis and then continue to have similar issues after. For some it will be either

Read More »

A cup of tea

clicking this picture will take you to my website, open any post to find the widget.

I would also mention those who contributed to my “Tea Fund” which resides on PayPal.  You don’t need a PayPal account as you can select a card but don’t forget to select the number of units first (i.e. 1 = £4, 2 = £8, 3 = £12, and so on), plus further on, tick a button to NOT create a PayPal account if you don’t need one.  Clearly, if you have a PayPal account, the process is much simpler 

Through your generosity, I am able to keep my sites running and provide various services for you.  I have some ideas for 2023 but they are not detailed enough to make announcements yet. 

This screenshot is from every single post on my website and depending on which machine you are using, it will either be top right of the post or at the bottom (my posts are often long, so scroll down!)

I love comments - feel free!

%d bloggers like this: