The Society of Interventional Oncology (SIO) National Comprehensive Cancer Network (NCCN) Task Force submitted recommendations to the NCCN for the latest revision of the Neuroendocrine Tumour treatment guidelines. These have been accepted by the national body. According to the society, this is the first time interventional radiology (IR) has been called out as a separate body contributing to the guidelines (see figure 1).
The inverted “U” is the mathematical symbol for intersection; SIO describe this symbol as “a fitting designation for interventional oncology operating at the intersection of cancer therapies”.
For lung neuroendocrine tumours (NETS), ablation was added for treatment of primary tumours, and liver-directed therapy added for liver-dominant metastases.
An entirely new section on “Principles of Liver-Directed Therapy” was added to the guidelines and referenced in the sections on treatment of metastatic gastrointestinal and pancreatic NETS. The principles cover the spectrum of embolotherapies and include thermal ablation as an option, while acknowledging the limited prospective data for ablation. Adding an entirely new section of this name was the first request made from SIO late last year.
Cautions about liver-directed therapies in the setting of a Whipple were modified to include any prior biliary instrumentation.
Ablation was added as an option for malignant adrenal tumours.
A new section on “Principles of Imaging” was created to codify recommendations for anatomical and nuclear imaging.
Rony Avritscher (MD Anderson Cancer Center, Houston, USA), Nick Fidelman (University of California San Francisco, San Francisco, USA), and Etay Ziv (Memorial Sloan Kettering Cancer Center, New York, USA) authored the SIO submission. Their letter, dated 15 October 2019, requested the NCCN Neuroendocrine and Adrenal Tumours guideline panel review data regarding six specific changes to update the role of liver-directed therapies in the clinical practice guidelines in oncology.