Carcinoid Syndrome When Loco-Regional Liver-Directed Therapy Has Not Controlled Symptoms

This protocol applies to patients with carcinoid syndrome who have already undergone loco-regional liver-directed treatment and whose CS symptoms remain inadequately controlled. It defines the next therapeutic step and the clinical goals that signal a meaningful response.

Previous Treatment Line — Goals Not Achieved

Loco-regional liver-directed approaches — including hepatic trans-arterial embolisation (TAE), trans-arterial chemoembolisation (TACE), and trans-arterial radioembolisation / selective internal radiotherapy (TARE/SIRT), with or without surgical evaluation for hepatic resection or cytoreductive surgery — did not achieve adequate control of carcinoid syndrome symptoms.

Next Step — Partial Overview

For patients with positive somatostatin-receptor imaging, a systemic radionuclide-based therapeutic approach is indicated at this stage. The full eligibility criteria, regimen details, and accompanying measures are available in the complete protocol below.

Treatment Goals

Meaningful reduction in diarrhoea, pain, fatigue, and flushing, alongside a measurable decrease in urinary 5-HIAA, define a clinically significant response at this stage.

Instant Access to Structured Evidence-Based Regimens

References

PRRT with 177Lutetium-DOTATATE represents an effective option for NET patients.
With positive SRI and RCS, with significant decrease in diarrhoea, pain, fatigue, and flushing, and > 30% decrease in u5-HIAA in 56% of patients.

DOI: 10.1111/jne.13146

View source ↗