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issues for these patients. Therefore in advanced patients   Conflicts of interest
            with orbital metastases, the alternative  loco-regional   There are no conflicts of interest.
            treatments alone or in combination with systemic therapy
            may constitute a viable treatment alternative to a surgical   Patient consent
            excision (exenteratio orbitis). [7]               Obtained.

            The currently proposed treatment  of orbital metastases   Ethics approval
            in well-differentiated  NETs includes surgery, beam   The patient was treated within the standards of our institute
            radiotherapy, especially  for single  and  symptomatic   and the report was approved.
            lesions, peptide receptor radiotherapy or systemic medical
            treatment. The integration of local treatment with SSA could   REFERENCES
            provide long-term disease control, preserving the patient’s
            quality of life. Although the SSA objective response rates   1.   Modlin IM,  Lye KD,  Kidd M.  A 5-decade analysis of 13,715
                                                                  carcinoid tumors. Cancer 2003;97:934-59.
            are limited (5-10%), these drugs are characterized by high   2.   Pinchot  SN, Holen K, Sippel  RS, Shen H. Carcinoid  tumors.
            rates of disease stabilization,  up to 50-60% in clinical   Oncologist 2008;13:1255-69.
            trials and with optimal profiles of safety and tolerability.    3.   Zuetenhorst JM, Taal BG. Metastatic carcinoid tumors: a clinical
                                                         [8]
            Moreover, the efficacy of SSA has been recently shown   review. Oncologist 2005;10:123-31.
            by two prospective, randomized, placebo-controlled trials,   4.   Karcioglu ZA. Orbital tumours: Diagnosis and treatment. 2nd ed.
                                                                  New York: Springer; 2005. p. 187-9.
            the PROMID and CLARINET studies. [9,10]  These studies   5.   Peixoto RD, Lim HJ, Cheung WY. Neuroendocrine tumor metastatic
            evaluated the impact of SSA treatment (octreotide long-  to the orbit treated with radiotherapy. World J Gastrointest Oncol
            acting release 30 mg every 28 days and Lanreotide ATG   2013;5:177-80.
            120 mg every 28 days), leading to demonstration of their   6.   Mehta JS, Abou-Rayyah Y, Rose GE. Orbital carcinoid metastases.
            antiproliferative  effects.  The mean time  to progression   Ophthalmology 2006;113:466-72.
            in the PROMID trial was 14.3 months in the octreotide   7.   Borota OC, Kloster R, Lindal  S. Carcinoid  tumour metastatic  to
                                                                  the orbit with infiltration to the extraocular orbital muscle. APMIS
            LAR arm  compared to 6 months in the  placebo  arm.    2005;113:135-9.
                                                         [9]
            In the CLARINET trial, Lanreotide ATG was associated   8.   Modlin  IM, Pavel  M, Kidd M, Gustafsson BI.  Review  article:
            with a significant improvement in mean progression free   somatostatin analogues in the treatment of gastroenteropancreatic
            survival compared  to placebo  (progression-free survival   neuroendocrine  (carcinoid)  tumours.  Aliment  Pharmacol  Ther
            not reached in the treatment group vs. 18 months in the   2010;31:169-88.
            placebo group).  Based on these results, the use of SSA   9.   Rinke  A, Müller HH,  Schade-brittinger C, Klose KJ,  Barth P,
                         [10]
                                                                  Wied M, Mayer C, Aminossadati B, Pape UF, Bläker M, Harder
            is recommended  for its antiproliferative  effect  in well   J, Arnold C, Gress T, Arnold R; PROMID Study Group. Placebo-
            differentiated NENs with an  indolent  course in patients   controlled, double-blind, prospective, randomized study on the
            with both functioning and non-functioning tumors. SSAs   effect of octreotide LAR in the control of tumor growth in patients
            represent a valid treatment option in cases where good   with  metastatic  neuroendocrine  midgut  tumors.  J  Clin  Oncol
            quality of life is paramount and in which a surgical   2009;27:4656-63.
            approach is not accepted, feasible or is contraindicated.  10.  Caplin ME, Pavel M, Ćwikła JB, Phan AT, Raderer M, Seedláčková
                                                                  E, Cadiot G, Wolin EM, Capdevila J, Wall L, Rindi G, Lanley A,
            Financial support and sponsorship                     Martinez S, Blumberg J, Ruszniewski P. Lanreotide in Metastatic
                                                                  Enteropancreatic  Neuroendocrine  Tumors.  N Engl J Med
            Nil.                                                  2014;371:224-33.



























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