{"id":2234,"date":"2026-06-10T04:00:00","date_gmt":"2026-06-10T07:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2234"},"modified":"2026-06-10T04:00:00","modified_gmt":"2026-06-10T07:00:00","slug":"pgrss-clinica-medicina-cir-oncologica-neuroendocrino-net-g1-g3-lu-177-prrt-somatuline-everolimus","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/pgrss-clinica-medicina-cir-oncologica-neuroendocrino-net-g1-g3-lu-177-prrt-somatuline-everolimus\/","title":{"rendered":"PGRSS NET: G1-G3, Lu-177, somatuline, everol"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente subaproveitada por gestores de cl\u00ednicas de cirurgia oncol\u00f3gica neuroend\u00f3crina que reduzem PGRSS a descarte de bisturi e gaze<\/strong>. Em 2026, h\u00e1 um cen\u00e1rio desafiador \u2014 cl\u00ednicas de cir oncol\u00f3gica NET<\/strong> + NET pancre\u00e1tico + intestinal + g\u00e1strico + br\u00f4nquico + t\u00edmico + adrenal<\/strong> + Ki-67 G1<3%\/G2 3-20%\/G3>20% + WHO 2022 classification<\/strong> + Lu-177 DOTATATE Lutathera Novartis PRRT NETTER-1+2<\/strong> + somatostatin analog SSA octreotide LAR Sandostatin + lanreotide Somatuline + pasireotide Signifor LAR<\/strong> + everolimus Afinitor + sunitinib Sutent + capecitabina+temozolomida CAPTEM<\/strong> geram fluxos heterog\u00eaneos de RSS Grupo A1 (NET pancre\u00e1tico insulinoma+gastrinoma+VIPoma+glucagonoma+somatostatinoma + intestinal carcinoide + br\u00f4nquico typical\/atypical + g\u00e1strico tipo I\/II\/III + t\u00edmico) + Grupo A4 (linfa peripancre\u00e1tica + mesent\u00e9rica + porta hepatis + mediastino) + Grupo C (Lu-177 DOTATATE Lutathera + Y-90 SIRT met\u00e1stase hep\u00e1tica + Ga-68 DOTATATE PET-CT + I-131 MIBG) + Grupo E (perfuro bi\u00f3psia EUS-FNA + agulha core + bi\u00f3psia hep\u00e1tica) + Lista C5 (octreotide+lanreotide+pasireotide SSA + everolimus Afinitor + sunitinib Sutent + capecitabina+temozolomida CAPTEM + telotristat Xermelo s\u00edndrome carcinoide diarreia + interferon-\u03b1). A consequ\u00eancia \u00e9 a pr\u00e1tica de cl\u00ednicas que otimizam apenas para gaze cir\u00fargica<\/strong> + ignoram especificidades NET + Ki-67 grading + Lu-177 PRRT<\/strong> + subdimensionam SSA Lista C5<\/strong> + perdem rastreabilidade tumor neuroend\u00f3crino<\/strong>. A realidade \u00e9 exatamente o oposto. PGRSS NET opera em 5 fluxos oncol\u00f3gicos<\/strong> \u2014 A1 (NET pancre\u00e1tico 35% + intestinal 35% + br\u00f4nquico 25% + outros 5%), A4 (linfadenectomia peripancre\u00e1tica+mesent\u00e9rica+porta hepatis), C (Lu-177 DOTATATE Lutathera PRRT + Ga-68 PET-CT + Y-90 SIRT + I-131 MIBG), E (EUS-FNA + bi\u00f3psia core + cromogranina A+sinaptofisina IHC), Lista C5 (SSA octreotide LAR+lanreotide Somatuline+pasireotide LAR + everolimus Afinitor + sunitinib Sutent + CAPTEM + telotristat).<\/p>\n

Para o gestor que opera ou planeja cl\u00ednica de cir oncol\u00f3gica neuroend\u00f3crina, \u00e9 fundamental dimensionar PGRSS espec\u00edfico desde o in\u00edcio.<\/p>\n

