Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Retrospective case series on rural and regional experience of neuroendocrine tumour (NET) management in Illawarra Shoalhaven Local Health District (ISLHD) between 2015-2020 (#246)

Danka Zebic 1 2 , Deborah Zhou 1 2 , Nicholas Yeo 3 , Lorraine Chantrill 3 4
  1. St George Hospital, Sydney, NSW, Australia
  2. NHMRC Clinical Trials Centre, Allawah, NSW, Australia
  3. Illawarra Cancer Care Centre, Wollongong, NSW, Australia
  4. The Australasian Gastro-Intestinal Cancer Trials Group (AGITG), Sydney, NSW, Australia

Background: NETs represent a rare group of heterogenous malignancies frequently arising in the gastrointestinal system. In addition to surgery, targeted therapy and chemotherapy, peptide receptor radionuclide therapy (PPRT) with 177Lu-octreotide showed improved PFS in advanced midgut NETs. Access to PPRT in Australia is limited to clinical trials and specialist centres. Rural/regional NET data on management are lacking, especially in the PPRT era. Therefore, aim was to evaluate treatment strategies and outcomes of gastrointestinal NETs in ISLHD over a 5-year period.

 

Methods: Adults diagnosed with NETs between January-2015 and August-2020 were identified from electronic health records. Gastrointestinal NETs were assessed for clinicopathological characteristics, treatment strategies and survival. Descriptive analyses were performed, and survival analysis estimated using Kaplan-Meir method.

 

Results: 149 patients with NETs were identified. Primary analysis included 68 patients with GI NETs. Majority were males (57%) with mean age 70-years (range:21-90). Most common primary sites were small bowel (32%) and pancreas (26%). 49% had metastatic versus localised disease at diagnosis (38%). More had grade 1/2 disease (54%) versus grade 3 (24%). Most frequent treatment modality was surgery (50%), followed by somatostatin analogues (34%), chemotherapy (30%), radiation (18%), and 177Lu-octreotide (10%). Only 50% of metastatic grade 3 disease and 40% of metastatic grade 1/2 had chemotherapy. Majority of patients (63%) were from rural/regional area, of these 29% had chemotherapy and 11% had 177Lu-octreotide.  Overall survival was 60% (HR 1.09, 95%CI 0.49-2.40, p=0.84) for both metropolitan and rural/regional populations with median survival 16.8 months (range:0.59-54.74) in metropolitan versus 10.5 months (range:0.33-62.52) in rural/regional population.

 

Conclusion: This is the first retrospective review of patients in ISLHD with gastrointestinal NETs. Chemotherapy and PPRT is underutilized particularly in rural/regional areas, likely due to limited access to specialised scans and treatments. Further data is required to identify underlying causes to improve health outcomes in this population.