Neuroendocrine Neoplasms of the Pancreas: A Multidisciplinary Approach

The most accurate answer is the third option. The other options are mostly utilized in the setting of WD NETs. Due to rarity of PNECs, studies evaluating their medical management are limited. Patients with PNEC are at extremely high risk of metastatic disease and are not expected to achieve disease control with surgery alone; current NCCN guideline recommends the regimen of platinum-based chemotherapy (i.e. cisplatin/ carboplatin) and etoposide. This recommendation is extrapolated from treatment algorithms for small cell lung cancer. Adjuvant chemotherapy with or without radiation (cisplatin, etoposide, and radiation generally favored) should be considered for all resectable PNECs. Chemotherapy is associated with improved survival, even in patients with early-stage disease. Following recurrence, due to concerns for cumulative toxicity (e.g. nephrotoxicity) from previous cisplatin administration, carboplatin is often substituted for cisplatin.


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