After R1 resection of a locally advanced, node-positive neuroendocrine tumor of the terminal ilium, would you offer adjuvant radiation therapy?

This is a very nuanced question, and I disagree with those suggesting radiation. The great majority of NETs occur at the terminal ileum and the great majority of these tumors are grade 1 or 2. If there was a positive margin it could take many years for that disease to manifest locally. I think radia...

Small bowel neuroendocrine tumors have a significant metastatic potential at diagnosis with a 12% nodal, 5% distant metastasis incidence for tumors less than 1 cm, 70% nodal, 19% distant metastasis for tumors >1 cm <2 cm, and 85% nodal, 47% distant metastasis for tumors >2 cm. (Rorstad, PMID 1571937...

For young fit patients, I would consider adjuvant RT for node positive resections. Depending on the grade and Ki-67, I would defer to the med oncs regarding whether they thought there is a role for adjuvant systemic therapy and have a discussion regarding optimal sequencing. There's little prospecti...

Obviously, one could do radiation, but I would not.

Without clear evidence of OS or even PFS, I would not recommend radiation. I would assume they would have some, potentially much, toxicity from radiation to that area and limited benefit.

Yes

There is no role of adjuvant therapy for resected SB NET. We usually follow up with an anatomical scan, and when there is a new recurrence, you can consider PET-DOTATATE, and the treatment decision will be according to where the recurrence is, tumor burden, hepatic vs EH, and if re-biopsy is needed ...