Os 5 fluxos oncol\u00f3gicos NET<\/h2>\n

Em uma opera\u00e7\u00e3o de qualquer porte, o PGRSS NET tem 5 fluxos.<\/p>\n\n\n\n\n\n\n\n\n\n
Fluxo<\/th>\nVolume<\/th>\nFrequ\u00eancia<\/th>\nParticularidade<\/th>\n<\/tr>\n<\/thead>\n
A1 NET p\u00e2ncreas+intestino<\/td>\n4-12 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nInsulinoma+gastrin+VIP<\/td>\n<\/tr>\n
A4 linfa perip\u00e2ncreas<\/td>\n3-9 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nMesent\u00e9rica+porta hep<\/td>\n<\/tr>\n
C Lu-177+Ga-68+Y-90<\/td>\n0,8-2,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nDOTATATE+SIRT+MIBG<\/td>\n<\/tr>\n
E EUS-FNA+core+IHC<\/td>\n0,5-1,5 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nCromogranina+sinapto<\/td>\n<\/tr>\n
Lista C5 SSA+TKI+CAPTEM<\/td>\n1,5-4,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nOctreo+lanr+everol<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A soma t\u00edpica \u00e9 9,8-29,5 kg\/dia<\/strong> em cl\u00ednica cir oncol\u00f3gica NET m\u00e9dia porte.<\/p>\n

A1 NET pancre\u00e1tico + intestinal + grading Ki-67 WHO 2022: o est\u00e1gio cir\u00fargico<\/h2>\n

A primeira camada do PGRSS NET \u00e9 A1. Padr\u00e3o setorial inclui (a) NET pancre\u00e1tico 35%<\/strong> com funcional insulinoma 60% benigno+gastrinoma Zollinger-Ellison ZES+VIPoma s\u00edndrome WDHA Verner-Morrison watery diarrhea hypokalemia achlorhydria+glucagonoma s\u00edndrome 4D dermatite necrol\u00edtica migrat\u00f3ria+somatostatinoma rar\u00edssimo + n\u00e3o-funcional 50% incidental; (b) NET intestinal 35%<\/strong> com carcinoide jejuno-ileal + apendicite carcinoide + c\u00f3lon + reto + s\u00edndrome carcinoide flushing+diarreia+broncoconstri\u00e7\u00e3o+cardiopatia carcinoide; (c) NET br\u00f4nquico 25%<\/strong> com typical 80% + atypical 20% + carcinoide pulmonar + Cushing ect\u00f3pico ACTH; (d) WHO 2022 classification<\/strong> com NET well-differentiated G1 Ki-67<3% + G2 Ki-67 3-20% + G3 Ki-67>20% well-diff + NEC neuroendocrine carcinoma poorly-diff small\/large cell + MiNEN mixed neuroendocrine non-neuroendocrine; (e) estadiamento ENETS+UICC TNM<\/strong> + biomarker Cromogranina A CgA + Sinaptofisina + 5-HIAA urin\u00e1rio 24h + insulina+gastrina+VIP+glucagon+somatostatina + Octreoscan In-111 + Ga-68 DOTATATE PET-CT.<\/p>\n

Cl\u00ednica com A1 NET madura garante margem R0<\/strong> + previne recidiva regional<\/strong> + otimiza grading Ki-67 G1\/G2\/G3<\/strong>. Como discutimos no post sobre adrenal<\/a>, A1 NET \u00e9 base.<\/p>\n

A4 linfadenectomia peripancre\u00e1tica + Lu-177 DOTATATE PRRT NETTER-1\/2: o est\u00e1gio metast\u00e1tico+radio<\/h2>\n

A segunda camada \u00e9 A4+PRRT. Padr\u00e3o setorial inclui (a) linfadenectomia NET pancre\u00e1tico<\/strong> com peripancre\u00e1tica + mesent\u00e9rica + porta hepatis 8 + 12 + 13 + 14 + tronco cel\u00edaco 9 + AMS 14 + 15-25 LN dissecados; (b) enuclea\u00e7\u00e3o pancre\u00e1tica<\/strong> preservar par\u00eanquima insulinoma <2cm + par\u00eanquima-poupador + endocrine-saving + DPC cl\u00e1ssico ressec\u00e7\u00e3o formal G2-G3; (c) Lu-177 DOTATATE Lutathera Novartis PRRT<\/strong> Peptide Receptor Radionuclide Therapy 7,4 GBq IV q8w \u00d7 4 doses + somatostatin receptor SSTR2\/5 express\u00e3o + NETTER-1 G1-G2 GEP-NET + NETTER-2 1L high-grade GEP-NET + OS extens\u00e3o 65 meses; (d) Ga-68 DOTATATE PET-CT<\/strong> Krenning score 0-4 + somatostatin receptor imaging substituiu Octreoscan In-111 + sensibilidade >90% + specificity >85%; (e) Y-90 SIRT met\u00e1stase hep\u00e1tica<\/strong> SIR-Spheres+TheraSphere + dosimetria MAA Tc-99m + I-131 MIBG NET avan\u00e7ado SSTR-negativo neuroendocrine + Cobalt-60 raro.<\/p>\n

