Background: PRRT can be an option for all-grade GEP-NETs, but selecting patients is challenging. In this scenario, clinical-pathological and radiological characteristics, such as pre-treatment Ga-68 DOTA PET/CT, might have the potential to help. Methods: A retrospective chart review was conducted on advanced GEP-NETs treated with at least one PRRT dose. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan–Meier method. Krenning Score (KS), and the maximum standardized uptake value (SUVmax) were derived from the pre-treatment scans. A maximally selected rank statistics test was used for SUVmax simple cut point estimate. Results: Among 36 patients, 19 had primary pancreatic tumors. The numbers of G1, G2, and G3 tumors were 10, 18, and 7, respectively. During a median follow-up of 90.5 months, 4 patients died. Median OS was not reached for G1 and G2 tumors, and it was 30 months for G3 (p = 0.001). Median PFS was 23 months, with G3 showing lower PFS compared to G1 [7 versus 30 months; HR 8.41 (95%CI 2.2–31.0; p = 0.001)]. Conclusions: PRRT provides long-term PFS in patients with G1/G2 GEP-NETs independent of clinical characteristics and primary site. G3 has worse survival, but selected patients may experience long OS after PRRT treatment.

Purpose of review: Patient-reported outcomes (PROs) have become increasingly important in oncology, capturing the patient perspective on symptoms, treatment effects, and health-related quality of life. Transitioning to electronic platforms (ePROs) enables real-time monitoring, efficient integration into clinical workflows, and enhanced patient-centered care. This review explores recent evidence on the clinical utility, barriers, and future directions of integrating ePROs in supportive care in oncology. Recent findings: ePROs improve symptom control, quality of life, engagement, and in some studies, overall survival. They support earlier clinical interventions, reducing emergency visits and hospitalizations and help improve outcomes. Barriers persist at system (infrastructure, interoperability, and data security), clinician (workflow disruption, time constraints, and alert fatigue), and patient (digital literacy, access, and usability) levels. Mitigation strategies include organizational support, clinician champions, codesigned inclusive platforms, and robust privacy safeguards. Emerging opportunities involve integration with artificial intelligence, big data, and decision-support systems to advance precision oncology and population health management. Summary: ePROs represent a transformative approach in supportive cancer care. Overcoming multilevel barriers and harnessing digital innovations are essential to optimize clinical outcomes, equity, and long-term sustainability.

Background: Surgical resection of locally advanced or borderline pancreatic ductal adenocarcinoma is a recognized procedure with curative intent performed in specialized oncology centers. Postoperative dysautonomia such as gastroparesis, mild hypotension, and diarrhea are common in elderly patients undergoing pancreaticoduodenectomy. A distinctive feature of our case, is the severing of an important sympathetic chain by the surgical procedure, leading to recurrent severe neurogenic shock. Locally advanced borderline tumor extension, aggressive maximal local tumor resection, and advanced age of the patient were the combined factors that explained the observed postoperative complication. Case Description: An 80-year-old woman underwent an elective R0 pancreaticoduodenectomy with total mesopancreas excision, distal gastrectomy and portal vein resection without relevant intraoperative and immediate postoperative complication. Pathology confirmed a 5.0 cm × 3.2 cm × 1.9 cm ductal adenocarcinoma in the head of the pancreas. After discharge, the patient returned to the emergency room complaining of nonspecific malaise, lipothymia, and cold sweating that was exacerbated by bowel movement attempts. During hospitalization, the patient experienced two additional severe hypotensive episodes with identical clinical presentation that required resuscitative measures in the intensive care unit (ICU). Because the third hypotensive episode developed without an obvious causal factor, apart from evacuation attempts, the hypothesis of neurogenic shock due to secondary splanchnic dysautonomia caused by extensive resection of the celiac plexus nerve structures after duodenopancreatectomy was considered. Conclusions: This discussion is important, as it enables the care team to recognize this differential diagnosis and provide the best care for the patient. The patient was treated with sympathomimetics, fludrocortisone, and mechanisms to increase venous return when clinical improvement promptly occurred, allowing discharge from the hospital. Despite the challenging prognosis of the disease, we were able to provide the patient with moments at home with their family.