Multidisciplinary Management of Neuroendocrine Neoplasms Beyond Centers of Excellence: Retrospective Real-World Data from a Referral Center in Eastern Europe.

Background and Objectives: Neuroendocrine neoplasms (NENs) require multidisciplinary management, yet access to advanced imaging and therapies is uneven across Europe. We aimed to describe real-world management of NENs in an Eastern Europe referral center. Methods: This retrospective single-center study included 192 NEN patients treated between 2011 and 2026 at a national referral center in Romania. Results: Most tumors were well-differentiated (88%), pancreatic primary (59.9%), and non-functioning (77.1%); 51.0% were metastatic at diagnosis. Overall, 30.7% (n = 59) of patients underwent somatostatin receptor imaging, mainly with locally available 99mTc-HYNIC-TOC scintigraphy (n = 56). Among therapeutic modalities, 68.2% of patients underwent conventional systemic therapy and 69.3% had surgery (R0 resection was achieved in 98.9% of curative-intent surgeries; recurrence rate 40%). Peptide receptor radionuclide therapy (PRRT) was performed in 14.6% (19/130) of metastatic NENs and liver-directed therapy (LDT) in 13.6% (16/118) of NENs with liver metastases. Median time to treatment was 78 days for somatostatin analogs, 29 days for chemotherapy in neuroendocrine carcinoma, 30 days for surgery, 62.5 days for LDT, and 144 days for PRRT. Conclusions: This is one of the few reports on real-world management of NENs in an Eastern European tertiary care referral center, which highlights the available multidisciplinary care but also the challenges in diagnostics and therapeutic access for patients with NEN.