The treatment of neuroendocrine tumours of the gastroenteropancreatic tract (NET-GEP) is to a large extent accepted to be aiming primarily at lowering symptoms related to the hormonal overproduction these tumours lead to. The introduction of somatostatin analogues (octreotide, lanreotide) several decades ago was indeed a major breakthrough, in that patients could experience symptomatic relief, and that surgery could be performed, from an anaesthesiological point of view, in a more controlled and safe way than before. The surgical procedure in its turn, is most often aimed at removing the primary tumour, and, if technically feasible, debulking metastatic disease. This strategy has been proven to be beneficial in terms of decreasing symptoms and improving quality of life. Still, whether this strategy actually significantly extends patient survival, has not been proven in any traditional randomized clinical trial. Such evidence will of course never be presented: which serious investigator would suggest withholding any patient group a treatment so obviously beneficial for the individual? At the same time, clinicians caring fore NET-GEP patients can bear witness to anecdotal cases who were judged to be beyond cure, but despite this continue to survive year after year with or without symptomatic treatment. Adjuvant treatment for operated NET-GEP patients with or without demonstrable remaining tumour burden is somewhat more controversial. Should a patient without any clinical sign of disease, radiological or biochemical, be without medication until recurrence is proven? Is the disease-free interval likely to be longer with the post-operative use of somatostatin analogues and/or interferon-a? Even in the case of metastatic or inoperable disease, the superiority of this medical strategy has been very difficult to prove, often due to patient heterogeneity and difficulties to reach sufficient numbers of objects [1,2]. Hence, the strategies vary from centre to centre and may to a large extent be a matter of taste rather than based on convincing results from controlled trials. With the advent of peptide receptor radionuclide therapy (PRRT) in the 1990s, a completely different therapeutic option could be offered some patients with incurable NET-GEP. In a recent issue of Acta Oncologica, the Erasmus MC group from Rotterdam presented their truly eminent and pioneering experience of this novel strategy [3]. The results presented herein give a broad view of the various options and their possible benefits, and point to other yet unexplored paths of treatment choices for the future. The authors have since several years been presenting their data, not least at conferences on NET-GEP, and their convincing results have led to that several other centres have referred patients to the Rotterdam Clinic, or lately, have adopted this treatment strategy for similar clinical use. PRRT is today mainly reserved for patients with widespread disease, judged to be progressive, with tumours displaying a comparably low proliferation index. Furthermore, the tumours must show a sufficient somatostatin analogue uptake measured