Cl\u00ednica com A4+Lu-177 madura escala detec\u00e7\u00e3o Ga-68 PET >90%<\/strong> + escala Lu-177 PRRT OS NETTER-2 65m<\/strong> + escala Y-90 SIRT response 50-80%<\/strong>. Conex\u00e3o com Lu-177 brachy<\/a>.<\/p>\n

SSA + everolimus Afinitor + sunitinib Sutent + CAPTEM: o est\u00e1gio sist\u00eamico<\/h2>\n

A terceira camada \u00e9 SSA+TKI+CAPTEM. Padr\u00e3o setorial inclui (a) SSA Somatostatin Analog 1L<\/strong> octreotide LAR Sandostatin Novartis 20-30mg IM q4w + lanreotide Somatuline Autogel Ipsen 90-120mg SC profundo q4w + pasireotide Signifor LAR 20-60mg IM q4w; (b) CLARINET trial<\/strong> lanreotide PFS 22m vs placebo 16m G1-G2 GEP-NET + PROMID octreotide PFS 14m vs placebo 6m midgut NET; (c) everolimus Afinitor mTOR inhibitor 2L<\/strong> Novartis 10mg PO QD + RADIANT-3 pancreatic NET + RADIANT-4 GI\/lung NET + estomatite+rash+pneumonite efeitos adversos; (d) sunitinib Sutent VEGFR\/PDGFR\/KIT 2L<\/strong> Pfizer 37,5mg PO QD + pancreatic NET only + Raymond NEJM 2011 PFS 11m vs 5m placebo; (e) CAPTEM capecitabina+temozolomida<\/strong> quimioterapia oral + temozolomida 200mg\/m\u00b2+capecitabina 750mg\/m\u00b2 BID + ECOG-ACRIN E2211 PFS 22,7m PRRT-na\u00efve pancreatic NET; (f) telotristat Xermelo TPH inhibitor s\u00edndrome carcinoide diarreia<\/strong> + 250mg PO TID + TELESTAR + interferon-\u03b1-2b raro descontinua\u00e7\u00e3o.<\/p>\n

Cl\u00ednica com SSA+everolimus+sunitinib+CAPTEM madura escala SSA PFS 22m + everolimus PFS 11m + sunitinib PFS 11m + CAPTEM PFS 22,7m<\/strong>. Conex\u00e3o com Lista C5<\/a>.<\/p>\n

Tr\u00eas perfis de PGRSS por capacidade NET<\/h2>\n

Cl\u00ednica NET s\u00f3 A1.<\/strong> 1 fluxo. Custo mensal R$ 8.000-24.000<\/strong> mas perda de A4+C+E+sist\u00eamico.<\/p>\n

Cl\u00ednica NET A1 + A4 + SSA.<\/strong> 3 fluxos. Custo mensal R$ 20.000-50.000<\/strong>, captura cirurgia + linfa + SSA.<\/p>\n

Cl\u00ednica NET 5 fluxos completos.<\/strong> A1+A4+C+E+sist\u00eamico + integra\u00e7\u00e3o com servi\u00e7os hospitalares<\/a>. Custo mensal R$ 38.000-90.000<\/strong>, efic\u00e1cia 95%, ROI 800-2.500% via captura completa NET + Lu-177 PRRT OS 65m + SSA PFS 22m.<\/p>\n

