Small bowel neuroendocrine tumors: From pathophysiology to clinical approach

Table 1 Duodenal neuroendocrine tumors treatment

Duodenal NETs – surgical treatment
≤ 1 cm	Local ressection (if possible)
≥ 2 cm OR lymph nodes metastasis	Surgical ressection
Potentially resectable hepatic metastases without distant metastases and no other significant comorbility	Palliative surgery
Duodenal NETs – farmacological treatment
Functional duodenal NETs	Hormone suppression treatment
Well-differentiated NETs	Systemic chemotherapy if advanced metastatic disease
Poorly differentiated tumors	Combination chemotherapy – variable duration disease remission
	mTOR, tyrosine kinase and VEGF inhibitors – phase 3 trials with promising results
Metastatic or inoperable disease	Peptide receptor radionuclide therapy
	When all other treatment options fail
	If positive octreoscan

NETs: Neuroendocrine tumors; VEGF: Vascular endothelial growth factor.