Neuroendocrine tumors: A multidisciplinary approach

This book has done justice to the ever evolving and often baffling subject of neuroendocrine tumours (NETs). It covers a broad spectrum of topics ranging from the epidemiology to modern novel approaches in the management of these tumours. The abstracts at the beginning of each chapter are concise for the readers to have a quick grasp of the content. The first chapter on epidemiology is crucial and has addressed fundamental issues with respect to histologic classification, anatomic sites and coding systems for NETs, in addition to various national registries. The tumour site specific epidemiological aspects have been covered in detail for all sites of NETs with clear tables and charts. The second chapter on biochemical testing addresses the various general tumour markers of NETs as well as site-specific markers and most importantly discusses their implications in the diagnostic and prognostic arenas.

The third chapter on clinical syndromes is a compact review of various syndromes which have been well elaborated in simple tables and clinical photographs. Also, the management of various syndromes has been well addressed. Modern radiology has been a boon but can also be a source of confusion. Chapter 4, on radiological imaging has discussed the specific roles of computed tomography, magnetic resonance imaging and ultrasonography individually with high quality clinical photographs. Furthermore, site-specific imaging modality has also been addressed well with appropriate evidence with a note on image surveillance and radiologic monitoring of NET therapy. Somatostatin receptor-based imaging has been addressed in a separate chapter where different radioisotopes have been discussed with their pros and cons ending with a note on imaging response after therapy. Endoscopy and endoscopic ultrasound in assessing and managing NETs has been dealt with in an exclusive chapter with techniques in the management of gastric, duodenal, rectal and pancreatic NETs with good quality colour images. The endoscopic ultrasound (EUS) based fine-needle aspiration (FNA) technique has been dealt with latest evidence and high quality images. Chapter 7 on pathology is exhaustive with discussion on individual pathologic types and an elaborate description on modern immunohistochemistry.

The genetics and epigenetics of pancreatic neuroendocrine tumours and pulmonary carcinoids have been discussed with emphasis on MEN (multiple endocrine neoplasia) syndromes, VHL (Von Hippel-Lindau) disease, etc. with detailed description of the molecular mechanisms with diagrams. Chapter 9, exclusively on pancreatic surgery is well written describing the surgical approaches for primary tumour with clinical endocrine syndrome. The indications for various procedures such as pancreaticoduodenectomy, distal pancreatectomy, total pancreatectomy, middle pancreatectomy and enucleation have been clearly discussed by a group well known for surgery of pancreatic NETs. The chapter on gastrointestinal surgery compiles the surgical indications for all sub-sites including oesophageal, gastric, duodenal, small intestinal, appendiceal, colonic, and rectal among others, also the management of neuroendocrine liver metastases has been discussed well. Chapter 11 on transplantation and debulking procedures elaborates on cytoreductive surgery, and liver transplantation with updated references compiled in a table with survival figures enabling the reader to have a comprehensive understanding of the subject. The therapy of NETs with respect to somatostatin analogues has been detailed under separate topics of carcinoid tumour and pancreatic NETs. The various depot formulations have been mentioned with all adverse effects and, major trials of PROMID and CLARINET have been compared in a separate table.

The medical therapy of pulmonary NETs has been discussed in the metastatic setting or in patients who are not candidates for surgery and the concept of targeted therapy has been explored well in chapter 13. Peptide receptor radionuclide therapy (PRRT) has now become an accepted therapeutic modality for metastatic or inoperable NETs. Chapter 14 gives a detailed account of PRRT describing various techniques of administration, the outcomes with respect to different isotopes such as ⁹⁰Y peptides, ¹⁷⁷Lu-peptides and the safety profile of these agents. Other potential hormonal receptors which are targets for biotherapy such as GLP-1 (glucagon-like peptide 1), CCK (cholecystokinin), GRP (gastrin releasing peptide), secretin, etc. have been described in a separate chapter thus completing a comprehensive overview of biotherapy. The marginal role of chemotherapy in well differentiated gastropancreatic NETs has also been addressed with data on different regimens including streptozocin, dacarbazine, temozolomide and oxaliplatin-based regimens. The concluding chapter is an eye opener on novel therapies which discusses about microRNAs, microRNA inhibitors, epigenetic modifications of NETs, cancer immunotherapy, cancer vaccinations, oncolytic viruses as immunotherapy, etc.

To conclude, this book renders a comprehensive high quality review of various aspects of neuroendocrine tumours in chapters written in a plain and simple language with appropriate illustrations, tables and references. Although it is extensive, the prime focus has been rightly retained on gastro-entero-pancreatic NETs, however, some lacunae exist on the multidisciplinary management aspects of other non-gastrointestinal NETs. In the true sense, the book lives up to its title and does highlight the multidisciplinary approach, crucial in the management of these ill understood tumours. It will be a valuable resource of information for surgeons, endocrinologists, medical oncologists, pathologists, radiation oncologists and nuclear physicians involved in the decision making for patients with neuroendocrine tumours.