Os tr\u00eas erros que aparecem em cir oncol\u00f3gica NET<\/h2>\n

O primeiro \u00e9 a subdimensionamento Lu-177 DOTATATE CNEN-NN-3.05<\/strong>. Sem segrega\u00e7\u00e3o Lutathera + decaimento + IPEN\/CNEN = n\u00e3o-conformidade radioativa + risco multa interdi\u00e7\u00e3o + zero prote\u00e7\u00e3o radiol\u00f3gica.<\/p>\n

O segundo \u00e9 a mistura A1 NET grading + WHO 2022<\/strong>. Confunde rastreabilidade Ki-67 G1\/G2\/G3+NEC+MiNEN + impossibilita stratifica\u00e7\u00e3o progn\u00f3stica + risco indica\u00e7\u00e3o inadequada SSA vs PRRT vs CAPTEM.<\/p>\n

O terceiro \u00e9 a falta de protocolo Ga-68 DOTATATE PET-CT pr\u00e9-PRRT<\/strong>. Sem Krenning score + SSTR2\/5 express\u00e3o + sensibilidade>90% = perda elegibilidade Lu-177 + zero rastreabilidade biomarker.<\/p>\n

A regula\u00e7\u00e3o de PGRSS NET no Brasil est\u00e1 em fase de moderniza\u00e7\u00e3o t\u00e9cnica acelerada com cir oncol\u00f3gica preservadora como prioridade. As institui\u00e7\u00f5es que estruturam fluxos completos desde o in\u00edcio \u2014 alinhadas com PGRSS cl\u00ednicas especializadas<\/a> \u2014 atravessam o crescimento sem solavanco. Para gestores que precisam alinhar com gest\u00e3o paralela industrial, o portal Seven Res\u00edduos sobre servi\u00e7os completos<\/a> traz a perspectiva integrada. A ENETS European NET Society<\/a> \u00e9 refer\u00eancia t\u00e9cnica global.<\/p>\n

Solicite cota\u00e7\u00e3o PGRSS NET 5 fluxos oncol\u00f3gicos<\/a><\/strong> \u2014 cap\u00edtulo dedicado a A1 NET pancre\u00e1tico insulinoma+gastrinoma ZES+VIPoma WDHA Verner-Morrison+glucagonoma 4D+somatostatinoma+n\u00e3o-funcional+intestinal carcinoide jejuno-ileal+apendicite+s\u00edndrome carcinoide+br\u00f4nquico typical\/atypical+ACTH ect\u00f3pico+WHO 2022 G1<3%\/G2 3-20%\/G3>20% well-diff+NEC poorly-diff+MiNEN+CgA+Sinaptofisina+5-HIAA 24h+ENETS+UICC TNM+CID C7A, A4 linfadenectomia peripancre\u00e1tica+mesent\u00e9rica+porta hepatis 8+12+13+14+cel\u00edaco 9+AMS 14+15-25 LN+enuclea\u00e7\u00e3o par\u00eanquima-poupador, C Lu-177 DOTATATE Lutathera Novartis 7,4 GBq\u00d74 NETTER-1\/2 OS 65m+Ga-68 DOTATATE PET-CT Krenning 0-4+Y-90 SIR-Spheres+TheraSphere+I-131 MIBG+CNEN-NN-3.05, E EUS-FNA endoscopic ultrasound+core+IHC cromogranina+sinaptofisina, sist\u00eamico SSA octreotide LAR Sandostatin+lanreotide Somatuline Autogel CLARINET PFS 22m+pasireotide Signifor+everolimus Afinitor mTOR RADIANT-3\/4+sunitinib Sutent Raymond NEJM 2011+CAPTEM capecitabina+temozolomida ECOG E2211 PFS 22,7m+telotristat Xermelo TPH s\u00edndrome carcinoide TELESTAR+interferon-\u03b1 Lista C5.<\/p>\n","protected":false},"excerpt":{"rendered":"

PGRSS oncologia NET: G1-G3 + Lu-177 PRRT + SSA + everolimus. Veja.<\/p>\n","protected":false},"author":3,"featured_media":2233,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2712,3068,3067,3069],"class_list":["post-2234","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-cirurgia-oncologica","tag-lu-177","tag-net","tag-prrt"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2234","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/comments?post=2234"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2234\/revisions"}],"predecessor-version":[{"id":4340,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2234\/revisions\/4340"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2233"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2234"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2234"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2234"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}