In November 2005, the European Neuroendocrine Tumor Society organized its first of two consensus conferences, dedicated to revising the Society's Guidelines on diagnosing and treating neuroendocrine tumor disease.
Delegates to the conference -- 63 in all, representing 20 countries and of the disciplines endocrinology, gastroenterology, imaging, pathology, oncology, and surgery -- comprised a general assembly which listened to various presentations, and then retreated to break-out sessions based on their disciplines internal medicine (endocrinology, gastroenterology, oncology), surgery, pathology and imaging. In these sessions, they discussed questions, compiled in a workbook, that would lead to consensus on the Society's Guidelines.
Surgical procedures for curative surgery and criteria for decision-making were agreed upon by the surgical group, as well as surgical and interventional treatment options for irresectable and/or metastatic disease. Medical treatment options in palliative care, with a special focus on somatostatin analogs and interferon therapy, as well as chemotherapeutical options, were discussed intensely. This discussion also high-lighted the necessity of controlled clinical trials in the future to better validate the treatment options for NETs. The role of peptide-receptor-guided radionuclide therapy was also considered carefully for each of the discussed tumor entities and common follow-up strategies were agreed upon.
The result of all this work has been the publication of a TNM scoring system in the influential journal, Virchows Archiv. (Rindi G, Klöppel G, Alhman H, Caplin M, Couvelard A, de Herder WW, Eriksson B, Falchetti A, Falconi M, Komminoth P, Körner M, Lopes JM, McNicol AM, Nilsson O, Perren A, Scarpa A, Scoazec J-Y, Wiedenmann B and all other Frascati Consensus Conference participants. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Archiv 2006, 449:395-401.) An additional milestone, as well, has been reached: the publication of a series of consensus papers on foregut tumor diagnosis and therapy in the journal Neuroendocrinology. See WW de Herder, D O’Toole, G Rindi, B Wiedenmann et al. ENETS Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Tumors. Part 1 – Stomach, Duodenum and Pancreas. Neuroendocrinology 2006; Suppl 84: 151-216.)
By clicking on the links below, you can see the questions and answers delegates reviewed in the process of arriving at consensus on the various topics:
The Frascati conference in 2005 was followed in 2006 by another meeting, also in the Italian town, but this time focusing on midgut and hindgut tumors. The same format as the initiating conference was followed as the participants focused on diagnosing and treating tumors of the small intestine, appendix, colon and rectum, as well as metastases to the liver and poorly differentiated endocrine carcinomas. Sixty experts participated in this conference, many having participated in the first ENETS consensus meeting. The consensus-building questions and answers follow below: