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Briganti SI, Lanza O, Fioriti E, Leto G, Battisti S, Napoli N, Strollo R. Paget Disease of Bone Harboring Bone Metastatic Neuroendocrine Cancer: A Case Report. Calcif Tissue Int 2024; 114:550-553. [PMID: 38506956 DOI: 10.1007/s00223-024-01195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/06/2024] [Indexed: 03/22/2024]
Abstract
In this case report, we describe an uncommon case of neuroendocrine cancer of unknown origin began with cauda equina syndrome in a patient affected by Paget disease of bone (PDB). A 76-year-old man with diagnosis of PDB, without history of pain or bone deformity, developed sudden severe low back pain. Bone alkaline phosphatase was increased and MRI and whole-body scintigraphy confirmed the localization of the disease at the third vertebra of the lumbar spine. Treatment with Neridronic Acid was started, but after only 2 weeks of therapy anuria and bowel occlusion occurred together with lower limb weakness and walking impairment. Cauda equina syndrome consequent to spinal stenosis at the level of L2-L3 was diagnosed after admission to Emergency Department and the patient underwent neurosurgery for spinal medulla decompression. The histologic results showed a complete subversion of bone structure in neoplastic tissue, consistent with metastatic neuroendocrine carcinoma of unknown origin. In conclusion, low back pain in the elderly may require deep investigation to individuate rare diseases. In asymptomatic patients with apparently stable PDB, the sudden appearance of pain or neurologic symptoms may alert the clinician for the possibility of other superimposing diseases, like bone metastases.
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Affiliation(s)
| | - Oreste Lanza
- Fondazione Policlinico Campus Bio-Medico di Roma, Rome, Italy
| | - Elvira Fioriti
- Fondazione Policlinico Campus Bio-Medico di Roma, Rome, Italy
| | - Gaetano Leto
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Sofia Battisti
- Radiology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST), Dino Amadori", Meldola, FC, Italy
| | - Nicola Napoli
- Fondazione Policlinico Campus Bio-Medico di Roma, Rome, Italy
| | - Rocky Strollo
- Department of Endocrinology, Clinica Polispecialistica "Casa del Sole", Formia, LT, Italy.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Via Di Val Cannuta 247, 00166, Rome, Italy.
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Fabritius MP, Soltani V, Cyran CC, Ricke J, Bartenstein P, Auernhammer CJ, Spitzweg C, Schnitzer ML, Ebner R, Mansournia S, Hinterberger A, Lohse A, Sheikh GT, Winkelmann M, Knösel T, Ingenerf M, Schmid-Tannwald C, Kunz WG, Rübenthaler J, Grawe F. Diagnostic accuracy of SSR-PET/CT compared to histopathology in the identification of liver metastases from well-differentiated neuroendocrine tumors. Cancer Imaging 2023; 23:92. [PMID: 37770958 PMCID: PMC10537814 DOI: 10.1186/s40644-023-00614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Histopathology is the reference standard for diagnosing liver metastases of neuroendocrine tumors (NETs). Somatostatin receptor-positron emission tomography / computed tomography (SSR-PET/CT) has emerged as a promising non-invasive imaging modality for staging NETs. We aimed to assess the diagnostic accuracy of SSR-PET/CT in the identification of liver metastases in patients with proven NETs compared to histopathology. METHODS Histopathologic reports of 139 resected or biopsied liver lesions of patients with known NET were correlated with matching SSR-PET/CTs and the positive/negative predictive value (PPV/NPV), sensitivity, specificity, and diagnostic accuracy of SSR-PET/CT were evaluated. PET/CT reading was performed by one expert reader blinded to histopathology and clinical data. RESULTS 133 of 139 (95.7%) liver lesions showed malignant SSR-uptake in PET/CT while initial histopathology reported on 'liver metastases of NET´ in 127 (91.4%) cases, giving a PPV of 91.0%. Re-biopsy of the initially histopathologically negative lesions (reference standard) nevertheless diagnosed 'liver metastases of NET' in 6 cases, improving the PPV of PET/CT to 95.5%. Reasons for initial false-negative histopathology were inadequate sampling in the sense of non-target biopsies. The 6 (4.3%) SSR-negative lesions were all G2 NETs with a Ki-67 between 2-15%. CONCLUSION SSR-PET/CT is a highly accurate imaging modality for the diagnosis of liver metastases in patients with proven NETs. However, we found that due to the well-known tumor heterogeneity of NETs, specifically in G2 NETs approximately 4-5% are SSR-negative and may require additional imaging with [18F]FDG PET/CT.
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Affiliation(s)
- M P Fabritius
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - V Soltani
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - C C Cyran
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - J Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - C J Auernhammer
- Department of Internal Medicine 4, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - C Spitzweg
- Department of Internal Medicine 4, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - M L Schnitzer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - R Ebner
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - S Mansournia
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - A Hinterberger
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - A Lohse
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - G T Sheikh
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
| | - M Winkelmann
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - T Knösel
- Department of Pathology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - M Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - C Schmid-Tannwald
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - W G Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - J Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Freba Grawe
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany.
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Funatsu N, Hara K, Takagi M, Onodera A, Ueno K, Endo K, Cho H. Robotically assisted total gastrectomy for lymphadenopathy after long-term follow-up for multiple type 1 gastric neuroendocrine tumor (NET): a case report. Surg Case Rep 2023; 9:142. [PMID: 37556088 PMCID: PMC10412512 DOI: 10.1186/s40792-023-01725-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Type 1 gastric neuroendrine tumor (NET) is usually associated with chronic atrophic gastritis and forms multiple lesions. While most cases of type 1 gastric NET are generally slowly growing, some develop regional lymph node metastases even after long-term dormancy. CASE PRESENTATION A 73-year-old male patient with a 32-year history of multiple gastric NET was being followed-up at the study center after endoscopic submucosal dissection (ESD) of a large gastric NET. A blood examination revealed high serum gastrin (> 3000 pg/ml). An endoscopic examination found atrophic mucosa and multiple, elevated lesions in the upper to lower stomach body. Computed tomography (CT) revealed regional lymphadenopathy in the greater omentum along the gastroepiploic artery. Robotically assisted total gastrectomy was performed with D2 lymphadenectomy and Roux-en-Y reconstruction. Pathological analysis revealed a large number of gastric NET (grade 1) with a maximum size of 4.5 mm invading the submucosal layer. A single lymph node metastasis was also detected pathologically at station #4d. The postoperative course was uneventful, and serum gastrin normalized postoperatively. At postoperative year 3, the patient has been doing well without any recurrences. CONCLUSIONS The present case of multiple gastric NET with a single regional lymph node metastasis at year 32 of follow-up was successfully treated with a robotically assisted total gastrectomy.
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Affiliation(s)
- Nozomi Funatsu
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Kentaro Hara
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan.
| | - Maki Takagi
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Atsushi Onodera
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Kohdai Ueno
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Kazuya Endo
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Haruhiko Cho
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
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Weber M, Telli T, Kersting D, Seifert R. Prognostic Implications of PET-Derived Tumor Volume and Uptake in Patients with Neuroendocrine Tumors. Cancers (Basel) 2023; 15:3581. [PMID: 37509242 PMCID: PMC10377105 DOI: 10.3390/cancers15143581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Historically, molecular imaging of somatostatin receptor (SSTR) expression in patients with neuroendocrine tumors (NET) was performed using SSTR scintigraphy (SRS). Sustained advances in medical imaging have led to its gradual replacement with SSTR positron-emission tomography (SSTR-PET). The higher sensitivity in comparison to SRS on the one hand and conventional cross-sectional imaging, on the other hand, enables more accurate staging and allows for image quantification. In addition, in recent years, a growing body of evidence has assessed the prognostic implications of SSTR-PET-derived prognostic biomarkers for NET patients, with the aim of risk stratification, outcome prognostication, and prediction of response to peptide receptor radionuclide therapy. In this narrative review, we give an overview of studies examining the prognostic value of advanced SSTR-PET-derived (semi-)quantitative metrics like tumor volume, uptake, and composite metrics. Complementing this analysis, a discussion of the current trends, clinical implications, and future directions is provided.
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Affiliation(s)
- Manuel Weber
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147 Essen, Germany
| | - Tugce Telli
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147 Essen, Germany
| | - David Kersting
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147 Essen, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147 Essen, Germany
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Grawe F, Rosenberger N, Ingenerf M, Beyer L, Eschbach R, Todica A, Seidensticker R, Schmid-Tannwald C, Cyran CC, Ricke J, Bartenstein P, Auernhammer CJ, Ruebenthaler J, Fabritius MP. Diagnostic performance of PET/CT in the detection of liver metastases in well-differentiated NETs. Cancer Imaging 2023; 23:41. [PMID: 37098632 PMCID: PMC10131442 DOI: 10.1186/s40644-023-00556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The aim of this retrospective study was to compare the diagnostic accuracy of somatostatin receptor (SSR)-PET/CT to liver MRI as reference standard in the evaluation of hepatic involvement in neuroendocrine tumors (NET). METHODS An institutional database was screened for "SSR" imaging studies between 2006 and 2021. 1000 NET Patients (grade 1/2) with 2383 SSR-PET/CT studies and matching liver MRI in an interval of +3 months were identified. Medical reports of SSR-PET/CT and MRI were retrospectively evaluated regarding hepatic involvement and either confirmed by both or observed in MRI but not in SSR-PET/CT (false-negative) or in SSR-PET but not in MRI (false-positive). RESULTS Metastatic hepatic involvement was reported in 1650 (69.2%) of the total 2383 SSR-PET/CT imaging studies, whereas MRI detected hepatic involvement in 1685 (70.7%) cases. There were 51 (2.1%) false-negative and 16 (0.7%) false-positive cases. In case of discrepant reports, MRI and PET/CT were reviewed side by side for consensus reading. SSR-PET/CT demonstrated a sensitivity of 97.0% (95%CI: 96.0%, 97.7%), a specificity of 97.7% (95%CI: 96.3%, 98.7%), a PPV of 99.0% (95%CI: 98.4%, 99.4%) and NPV of 93.0% (95%CI: 91.0, 94.8%) in identifying hepatic involvement. The most frequent reason for false-negative results was the small size of lesions with the majority < 0.6 cm. CONCLUSION This study confirms the high diagnostic accuracy of SSR-PET/CT in the detection of hepatic involvement in NET patients based on a patient-based analysis of metastatic hepatic involvement with a high sensitivity and specificity using liver MRI imaging as reference standard. However, one should be aware of possible pitfalls when a single imaging method is used in evaluating neuroendocrine liver metastases in patients.
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Affiliation(s)
- Freba Grawe
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Natalie Rosenberger
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Ralf Eschbach
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Ricarda Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Christine Schmid-Tannwald
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Clemens C Cyran
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Christoph J Auernhammer
- Department of Internal Medicine 4, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Johannes Ruebenthaler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Matthias P Fabritius
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Ma X, Ding Y, Li W, Li Q, Yang H. Diagnosis and management of gastroenteropancreatic neuroendocrine neoplasms by nuclear medicine: Update and future perspective. Front Oncol 2022; 12:1061065. [PMID: 36483036 PMCID: PMC9722972 DOI: 10.3389/fonc.2022.1061065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/07/2022] [Indexed: 11/14/2023] Open
Abstract
Gastrointestinal (GI) cancers are the second most common cause of cancer related deaths in the World. Neuroendocrine neoplasms (NENs) is a rare tumor that originated from peptidergic neurons and neuroendocrine cells. NENs occurs in all parts of the body, especially in stomach, intestine, pancreas and lung. These rare tumors are challenging to diagnose at earlier stages because of their wide anatomical distribution and complex clinical features. Traditional imaging methods including magnetic resonance imaging (MRI) and computed tomography (CT) are mostly of useful for detection of larger primary tumors that are 1cm in size. A new medical imaging specialty called nuclear medicine uses radioactive substances for both diagnostic and therapeutic purposes. Nuclear medicine imaging relies on the tissue-specific uptake of radiolabeled tracers. Nuclear medicine techniques can easily identify the NENs tissues for their ability to absorb and concentrate amine, precursors, and peptides, whereas the traditional imaging methods are difficult to perform well. The somatostatin receptor (SSTR) is a targetable receptor frequently expressed in the gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), and is a promising target for tumor-targeted therapies and radiography. SSTR based somatostatin receptor imaging and peptide receptor radionuclide therapy (PRRT) has emerged as a new hot subject in the diagnosis and treatment of GEP-NENs due to the rapid development of somatostatin analogues (SSAs) and radionuclide. This review aims to provide an overview of the current status of nuclear medicine imaging modalities in the imaging of GEP-NENs, and puts them in perspective of clinical practice.
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Affiliation(s)
| | | | | | | | - Hui Yang
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Muacevic A, Adler JR. Unresectable Mesenteric Mass Causing Small Bowel Obstruction. Cureus 2022; 14:e29871. [PMID: 36348891 PMCID: PMC9629657 DOI: 10.7759/cureus.29871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 01/24/2023] Open
Abstract
Small bowel obstruction (SBO) has a variety of etiologies, including but not limited to adhesions, malignancy, hernia, and inflammatory bowel diseases. Treatment for SBO may be nonoperative or operative, depending on the underlying condition and clinical symptoms. Clinical judgment and radiological findings cooperate in formulating an appropriate assessment and treatment plan. Mass effect due to malignancy is an indication for surgical intervention, as tumor resection is a mainstay of treatment. However, patient safety and chances of vascular compromise must be considered when determining if the tumor is resectable. Reported is a case of a 65-year-old female with severe abdominal pain, nausea, vomiting, and obstipation due to a malignant neuroendocrine tumor within the mesentery adjacent to the aortic bifurcation. Management included surgical intervention to alleviate bowel obstruction and biopsy of the tumor.
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Ramim JE, Matheos de Lima BA, Bulzico DA, Pujatti PB, Bergmann A. Prospective Cohort Real-World Study on Neuroendocrine Tumor Patient's Quality of Life During Peptide Receptor Radionuclide Therapy With 177Lu-DOTATATE. Pancreas 2022; 51:784-9. [PMID: 36395404 DOI: 10.1097/MPA.0000000000002101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to report lutetium-177 (177Lu)-DOTATATE radionuclide therapy from a patient perspective and their health-related quality of life. METHODS This prospective cohort study, including adult patients treated with 177Lu-DOTATATE. At the beginning of the follow-up (T1), socioeconomic and clinical information was collected, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30-v3 and GI.NET21 were applied. Follow-up was performed at the third cycle (T2) and 3 months after the end of treatment (T3). Student t test for paired samples was used to compare quality of life at T1, T2, and T3. RESULTS Thirty-eight patients with stage IV disease and mean age of 52.54 (standard deviation, 12.49) years were included. The most prevalent site was the gastrointestinal tract (39.7%). Global health improved between T2 and T3 (P = 0.022) and T1 and T3 (P = 0.038). Functional scales did not indicate significant changes between the periods. Regarding symptoms, significant improvements in nausea and vomiting and gastrointestinal symptoms were observed between T2 and T3 (P = 0.012 and 0.029) and T1 and T3 (P = 0.012 and 0.011), respectively. CONCLUSIONS 177Lu-DOTATATE therapy improved global health and reduced disease-related symptoms in NET patients, positively impacting health-related quality of life.
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Si Y, Huang C, Yuan J, Zhang X, He Q, Lin Z, He L, Liu Z, Teekaraman Y. Analysis of Prognostic Risk Factors of Endoscopic Submucosal Dissection (ESD) and Curative Resection of Gastrointestinal Neuroendocrine Neoplasms. Contrast Media & Molecular Imaging 2022; 2022:1-7. [PMID: 35854772 PMCID: PMC9286938 DOI: 10.1155/2022/5248256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/08/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Abstract
Objective To explore the prognostic risk factors of ESD curative resection of gastrointestinal-neuroendocrine neoplasms (GI-NENs). Methods A total of 97 patients treated with ESD successfully in our hospital were selected, their surgical site, size, number of resection lesions, operation time, intraoperative complications (such as bleeding and perforation), and treatment status were recorded, and the number of hemostatic clamps used after the postoperative follow-up results and the independent risk factors for ESD complications were obtained through the comparison between the noncomplication group and the ESD complication group using regression analysis. Results A total of 97 patients with gastrointestinal neuroendocrine tumors were treated with ESD. 61 were males, 36 were females, the ratio of male to female was 1.7 : 1, onset age was 20–78 years old, and median onset age was 50 years old. In 81 cases, tumors were located in the stomach, 10 in the duodenum, and 6 in the rectum. A total of 103 lesions were detected by endoscopy, including 1 case with 2 sites in the stomach, 5 cases with 2 sites in the rectum, and the rest were single. The tumor diameter was 0.3 ∼ 2.5 cm, and the median diameter was 0.6 cm; there were 25 sites with a diameter less than 5 cm. There were 57 places with 10 mm, 16 places with 10–15 mm, and 5 places with >15 mm. All ESD operations were performed in one piece, with a total resection rate of 100%; 89.6% (60/67) of postoperative pathology showed negative basal, and 90.3% (56/62) showed negative resection margin, with a complete resection rate of 88.9% (48/54). ESD's operation time is 6 ∼ 66 min, and the median time is 18 min. During the operation, 5 cases had small amount of bleeding, 3 cases were perforated, 2 cases of delayed postoperative bleeding, 1 case of bleeding was caused by the patient's failure to follow the advice of the doctor to eat a large amount of solid food too early, and 1 case of delayed perforation (all recovered and discharged). ESD operation that bled, age, gender, and perforation location, pathological grade, pathological classification, tumor diameter, tumor surface, operation time, number of titanium clips, origin, echo uniformity, and echo level were statistically insignificant (P > 0.05). Postoperative bleeding was related to the operation time (P=0.017), but it was not an independent risk factor for postoperative bleeding (P=0.118; OR, 0.226; 95% CI, 0.035–1.461). 59 cases were followed up by endoscopy after the operation, and recurrence or no new tumors were found. Conclusion ESD is an effective and safe treatment method for gastrointestinal neuroendocrine tumors with a diameter of 1-2 cm without invading the muscularis propria. The intraoperative complications seem to have little relationship with the patient; postoperative delayed bleeding is closely related to the ESD operation time but it is not an independent risk factor.
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Peer-Firozjaei M, Tajik-Mansoury MA, Geramifar P, Ghorbani R, Zarifi S, Miller C, Rahmim A. Optimized cocktail of 90Y/177Lu for radionuclide therapy of neuroendocrine tumors of various sizes: a simulation study. Nucl Med Commun 2022; 43:646-655. [PMID: 35256576 DOI: 10.1097/mnm.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES There is significant interest and potential in the treatment of neuroendocrine tumors via peptide receptor radionuclide therapy (PRRT) using one or both of 90Y and 177Lu-labeled peptides. Given the presence of different tumor sizes in patients and differing radionuclide dose delivery properties, the present study aims to use Monte Carlo simulations to estimate S-values to spherical tumors of various sizes with 90Y and 177Lu separately and in combination. The goal is to determine ratios of 90Y to 177Lu that result in the largest absorbed doses per decay of the radionuclides and the most suitable dose profiles to treat tumors of specific sizes. MATERIAL AND METHODS Particle transfer calculations and simulations were performed using the Monte Carlo GATE simulation software. Spherical tumors of different sizes, ranging from 0.5 to 20 mm in radius, were designed. Activities of 177Lu and 90Y, individually and in combination, were homogeneously placed within the total volume of the tumors. We determined the S-values to the tumors, and to the external volume outside of the tumors (cross-dose) which was used to approximate background tissue. The dose profiles were obtained for each of the different tumor sizes, and the uniformity of dose within each tumor was calculated. RESULTS For all tumor sizes, the self-dose and cross-dose per decay from 90Y were higher than that from 177Lu. We observed that 177Lu had the most uniform dose distribution within tumors with radii less than 5 mm. For tumors greater than 5 mm in radius, a ratio of 25% 90Y to 75% 177Lu resulted in the most uniform doses. When the ratio of 177Lu to 90Y was smaller, the uniformity improved more with increasing tumor size. The cross-dose stayed approximately constant for tumors larger than 15 mm for all ratios of 177Lu to 90Y. Finally, as the size of the tumor increased, differences in the S-values between different ratios of 177Lu to 90Y decreased. CONCLUSION Our work showed that to achieve a more uniform dose distribution within the tumor, 177Lu alone is more effective for small tumors. For medium and large tumors, a ratio of 90Y to 177Lu with more or less 177Lu, respectively, is recommended.
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Affiliation(s)
- Milad Peer-Firozjaei
- Department of Medical Physics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan
| | - Mohammad Ali Tajik-Mansoury
- Department of Medical Physics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences (SBMU), Tehran
| | - Parham Geramifar
- Nuclear Medicine Department, Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran
| | - Raheb Ghorbani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Shiva Zarifi
- Department of Medical Physics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan
| | - Cassandra Miller
- Department of Integrative Oncology, BC Cancer Research Institute
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada
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Feng Z, He X, Zhang X, Wu Y, Xing B, Knowles A, Shan Q, Miller S, Hojnacki T, Ma J, Katona BW, Gade TPF, Siegel DL, Schrader J, Metz DC, June CH, Hua X. Potent suppression of neuroendocrine tumors and gastrointestinal cancers by CDH17CAR T cells without toxicity to normal tissues. Nat Cancer 2022; 3:581-594. [PMID: 35314826 DOI: 10.1038/s43018-022-00344-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/09/2022] [Indexed: 12/15/2022]
Abstract
Gastrointestinal cancers (GICs) and neuroendocrine tumors (NETs) are often refractory to therapy after metastasis. Adoptive cell therapy using chimeric antigen receptor (CAR) T cells, though remarkably efficacious for treating leukemia, is yet to be developed for solid tumors such as GICs and NETs. Here we isolated a llama-derived nanobody, VHH1, and found that it bound cell surface adhesion protein CDH17 upregulated in GICs and NETs. VHH1-CAR T cells (CDH17CARTs) killed both human and mouse tumor cells in a CDH17-dependent manner. CDH17CARTs eradicated CDH17-expressing NETs and gastric, pancreatic and colorectal cancers in either tumor xenograft or autochthonous mouse models. Notably, CDH17CARTs do not attack normal intestinal epithelial cells, which also express CDH17, to cause toxicity, likely because CDH17 is localized only at the tight junction between normal intestinal epithelial cells. Thus, CDH17 represents a class of previously unappreciated tumor-associated antigens that is 'masked' in healthy tissues from attack by CAR T cells for developing safer cancer immunotherapy.
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Affiliation(s)
- Zijie Feng
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xin He
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xuyao Zhang
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yuan Wu
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bowen Xing
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Alison Knowles
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Qiaonan Shan
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Samuel Miller
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Taylor Hojnacki
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jian Ma
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bryson W Katona
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Terence P F Gade
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Don L Siegel
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jörg Schrader
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David C Metz
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carl H June
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Xianxin Hua
- Department of Cancer Biology, Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Hue JJ, Sugumar K, Ammori JB, Rothermel LD, Hardacre JM, Winter JM, Ocuin LM. Facility type and size-stratified analysis of management patterns and outcomes of patients with localized non-functional pancreatic neuroendocrine tumors. HPB (Oxford) 2022; 24:498-506. [PMID: 34419354 DOI: 10.1016/j.hpb.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/10/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-functional neuroendocrine tumors of the pancreas (NF-pNETs) are uncommon. Consensus guidelines have conflicting recommendations. We performed a nationwide analysis of patterns in management and outcomes based on facility type and tumor size. METHODS The National Cancer Database (2004-2016) was queried for patients with localized NF-pNETs (<1 cm, 1-2 cm, >2 cm) stratified by facility type. Management decisions, operative outcomes, and survival were compared. RESULTS A total of 7170 patients were included in the analysis (<1 cm = 916; 1-2 cm = 2180; >2 cm = 4074). Most patients were treated at academic facilities (62.8%). Over 67% of patients with tumors <1 cm underwent resection, independent of facility type (p = 0.443). There was no association between facility type and operative vs non-operative management of patients with NF-pNETs 1-2 cm in size. Patients treated at academic facilities were more likely to undergo resection for tumors >2 cm compared to other facility types. Resection was associated with improved survival among patients with tumors 1-2 cm (HR = 0.43,p < 0.001) and >2 cm (HR = 0.32,p < 0.001), but not <1 cm (HR = 0.64,p = 0.054), as compared to non-operative management. CONCLUSION There is heterogeneity in management of NF-pNETs across facility types. Treatment at academic facilities appears to be associated with higher resection rates for tumors >2 cm. There appears to be an independent association between operative management and improved survival for tumors ≥1 cm in size.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kavin Sugumar
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey M Hardacre
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Lee M Ocuin
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Ambrosini V, Zanoni L, Filice A, Lamberti G, Argalia G, Fortunati E, Campana D, Versari A, Fanti S. Radiolabeled Somatostatin Analogues for Diagnosis and Treatment of Neuroendocrine Tumors. Cancers (Basel) 2022; 14:cancers14041055. [PMID: 35205805 PMCID: PMC8870358 DOI: 10.3390/cancers14041055] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Neuroendocrine neoplasms (NENs) are rare and heterogeneous tumors, presenting in often challenging clinical scenarios, and require multidisciplinary discussion for optimal care. The theranostic approach (DOTA peptides labelled with 68Ga for imaging well-differentiated neuroendocrine tumors NETs, and labelled with 90Y or 177Lu for therapy) plays a crucial role in the management of NENs to assess disease extension and criteria for peptide receptor radionuclide therapy (PRRT) eligibility of based on somatostatin receptor (SSTR) expression. The present paper is an overview of currently employed radiolabeled SSTR analogues used for both diagnosis and therapy of NENs. Further emerging radiopharmaceuticals targeting SSTRs (e.g., fluorinated SSTR agonists, radiolabeled SSTR antagonists) as well as strategies to improve PRRT efficacy (by means of implementation of personalized treatment schemes, dosimetry, amelioration of response assessment strategies, and optimization of treatment sequencing) are also discussed. Finally, although very preliminary, some studies employing radiomic features in various kinds of NET are reported. Abstract Neuroendocrine neoplasms (NENs) are rare and heterogeneous tumors that require multidisciplinary discussion for optimal care. The theranostic approach (DOTA peptides labelled with 68Ga for diagnosis and with 90Y or 177Lu for therapy) plays a crucial role in the management of NENs to assess disease extension and as a criteria for peptide receptor radionuclide therapy (PRRT) eligibility based on somatostatin receptor (SSTR) expression. On the diagnostic side, [68Ga]Ga-DOTA peptides PET/CT (SSTR PET/CT) is the gold standard for imaging well-differentiated SSTR-expressing neuroendocrine tumors (NETs). [18F]FDG PET/CT is useful in higher grade NENs (NET G2 with Ki-67 > 10% and NET G3; NEC) for more accurate disease characterization and prognostication. Promising emerging radiopharmaceuticals include somatostatin analogues labelled with 18F (to overcome the limits imposed by 68Ga), and SSTR antagonists (for both diagnosis and therapy). On the therapeutic side, the evidence gathered over the past two decades indicates that PRRT is to be considered as an effective and safe treatment option for SSTR-expressing NETs, and is currently included in the therapeutic algorithms of the main scientific societies. The positioning of PRRT in the treatment sequence, as well as treatment personalization (e.g., tailored dosimetry, re-treatment, selection criteria, and combination with other alternative treatment options), is warranted in order to improve its efficacy while reducing toxicity. Although very preliminary (being mostly hampered by lack of methodological standardization, especially regarding feature selection/extraction) and often including small patient cohorts, radiomic studies in NETs are also presented. To date, the implementation of radiomics in clinical practice is still unclear. The purpose of this review is to offer an overview of radiolabeled SSTR analogues for theranostic use in NENs.
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Affiliation(s)
- Valentina Ambrosini
- Department of Experimental Diagnostic and Specialized Medicine, University of Bologna, 40138 Bologna, Italy; (V.A.); (G.L.); (G.A.); (E.F.); (D.C.); (S.F.)
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lucia Zanoni
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Correspondence:
| | - Angelina Filice
- Nuclear Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.F.); (A.V.)
| | - Giuseppe Lamberti
- Department of Experimental Diagnostic and Specialized Medicine, University of Bologna, 40138 Bologna, Italy; (V.A.); (G.L.); (G.A.); (E.F.); (D.C.); (S.F.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giulia Argalia
- Department of Experimental Diagnostic and Specialized Medicine, University of Bologna, 40138 Bologna, Italy; (V.A.); (G.L.); (G.A.); (E.F.); (D.C.); (S.F.)
| | - Emilia Fortunati
- Department of Experimental Diagnostic and Specialized Medicine, University of Bologna, 40138 Bologna, Italy; (V.A.); (G.L.); (G.A.); (E.F.); (D.C.); (S.F.)
| | - Davide Campana
- Department of Experimental Diagnostic and Specialized Medicine, University of Bologna, 40138 Bologna, Italy; (V.A.); (G.L.); (G.A.); (E.F.); (D.C.); (S.F.)
- Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (A.F.); (A.V.)
| | - Stefano Fanti
- Department of Experimental Diagnostic and Specialized Medicine, University of Bologna, 40138 Bologna, Italy; (V.A.); (G.L.); (G.A.); (E.F.); (D.C.); (S.F.)
- Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Rosiek V, Wójcik-Giertuga M, Kos-Kudła B. Serum tumor markers for detection of bone metastases in patients with lung neuroendocrine neoplasms". Cancer Treat Res Commun 2022; 31:100533. [PMID: 35202905 DOI: 10.1016/j.ctarc.2022.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Bone metastases (BM) are related to worse outcome in patients with neuroendocrine neoplasms (NENpts). AIM Assess utility of serum tumor markers (STM) for detection of BM in lung NENpts. MATERIAL AND METHODS Diagnostic metrics of STM, such as ferritin, carbohydrate antigens 19-9 (CA19-9), cancer antigen 125 (CA125), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and beta-2 microglobulin (BMG) were assessed in 62 Lung NEN patients (LNENpts), both with BM (BM-LNENpts) and without BM (non-BM-LNENpts) and 40 controls. RESULTS Except AFP, the mean circulating STM levels in LNENpts were significantly increased vs controls (p<0.04), but the most significant difference was in CA19-9 and CEA. BM-LNENpts exhibited an elevated level only for ferritin (n=6; 180.75±53.73 ng/ml; [182.68] compared to non-BM-LNENpts (n=56; 94.33±98.80 ng/ml; [70.35], p<0.001). Three from all used STM (ferritin, BMG and CA125) could differentiate BM-LNENpts from nonBM-LNENpts (area under the curve (AUC)=0.884 for ferritin, 0.74 for BMG and 0.658 for CA 125, p<0.05). These all three STM showed significant sensitivity (100%) by lower specificity in the detection of BM. CONCLUSIONS Some of the STM seem to have clinical utility for detection of BM-LNEN. The single good marker was ferritin (the high AUC, sensitivity and specificity) and fair biomarker was BMG. BM-LNENpts could be diagnosed by using CEA. The follow-up with combinations of STM (ferritin, BMG) could increase the diagnostic efficacy of BM-LNENpts. This requires further studies with larger patient groups.
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Affiliation(s)
- Violetta Rosiek
- Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, ul. Ceglana 35, 40-514 Katowice, Poland.
| | - Monika Wójcik-Giertuga
- Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, ul. Ceglana 35, 40-514 Katowice, Poland.
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, ul. Ceglana 35, 40-514 Katowice, Poland.
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Doroudinia A, Emami H, Hosseini MS. 68Ga-DOTATATE Radioisotope scan to detect neuroendocrine tumors; A Cross-Sectional Study. Asia Ocean J Nucl Med Biol 2022; 10:14-19. [PMID: 35083345 PMCID: PMC8742856 DOI: 10.22038/aojnmb.2021.56971.1397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/30/2021] [Accepted: 08/16/2021] [Indexed: 12/13/2022]
Abstract
OBJEVTIVES Neuroendocrine tumors are a heterogeneous group of neoplasms that arise from the peptide-producing cells of the neuroendocrine system. Different functional imaging methods have been suggested to diagnose NETs. There is still not enough evidence to recommend 68Ga-DOTATATE as a standard diagnostic tool in NETs. Therefore, the aim of this study was to assess the value of 68Ga-DOTATATE scan in detecting NETs. METHODS This was a cross-sectional study. All patients with a pathologically confirmed NET tumor referred to Masih Daneshvari Hospital affiliated to Shahid Beheshti University of Medical Sciences entered the study. Patients underwent a 68Ga-DOTATATE PET/CT. All statistical analysis were performed by SPSS software version 18. RESULTS Forty patients with a mean age of 48.1±15.80 years entered the study. Twenty-one (52.5%) were male and 19 (47.5%) female. In the studied patients, neuroendocrine tumor was present in 19 cases (47.5%) in pancreas and gastrointestinal tract, 9 (22.5%) in lung, 3 (7.5%) in mediastinum and adrenal gland, 6 cases (5%) in liver and 3 other sites. There was no significant association between mean age and gender with primary location of the tumor. The mean SUVmax was 11.62±20.02 and the the mean tumor size was 38.25±31.35 mm. The mean size of the metastasis was 40.55±24.53 mm. The mean percentage of ki-67 was 12.54±18.40. There was no significant correlation between SUVmax of the lesion and age (r=0.063, P=0.701), tumor size (r=-0.63, P=0.067) or Ki-67 (r=0.011, P=0.960). In 20 cases, metastases were reported, of which 14 were (70%) in the liver, 3 in the lungs (15%), 2 in the gastrointestinal and cervical lymph nodes, and 1 in the bones and pancreas(%5). CONCLUSION 68Ga-DOTA-peptide PET/CT could find the primary or metastasis sites of NETs with good quality images. In general, this modality can enhance the management in patients with NETs.
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Affiliation(s)
| | | | - Mahsa Sadat Hosseini
- Chronic Respiratory Diseases Research Center, National research institute of tuberculosis and lung diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Noh JH, Kim DH, Yoon H, Hsing LC, Na HK, Ahn JY, Lee JH, Jung KW, Choi KD, Song HJ, Lee GH, Jung HY. Clinical Outcomes of Endoscopic Treatment for Type 1 Gastric Neuroendocrine Tumor. J Gastrointest Surg 2021; 25:2495-2502. [PMID: 33825119 DOI: 10.1007/s11605-021-04997-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/23/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the rate of early detection and endoscopic treatment of gastric neuroendocrine tumors (NETs) is steadily increasing, there are insufficient studies on the long-term outcomes of endoscopic treatment. Therefore, we aimed to investigate the clinical features and long-term outcomes of endoscopic treatment for type 1 gastric NETs. METHODS Subjects who underwent endoscopic treatment for gastric NETs between March 1997 and December 2015 were included. Clinical features and endoscopic treatment outcomes were retrospectively investigated by reviewing medical records. RESULTS In total, 125 subjects underwent endoscopic treatment including forceps biopsy (n = 21), argon plasma coagulation (n = 1), endoscopic mucosal resection (EMR, n = 62), and endoscopic submucosal dissection (ESD, n = 41). In total, 103 patients with 114 lesions, who underwent EMR or ESD, were analyzed to evaluate endoscopic and oncologic outcomes. The rates of en bloc resection in the EMR and ESD groups were 91.5% and 97.7%, respectively. Complete resection rates were significantly higher in the ESD group than in the EMR group; it was also higher in < 1-cm small-sized lesions than in 1-2-cm large-sized lesions. Adverse events were similar between the two groups. During a median follow-up period of 63 months, local recurrence rates were 6.5% and 2.4% in the EMR and ESD groups, respectively, and the disease-free survival rate did not differ significantly between the groups. CONCLUSION Endoscopic treatment for type 1 gastric NETs less than 2 cm in diameter and confined to mucosal and submucosal layers could be an effective and safe treatment strategy based on the favorable long-term outcome.
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Affiliation(s)
- Jin Hee Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Hwan Yoon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Li-Chang Hsing
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Si Y, Kim S, Ou J, Lu Y, Ernst P, Chen K, Whitt J, Carter AM, Markert JM, Bibb JA, Chen H, Zhou L, Jaskula-Sztul R, Liu XM. Anti-SSTR2 antibody-drug conjugate for neuroendocrine tumor therapy. Cancer Gene Ther 2021; 28:799-812. [PMID: 32684623 PMCID: PMC7854894 DOI: 10.1038/s41417-020-0196-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 12/13/2022]
Abstract
Neuroendocrine (NE) tumors include a diverse spectrum of hormone-secreting neoplasms that arise from the endocrine and nervous systems. Current chemo- and radio-therapies have marginal curative benefits. The goal of this study was to develop an innovative antibody-drug conjugate (ADC) to effectively treat NE tumors (NETs). First, we confirmed that somatostatin receptor 2 (SSTR2) is an ideal cancer cell surface target by analyzing 38 patient-derived NET tissues, 33 normal organs, and three NET cell lines. Then, we developed a new monoclonal antibody (mAb, IgG1, and kappa) to target two extracellular domains of SSTR2, which showed strong and specific surface binding to NETs. The ADC was constructed by conjugating the anti-SSTR2 mAb and antimitotic monomethyl auristatin E. In vitro evaluations indicated that the ADC can effectively bind, internalize, release payload, and kill NET cells. Finally, the ADC was evaluated in vivo using a NET xenograft mouse model to assess cancer-specific targeting, tolerated dosage, pharmacokinetics, and antitumor efficacy. The anti-SSTR2 ADC exclusively targeted and killed NET cells with minimal toxicity and high stability in vivo. This study demonstrates that the anti-SSTR2 ADC has a high-therapeutic potential for NET therapy.
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Affiliation(s)
- Yingnan Si
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL, 35294, USA
| | - Seulhee Kim
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL, 35294, USA
| | - Jianfa Ou
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL, 35294, USA
| | - Yun Lu
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL, 35294, USA
| | - Patrick Ernst
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL, 35294, USA
| | - Kai Chen
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL, 35294, USA
| | - Jason Whitt
- Department of Surgery, UAB, 1808 7th Avenue South, Birmingham, AL, 35294, USA
| | - Angela M Carter
- Department of Surgery, UAB, 1808 7th Avenue South, Birmingham, AL, 35294, USA
| | - James M Markert
- Department of Neurosurgery, UAB, 510 20th Street South, Birmingham, AL, 35294, USA
- O'Neal Comprehensive Cancer Center, UAB, 1824 6th Avenue South, Birmingham, AL, 35233, USA
| | - James A Bibb
- Department of Surgery, UAB, 1808 7th Avenue South, Birmingham, AL, 35294, USA
- O'Neal Comprehensive Cancer Center, UAB, 1824 6th Avenue South, Birmingham, AL, 35233, USA
| | - Herbert Chen
- Department of Surgery, UAB, 1808 7th Avenue South, Birmingham, AL, 35294, USA
- O'Neal Comprehensive Cancer Center, UAB, 1824 6th Avenue South, Birmingham, AL, 35233, USA
| | - Lufang Zhou
- Department of Medicine, UAB, 703 19th Street South, Birmingham, AL, 35294, USA
| | - Renata Jaskula-Sztul
- Department of Surgery, UAB, 1808 7th Avenue South, Birmingham, AL, 35294, USA.
- O'Neal Comprehensive Cancer Center, UAB, 1824 6th Avenue South, Birmingham, AL, 35233, USA.
| | - Xiaoguang Margaret Liu
- Department of Biomedical Engineering, University of Alabama at Birmingham (UAB), 1825 University Blvd, Birmingham, AL, 35294, USA.
- O'Neal Comprehensive Cancer Center, UAB, 1824 6th Avenue South, Birmingham, AL, 35233, USA.
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Bhagat VH, Kim M, Kahaleh M. A Review of Endoscopic Full-thickness Resection, Submucosal Tunneling Endoscopic Resection, and Endoscopic Submucosal Dissection for Resection of Subepithelial Lesions. J Clin Gastroenterol 2021; 55:309-15. [PMID: 33606429 DOI: 10.1097/MCG.0000000000001500] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Gastrointestinal subepithelial tumors (SETs) are often found while performing routine endoscopy. Recently, there has been the development of new endoscopic techniques such as endoscopic submucosal dissection, submucosal tunnel endoscopic resection, and endoscopic full-thickness resection, all minimally invasive approaches which have made it possible to resect SETs that were previously resected with surgery. This review discusses the endoscopic treatment of patients with SETs, outcomes for endoscopic treatment, procedure-related complications, and advantages and disadvantages of these endoscopic techniques.
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Tudela-Lerma M, Orcajo-Rincón J, Ramón-Botella E, Álvarez-Luque A, Gonzalez-Leyte M, Rotger-Regi A, Velasco-Sánchez E, Colón-Rodriguez A. Efficacy and safety of Yttrium-90 radioembolization in the treatment of neuroendocrine liver metastases. Long-term monitoring and impact on survival. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remnie.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garcia-Torralba E, Spada F, Lim KHJ, Jacobs T, Barriuso J, Mansoor W, McNamara MG, Hubner RA, Manoharan P, Fazio N, Valle JW, Lamarca A. Knowns and unknowns of bone metastases in patients with neuroendocrine neoplasms: A systematic review and meta-analysis. Cancer Treat Rev 2021; 94:102168. [PMID: 33730627 DOI: 10.1016/j.ctrv.2021.102168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to develop an evidence-based summary of current knowledge of bone metastases (BMs) in neuroendocrine neoplasms (NENs), inform diagnosis and treatment and standardise management between institutions. METHODS PubMed, Medline, EMBASE and meeting proceedings were searched for eligible studies reporting data on patients with BMs and NENs of any grade of differentiation and site; poorly-differentiated large/small cell lung cancer were excluded. Data were extracted and analysed using STATA v.12. Meta-analysis of proportions for calculation of estimated pooled prevalence of BM and calculation of weighted pooled frequency and weighted pooled mean for other variables of interest was performed . RESULTS A total of 149 studies met the eligibility criteria. Pooled prevalence of BMs was 18.4% (95% CI 15.4-21.5). BMs were mainly metachronous with initial diagnosis of NEN (61.2%) and predominantly osteoblastic; around 61% were multifocal, with a predisposition in axial skeleton. PET/CT seemed to provide (together with MRI) the highest sensitivity and specificity for BM detection. Almost half of patients (46.4%) reported BM-related symptoms: pain (66%) and skeletal-related events (SREs, fracture/spinal cord compression) (26.2%; weightedweighted mean time-to-SRE 9.9 months). Management of BMs was multimodal [bisphosphonates and bone-modifying agents (45.2%), external beam radiotherapy (34.9%), surgery (14.8%)] and supported by little evidence. Overall survival (OS) from the time of diagnosis of BMs was long [weighted mean 50.9 months (95% CI 40.0-61.9)]. Patients with BMs had shorter OS [48.8 months (95% CI 37.9-59.6)] compared to patients without BMs [87.4 months (95% CI 74.9-100.0); p = 0.001]. Poor performance status and BM-related symptoms were also associated with worse OS. CONCLUSIONS BMs in patients with NENs remain underdiagnosed and undertreated. Recommendations for management of BMs derived from current knowledge are provided. Prospective studies to inform management are required.
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Affiliation(s)
- Esmeralda Garcia-Torralba
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Haematology and Medical Oncology, Hospital Morales Meseguer, Murcia, Spain
| | - Francesca Spada
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - Kok Haw Jonathan Lim
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Timothy Jacobs
- Medical Library, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jorge Barriuso
- Division of Cancer Sciences, University of Manchester, Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Was Mansoor
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Mairéad G McNamara
- Division of Cancer Sciences, University of Manchester, Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Richard A Hubner
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Prakash Manoharan
- Department of Radiology and Nuclear Medicine, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - Juan W Valle
- Division of Cancer Sciences, University of Manchester, Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Angela Lamarca
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom.
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21
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Weber M, Kessler L, Schaarschmidt B, Fendler WP, Lahner H, Antoch G, Umutlu L, Herrmann K, Rischpler C. Textural analysis of hybrid DOTATOC-PET/MRI and its association with histological grading in patients with liver metastases from neuroendocrine tumors. Nucl Med Commun 2020; 41:363-9. [PMID: 31977752 DOI: 10.1097/MNM.0000000000001150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS Neuroendocrine tumors (NETs) are known to overexpress somatostatin receptors (SSTR), which can be visualized by DOTATOC-PET. Reduced SSTR expression on the other hand may indicate dedifferentiation. The aim of this retrospective study was to assess, if conventional PET parameters and textural features (TF) derived from simultaneous PET and MRI including apparent diffusion coefficient (ADC) are associated with the proliferative activity of NETs, potentially allowing non-invasive tumor grading. METHODS Our institutional database was screened for patients with NET and liver metastases >1 cm. We assessed conventional PET parameters, such as maximum and mean standardized uptake value and more elaborate TF parameters from PET and ADC-MRI (including entropy and homogeneity) from up to the five largest liver lesions per patient. The association of proliferative activity as measured by Ki67-/MIB1-index with the aforementioned parameters was analyzed. RESULTS One hundred patients with NET/NECs were eligible with a Ki67-index ranging from <1% to 30%. Overall, 304 liver lesions were analyzed. Conventional PET parameters, entropy, homogeneity of PET and ADC maps differed significantly between G1 and G2 NETs. However, Spearman's test showed a weak association (r = -0.23 to 0.31). DISCUSSION In our study cohort, conventional PET parameters and TF of PET and ADC-MRI showed only a weak correlation with Ki67. This indicates that in patients with a Ki67-index of up to 30% TF analysis of combined PET/MRI may not be reliably used for accurate non-invasive tumor grading. On the other hand, DOTATOC-PET might be a suitable staging tool in some higher grade NET/NECs.
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Shaunfield S, Webster KA, Kaiser K, Greene GJ, Yount SE, Lacson L, Benson AB, Halperin DM, Yao JC, Singh S, Feuilly M, Marteau F, Cella D. Development of the Functional Assessment of Cancer Therapy-Carcinoid Syndrome Symptom Index. Neuroendocrinology 2021; 111:850-862. [PMID: 32911478 DOI: 10.1159/000511482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a symptom-focused index to evaluate representative symptoms, treatment side effects, and emotional and functional well-being of patients with carcinoid syndrome (CS). METHODS The development of the Functional Assessment of Cancer Therapy-Carcinoid Syndrome Symptom Index (FACT-CSI) followed US Food and Drug Administration guidelines for the development of patient-reported outcome (PRO) measures and involved the following: (a) literature review; (b) interviews with 14 CS patients; (c) interviews with 9 clinicians; and (d) instrument development involving input from a range of PRO measure development and CS experts. The resulting draft instrument underwent cognitive interviews with 7 CS patients. RESULTS Forty-six CS sources were reviewed. Analysis of patient interviews produced 23 patient-reported symptoms. The most frequently endorsed physical symptoms were flushing, diarrhea, abdominal pain, fatigue, and food sensitivity/triggers. Seven priority CS emotional and functional themes were also identified by patients. Expert interviews revealed 12 unique priority symptoms - the most common being diarrhea, flushing, wheezing, edema, abdominal pain/cramping, fatigue, and 8 emotional and functional concerns. Through an iterative process of team and clinical collaborator meetings, data review, item reduction and measure revision, 24 items were selected for the draft symptom index representing symptoms, emotional concerns, global assessment of treatment side effects, and functional well-being. Cognitive interview results demonstrated strong content validity, including positive endorsement of item clarity (>86% across items), symptom relevance (>70% for most items), and overall measure content (86%). CONCLUSIONS The FACT-CSI is a content-relevant, symptom-focused index reflecting the highest priority and clinically relevant symptoms and concerns of people with CS.
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Affiliation(s)
- Sara Shaunfield
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,
| | - Kimberly A Webster
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - George J Greene
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susan E Yount
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Leilani Lacson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Al B Benson
- Department of Medical Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel M Halperin
- Department Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - James C Yao
- Department Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Simron Singh
- Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada
| | - Marion Feuilly
- Ipsen Pharma, Health Economics and Outcomes Research, Boulogne Billancourt, France
| | - Florence Marteau
- Ipsen Pharma, Health Economics and Outcomes Research, Boulogne Billancourt, France
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Tudela-Lerma M, Orcajo-Rincón J, Ramón-Botella E, Álvarez-Luque A, González-Leyte M, Rotger-Regi A, Velasco-Sánchez E, Colón-Rodríguez A. Efficacy and safety of Yttrium-90 radioembolization in the treatment of neuroendocrine liver metastases. Long-term monitoring and impact on survival. Rev Esp Med Nucl Imagen Mol 2020; 40:82-90. [PMID: 33239249 DOI: 10.1016/j.remn.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVE Neuroendocrine tumors (NETs) debut in 75% of cases with liver metastases (LMNETs), whose therapeutic approach includes surgical resection and liver transplantation, while liver radioembolization with 90 Y-microspheres (TARE) is reserved for non-operable patients usually due to high tumor burden. We present the accumulated experience of 10 years in TARE treatment of LMNETs in order to describe the safety and the effectiveness of the oncological response in terms of survival, as well as to detect the prognostic factors involved. MATERIAL AND METHODS Of 136 TARE procedures, performed between January 2006 and December 2016, 30 LMNETs (11.1%) were retrospectively analyzed. The study variables were: Tumor response, time to liver progression, survival at 3 and 5 years, overall mortality and mortality associated with TARE. The radiological response assessment was assessed using RECIST 1.1 and mRECIST criteria. RESULTS An average activity of 2.4 ± 1.3 GBq of 90 Y was administered. No patient presented postembolization syndrome or carcinoid syndrome. There were also no vascular complications associated with the procedure. According to RECIST 1.1 criteria at 6 months, 78.6% presented partial response and 21.4% stable disease, there was no progression or complete response (1 by mRECIST). Survival at 3 and 5 years was 73% in both cases. CONCLUSION TARE treatment with 90 Y-microspheres in LMNETs, applied within a multidisciplinary approach, is a safe procedure, with low morbidity, capable of achieving a high rate of radiological response and achieving lasting tumor responses.
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Affiliation(s)
- M Tudela-Lerma
- Servicio de Cirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Orcajo-Rincón
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - E Ramón-Botella
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Álvarez-Luque
- Servicio de Radiología Vascular e Intervencionista, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M González-Leyte
- Servicio de Radiología Vascular e Intervencionista, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Rotger-Regi
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - E Velasco-Sánchez
- Servicio de Cirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Colón-Rodríguez
- Servicio de Cirugía, Hospital General Universitario Gregorio Marañón, Madrid, España
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Miyashita M, Ono Y, Takamatsu M, Inoue Y, Sato T, Ito H, Takahashi Y, Saiura A. Repeat hepatectomy for liver metastases from bile duct neuroendocrine tumor: a case report. Surg Case Rep 2020; 6:204. [PMID: 32770496 DOI: 10.1186/s40792-020-00967-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/29/2020] [Indexed: 01/26/2023] Open
Abstract
Background Primary neuroendocrine tumor (NET) originating from the extrahepatic bile duct is rare, although liver metastasis from gastroenteropancreatic NET is frequently observed. We herein report a case who successfully underwent repeat hepatectomy for liver metastases from bile duct NET grade 2 (G2). Case presentation A 75-year-old man presented with jaundice and was suspected of perihilar cholangiocarcinoma by computed tomography (CT) and magnetic resonance imaging (MRI). He underwent extended left hepatectomy, extrahepatic bile duct resection, and hepaticojejunostomy. Pathological findings showed a NET G2 of the biliary tract arising from the common bile duct. Two years and 11 months after surgery, a liver metastasis was detected and hepatectomy was performed. During the surgery, another liver metastasis was detected, and limited liver resection for the two lesions was performed. Pathological findings showed four liver metastases of NET G2. Five years and 4 months after the first surgery (2 years and 5 months after the second hepatectomy), four liver metastases were detected. Thereafter, he received somatostatin analogues for 1 year. Although the size of tumors increased slightly, the number did not change. He underwent limited liver resections and was diagnosed with 7 liver metastases of NET G2. Finally, another hepatectomy (fourth hepatectomy) was performed and long-term survival without recurrence was obtained for as long as 8 years after the first surgery. Conclusions Repeat hepatectomy is a good option to obtain long-term survival for liver metastases from bile duct NET G2 in select patients.
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Sartori S, Bianchi L, Di Vece F, Tombesi P. Liver-directed therapies for liver metastases from neuroendocrine neoplasms: Can laser ablation play any role? World J Gastroenterol 2020; 26:3118-3125. [PMID: 32684730 PMCID: PMC7336329 DOI: 10.3748/wjg.v26.i23.3118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Aggressive cytoreduction can prolong survival in patients with unresectable liver metastases (LM) from neuroendocrine neoplasms (NEN), and minimally invasive, liver-directed therapies are gaining increasing interest. Catheter-based treatments are used in disseminated disease, whereas ablation techniques are usually indicated when the number of LM is limited. Although radiofrequency ablation (RFA) is by far the most used ablative technique, the goal of this opinion review is to explore the potential role of laser ablation (LA) in the treatment of LM from NEN. LA uses thinner needles than RFA, and this is an advantage when the tumors are in at-risk locations. Moreover, the multi-fiber technique enables the use of one to four laser fibers at once, and each fiber provides an almost spherical thermal lesion of 12-15 mm in diameter. Such a characteristic enables to tailor the size of each thermal lesion to the size of each tumor, sparing the liver parenchyma more than any other liver-directed therapy, and allowing for repeated treatments with low risk of liver failure. A recent retrospective study reporting the largest series of LM treated with LA documents both safety and effectiveness of LA, that can play a useful role in the multimodality approach to LM from NEN.
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Affiliation(s)
- Sergio Sartori
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Lara Bianchi
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Francesca Di Vece
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
| | - Paola Tombesi
- Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
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Fust K, Maschio M, Kohli M, Singh S, Pritchard DM, Marteau F, Myrenfors P, Feuilly M. A Budget Impact Model of the Addition of Telotristat Ethyl Treatment to the Standard of Care in Patients with Uncontrolled Carcinoid Syndrome. Pharmacoeconomics 2020; 38:607-618. [PMID: 32157590 DOI: 10.1007/s40273-020-00896-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Carcinoid syndrome, a rare condition in patients with neuroendocrine tumours, characterised by flushing and diarrhoea, severely affects patients' quality of life. The current carcinoid syndrome standard of care includes somatostatin analogues, but some patients experience uncontrolled symptoms despite somatostatin analogue therapy. Telotristat ethyl is a novel treatment approved by the European Medicines Agency (EMA) and US FDA that significantly reduces bowel movement frequency in patients with uncontrolled carcinoid syndrome. OBJECTIVE We developed a model to evaluate the 5-year budget impact of introducing telotristat ethyl to standard care in Swedish patients with uncontrolled carcinoid syndrome. METHODS Treatment response in the 12-week phase III TELESTAR trial (NCT01677910) informed telotristat ethyl efficacy; subsequently, health states were captured by a Markov model using 4-week cycles. TELESTAR open-label extension data informed telotristat ethyl discontinuation. The number of treatment-eligible patients was estimated from literature reviews reporting the prevalence, incidence and mortality of carcinoid syndrome. A Swedish database study informed real-world costs related to carcinoid syndrome and carcinoid heart disease costs. Telotristat ethyl market share was assumed to increase annually from 24% (year 1) to 70% (year 5). RESULTS Over the 5-year model horizon, 44 patients were expected to initiate telotristat ethyl treatment. The cumulative net budget impact of adding telotristat ethyl to current standard of care was €172,346; per-year costs decreased from €66,495 (year 1) to €29,818 (year 5). Increased drug costs from adding telotristat ethyl were offset by reduced costs elsewhere. CONCLUSIONS The expected budget impact of adding telotristat ethyl to the standard of care in Sweden was relatively low, largely because of the rarity of carcinoid syndrome.
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Affiliation(s)
- Kelly Fust
- Optum, 1325 Boylston Street, Boston, MA, 02215, USA
| | - Michael Maschio
- Formerly affiliated with Optum, 5500 North Service Road, Suite 501, Burlington, ON, L7L 6W6, Canada
| | - Michele Kohli
- Formerly affiliated with Optum, 5500 North Service Road, Suite 501, Burlington, ON, L7L 6W6, Canada
| | - Simron Singh
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - D Mark Pritchard
- Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, L69 3BX, UK
| | - Florence Marteau
- Ipsen Pharma, 65 Quai Georges Gorse, 92100, Boulogne-Billancourt, France
| | | | - Marion Feuilly
- Ipsen Pharma, 65 Quai Georges Gorse, 92100, Boulogne-Billancourt, France.
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Lin E, Chen T, Little A, Holliday L, Roach P, Butler P, Hosking E, Bailey E, Elison B, Currow D. Safety and outcomes of 177 Lu-DOTATATE for neuroendocrine tumours: experience in New South Wales, Australia. Intern Med J 2020; 49:1268-1277. [PMID: 31062490 DOI: 10.1111/imj.14336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 04/14/2019] [Accepted: 04/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Peptide receptor radionuclide therapy with 177 Lu-DOTATATE is a promising treatment for inoperable or metastatic neuroendocrine tumours (NET). In 2015, the NSW Ministry of Health provided funding for 177 Lu-DOTATATE treatment of NET under an evaluation framework. AIMS To examine the safety and outcomes of NET patients treated with 177 Lu-DOTATATE under the evaluation framework and assess the statewide implementation of the NSW Lutate therapy referral and protocol for neuroendocrine cancer patients. METHODS A quality of care clinical audit was conducted on all NET patients treated with 177 Lu-DOTATATE from October 2010 to October 2015 at St George Hospital, and from August 2013 to March 2017 at Royal North Shore Hospital. Percentage of patients who met protocol selection criteria was calculated. Survival was estimated using the Kaplan-Meier method. Adjusted regression analyses assessed associations between key clinical factors and outcomes. RESULTS A total of 279 patients was treated. Statewide protocol implementation led to an increase from 60.5 to 83.8% in patients meeting selection criteria. Estimated median overall survival was significantly longer for patients who met selection criteria compared with those who did not (50.7 vs 34.2 months) (P = 0.018). This was driven by the significantly worse overall survival in patients who failed exclusion criteria (P < 0.001). 177 Lu-DOTATATE was well tolerated with haematological, renal and hepatic treatment-related serious adverse events experienced by 9.7, 0.4 and 0.4% of patients respectively. CONCLUSIONS 177 Lu-DOTATATE is a promising treatment for advanced NET. Superior survival in patients who met selection criteria emphasise the importance of protocol adherence.
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Affiliation(s)
- Enmoore Lin
- Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Tina Chen
- Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Alana Little
- Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Laura Holliday
- Cancer Institute NSW, Sydney, New South Wales, Australia
| | - Paul Roach
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Patrick Butler
- Department of Nuclear Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Erika Hosking
- Department of Nuclear Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Elizabeth Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Barry Elison
- Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - David Currow
- Cancer Institute NSW, Sydney, New South Wales, Australia
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Weber M, Kessler L, Schaarschmidt B, Fendler WP, Lahner H, Antoch G, Umutlu L, Herrmann K, Rischpler C. Treatment-related changes in neuroendocrine tumors as assessed by textural features derived from 68Ga-DOTATOC PET/MRI with simultaneous acquisition of apparent diffusion coefficient. BMC Cancer 2020; 20:326. [PMID: 32299391 PMCID: PMC7161278 DOI: 10.1186/s12885-020-06836-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/06/2020] [Indexed: 12/17/2022] Open
Abstract
Background Neuroendocrine tumors (NETs) frequently overexpress somatostatin receptors (SSTRs), which is the molecular basis for 68Ga-DOTATOC positron-emission tomography (PET) and radiopeptide therapy (PRRT). However, SSTR expression fluctuates and can be subject to treatment-related changes. The aim of this retrospective study was to assess, which changes in PET and apparent diffusion coefficient (ADC) occur for different treatments and if pre-therapeutic 68Ga-DOTATOC-PET/MRI was able to predict treatment response to PRRT. Methods Patients with histopathologically confirmed NET, at least one liver metastasis > 1 cm and at least two 68Ga-DOTATOC-PET/MRI including ADC maps were eligible. 68Ga-DOTATOC-PET/MRI of up to 5 liver lesions per patients was subsequently analyzed. Extracted features comprise conventional PET parameters, such as maximum and mean standardized uptake value (SUVmax and SUVmean) and ADC values. Furthermore, textural features (TFs) from both modalities were extracted. In patients with multiple 68Ga-DOTATOC-PET/MRI a pair of 2 scans each was analyzed separately and the parameter changes between both scans calculated. The same image analysis was performed in patients with 68Ga-DOTATOC-PET/MRI before PRRT. Differences in PET and ADC maps parameters between PRRT-responders and non-responders were compared using Mann-Whitney test to test differences among groups for statistical significance. Results 29 pairs of 68Ga-DOTATOC-PET/MRI scans of 18 patients were eligible for the assessment of treatment-related changes. In 12 cases patients were treated with somatostatin analogues between scans, in 9 cases with PRRT and in 2 cases each patients received local treatment, chemotherapy and sunitinib. Treatment responders showed a statistically significant decrease in lesion volume and a borderline significant decrease in entropy on ADC maps when compared to non-responders. Patients treated with standalone SSA showed a borderline significant decrease in mean and maximum ADC, compared to patients treated with PRRT. No parameters were able to predict treatment response to PRRT on pre-therapeutic 68Ga-DOTATOC-PET/MRI. Conclusions Patients responding to current treatment showed a statistically significant decrease in lesion volume on ADC maps and a borderline significant decrease in entropy. No statistically significant changes in PET parameters were observed. No PET or ADC maps parameters predicted treatment response to PRRT. However, the sample size of this preliminary study is small and further research needed.
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Affiliation(s)
- Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Benedikt Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Harald Lahner
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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La Salvia A, Brizzi MP, Trevisi E, Parisi F, Muratori L, Atzeni F, Di Maio M, Scagliotti GV. Carcinoid heart failure in a duodenal neuroendocrine tumor: role of cardiac surgery in a challenging patient and brief review of the literature. Acta Oncol 2020; 59:315-319. [PMID: 31583924 DOI: 10.1080/0284186x.2019.1672891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Anna La Salvia
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | - Maria Pia Brizzi
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | - Elena Trevisi
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | | | - Leonardo Muratori
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
| | - Francesco Atzeni
- Cardiac Surgery, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - Massimo Di Maio
- Medical Oncology, Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
| | - Giorgio V. Scagliotti
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi, Orbassano, Turin, Italy
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Naito S, Naito M, Yamamoto N, Kume T, Hosino S, Kinjyo Y, Naito Y, Naito H, Hasegawa S. Polypoid gallbladder neuroendocrine tumor diagnosed as benign polyp before surgery: A case report. Mol Clin Oncol 2019; 12:225-229. [PMID: 32064098 PMCID: PMC7017218 DOI: 10.3892/mco.2019.1971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 11/25/2019] [Indexed: 01/24/2023] Open
Abstract
Gallbladder neuroendocrine tumors (GB-NETs) comprise only 0.5% of all NET cases, and their biology has been incompletely characterized. In the present study we report the case of a 50-year-old male patient with GB-NET who was admitted to Naito Hospital with diarrhea as the main complaint. At initial diagnosis, serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were within the normal range. Abdominal ultrasonography and contrast-enhanced computed tomography (CT) revealed gallbladder adenomyomatosis and cholecystitis, and an 8-mm pedunculated polypoid lesion was found in the neck of the gallbladder using drip infusion cholecystocholangiography-CT. As it was considered a benign polyp, laparoscopic cholecystectomy was performed. Pathological examination revealed a polypoid lesion that comprised NET cells with a cord-like or ribbon-like arrangement, and the cells exhibited positive immunostaining for chromogranin A and synaptophysin. In addition, immunohistochemical staining showed a Ki-67 index (i.e., proliferation index) of <1%, and no necrosis or mitotic figures were observed in the background. Based on these observations, we diagnosed the following: GB-NET, G1, 10x12 mm in size and located in the gallbladder neck. According to the World Health Organization 2010 classification, NET G1 is a well-differentiated tumor, with the tumor cells having a low proliferative potential [Ki-67 index ≤2%; mitotic figure number <2 (/10 HPF)]. It is regarded as a low- to mild-grade malignancy. Low-grade GB-NET occurs relatively rarely, and no clear guidelines have been formulated regarding its surgical treatment, such as minimal surgical excision margins or lymph node dissection. Detailed treatment recommendations should be developed after systematic studies of additional cases of GB-NET.
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Affiliation(s)
- Shigetoshi Naito
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Jonan-ku, Fukuoka 814-0180, Japan.,Naito Hospital, Kurume, Fukuoka 830-0038, Japan
| | | | | | - Tohru Kume
- Naito Hospital, Kurume, Fukuoka 830-0038, Japan
| | | | - Yoshinao Kinjyo
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | - Yoshiki Naito
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan
| | | | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Jonan-ku, Fukuoka 814-0180, Japan
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Adnan A, Basu S. Rare-Site Primary Soft-Tissue Neuroendocrine Tumor with Metastases and Near-Complete Resolution with 177Lu-DOTATATE: Documenting a Promising Clinical Application of Peptide Receptor Radionuclide Therapy. J Nucl Med Technol 2019; 48:36-39. [PMID: 31401619 DOI: 10.2967/jnmt.119.227058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
Neuroendocrine tumors (NETs) of the skin or soft tissue are rare (mostly described as sites of metastasis), whereas primary soft-tissue NETs are extremely rare; they are usually diagnosed at advanced stages with distant metastases because of their indolent nature. We herein describe our experience with 2 such cases. In the first case, the NET originated in the retroperitoneal soft tissue, and in the second case, the patient was a middle-aged lady with NET arising from soft tissue in the pelvis. Both patients were treated with 177Lu-DOTATATE in view of their somatostatin receptor-expressing metastatic lesions, demonstrating an excellent outcome as reflected by a complete metabolic response and near-complete anatomic response to the administered peptide receptor radionuclide therapy. The noteworthy factors of the reported cases were, first, unusual sites of primary tumor and, second, near-complete to complete symptomatic, anatomic, and metabolic resolution of the recurrent primary tumor and metastatic lesions with peptide receptor radionuclide therapy alone. NETs arising from rare anatomic locations are usually nonfunctioning, with good clinical outcomes, and 177Lu-DOTATATE peptide receptor radionuclide therapy can be considered promising in patients with metastatic or advanced disease.
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Affiliation(s)
- Aadil Adnan
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, and Homi Bhabha National Institute, Mumbai, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, and Homi Bhabha National Institute, Mumbai, India
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Kulke MH, Benson AB, Dasari A, Huynh L, Cai B, Totev T, Roesner N, Duh MS, Neary MP, Maurer VE, Shih BE, Dagohoy CG, Chan J, Bergsland EK. Real-World Treatment Patterns and Clinical Outcomes in Advanced Gastrointestinal Neuroendocrine Tumors (GI NET): A Multicenter Retrospective Chart Review Study. Oncologist 2019; 24:1056-1065. [PMID: 30606883 PMCID: PMC6693731 DOI: 10.1634/theoncologist.2018-0519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/15/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We assessed treatment patterns and outcomes of patients with advanced gastrointestinal (GI) neuroendocrine tumors (NET) at four large tertiary referral centers in the U.S. PATIENTS AND METHODS We performed a retrospective chart review of patients aged ≥18 years at advanced GI NET diagnosis, treated between July 2011 and December 2014. Index date was the histologically confirmed diagnosis date of locally advanced/metastatic GI NET. Data included baseline characteristics, treatment patterns, progression, death, and GI NET-related health care resource utilization from index date through last contact or death. Time-to-event analyses, including treatment discontinuation, progression, and overall survival (OS), were performed using Kaplan-Meier analysis. RESULTS We identified 273 patients; 156 (57%) had primary ileum NET, and 174 (64%) had functional NET. First-line treatments included somatostatin analog (SSA) alone (89%) or in combination (2%), liver-directed therapy (LDT; 8%), and cytotoxic chemotherapy or interferon (2%). One hundred fifty-five patients continued with second-line therapy, including SSA alone (17%) or in combination (75%, with 3% combined with peptide receptor radionuclide therapy), LDT (4%), and other treatments (3%). Median time (months) to first-line discontinuation was 154.0 for SSAs and 3.8 for cytotoxic chemotherapy. Overall median time to investigator-assessed progression following treatment initiation was 30.3 months. Median OS (months) following first-line initiation was 151.8 for all patients and 178.9 for first-line SSA. CONCLUSION Our study illustrates the common use of SSAs in both first-line and subsequent treatment of patients with GI NETs, as well as the relatively long survival durations and multiple additional treatments received by patients with this condition. Treatment pattern assessment at later times, following approval of newer treatments, is warranted. IMPLICATIONS FOR PRACTICE This study, assessing treatment patterns over a period of up to 30 years, showed that SSAs, LDT, cytotoxic chemotherapy, and interferon are common treatments for advanced GI NETs. SSAs alone or in combination with other treatments were the most frequent therapy in first and subsequent lines. Patients in this study remained on SSAs long-term, with median treatment duration of 12.8 years in first line. Treatment patterns should be assessed beyond this study's time period, given recent U.S. Food and Drug Administration approvals for additional treatments for GI NET, which will likely be incorporated in the continuum of care of patients.
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Affiliation(s)
- Matthew H Kulke
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Hematology/Oncology Section, Boston University Cancer Center, Boston, Massachusetts, USA
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Arvind Dasari
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Lynn Huynh
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Beilei Cai
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Todor Totev
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Nina Roesner
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Maureen P Neary
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Victoria E Maurer
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Brandon E Shih
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Cecile G Dagohoy
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Jennifer Chan
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emily K Bergsland
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
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Dasari A, Bergsland EK, Benson AB, Cai B, Huynh L, Totev T, Shea J, Duh MS, Neary MP, Dagohoy CG, Shih BE, Maurer VE, Chan J, Kulke MH. Treatment Patterns and Clinical Outcomes in Advanced Lung Neuroendocrine Tumors in Real-World Settings: A Multicenter Retrospective Chart Review Study. Oncologist 2019; 24:1066-1075. [PMID: 30610008 PMCID: PMC6693720 DOI: 10.1634/theoncologist.2018-0520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/14/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Using data from four tertiary referral centers in the U.S., we assessed real-world treatment patterns and clinical outcomes of patients with advanced lung neuroendocrine tumors (NETs). SUBJECTS, MATERIALS, AND METHODS We performed a retrospective chart review of adult patients with locally advanced/metastatic (typical/atypical) lung NETs treated between July 2011 and December 2014. Index date was histologically confirmed typical/atypical carcinoid tumor diagnosis date. Data included baseline characteristics, treatment patterns, progression, death, and lung NET-related health care resource use from index date through last contact/death. Time to treatment discontinuation and first progression, time from first to second progression, and overall survival (OS) were estimated using Kaplan-Meier analysis. RESULTS We identified 83 patients; 19 (23%) had functional NET. First-line treatments included somatostatin analogs (SSAs) alone (56%) or in combination with other therapies (6%), cytotoxic chemotherapy (20%), external beam radiation therapy (EBRT) (9%), liver-directed therapy (LDT) (4%), and everolimus/other (5%). Sixty patients had second-line therapy including SSA alone (18%) or in combination (40%), cytotoxic chemotherapy (17%), everolimus (12%), LDT (7%), EBRT (3%), and other treatments (3%). Median time (months) to first-line discontinuation were as follows: SSAs, 43.3; cytotoxic chemotherapy, 3.6. Overall median time (months) to investigator-assessed progression following treatment initiation was 12.4. Median OS (months) following treatment initiation was 66.4 for all patients and 81.5 for patients receiving SSAs. CONCLUSION SSAs, alone and in combination, are common treatments for advanced lung NETs. Patients have additional treatment options and relatively long survival compared with patients with other advanced cancers. Treatment pattern assessment following approval of newer treatments is needed. IMPLICATIONS FOR PRACTICE Somatostatin analogs (SSAs), cytotoxic chemotherapy, EBRT, liver-directed therapy, and targeted therapies are common treatments for locally advanced/metastatic (typical/atypical) lung neuroendocrine tumors (NETs). SSAs alone or in combination with other treatment modalities were the most common first- and second-line therapy, followed by cytotoxic chemotherapy. Patients continued treatment with SSAs long-term with median treatment duration of 43 months. Median overall survival was 66 months following initiation of first-line therapy for all patients. Treatment pattern assessment beyond the time period of this study is needed given recent U.S. Food and Drug Administration approvals for additional treatments for lung NETs that will likely be incorporated in the treatment landscape.
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Affiliation(s)
- Arvind Dasari
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Emily K Bergsland
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
| | - Al B Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Beilei Cai
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Lynn Huynh
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Todor Totev
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Jerome Shea
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Maureen P Neary
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Cecile G Dagohoy
- MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Brandon E Shih
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
| | - Victoria E Maurer
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA
| | - Jennifer Chan
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Matthew H Kulke
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Section of Hematology/Oncology, Cancer Center at Boston Medical Center, Boston, Massachusetts, USA
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Abstract
Neuroendocrine cells are dispersed diffusely throughout many organ systems in the body and hence neuroendocrine tumors (NETs) can arise from almost anywhere in the body. NETs are considered rare tumors, and the current incidence is reported to be about 6 cases in 100 000 in adults and about 2.8 cases per million in the pediatric age group. Despite the indolent nature of these tumors, they have the potential for metastasis and significant morbidity. NETs can be asymptomatic at the time of diagnosis or can present with flushing, diarrhea, wheezing, weight loss, and fatigue among other symptoms. Due to the ambiguity of presenting symptoms, it is not uncommon for NETs to be diagnosed late in the disease course. Despite low incidence, the prevalence of the disease is high since patients live for many years and sometimes decades. Early detection of well-differentiated NETs has excellent outcomes with the majority of early-stage diseases being cured with surgical resection alone. There have been recent advancements in the management of metastatic progressive NETs with approval of peptide receptor radionuclide therapy, telotristat, and everolimus. Awareness of these rare tumors and its management is crucial for optimal management. This article will focus on pediatric NETs and current advances in its management.
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Affiliation(s)
| | - Aman Chauhan
- Markey Cancer Center, Lexington, KY, USA
- University of Kentucky, Lexington, KY, USA
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Sugiura R, Kuwatani M, Hirata K, Sano I, Kato S, Kawakubo K, Sakamoto N. Effect of Pancreatic Mass Size on Clinical Outcomes of Endoscopic Ultrasound-Guided Fine-Needle Aspiration. Dig Dis Sci 2019; 64:2006-2013. [PMID: 30604374 DOI: 10.1007/s10620-018-5435-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/14/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has high diagnostic accuracy for pancreatic diseases. However, the effect of mass size on diagnostic accuracy has yet to be determined, especially for small pancreatic lesions. We aimed to determine the effect of pancreatic mass size on the diagnostic yield of EUS-FNA. METHODS We searched the database in Hokkaido University Hospital between May 2008 and December 2016 and identified solid pancreatic lesions examined by EUS-FNA. All lesions were stratified into five groups based on mass sizes: groups A (< 10 mm), B (10-20 mm), C (20-30 mm), D (30-40 mm) and E (≥ 40 mm). The sensitivity, specificity, diagnostic accuracy and adverse event rate were retrospectively evaluated. RESULTS We analyzed a total of 788 solid pancreatic lesions in 761 patients. The patients included 440 males (57.8%) with a mean age of 65.7 years. The sensitivities in groups A (n = 36), B (n = 223), C (n = 304), D (n = 147) and E (n = 78) were 89.3%, 95.0%, 97.4%, 98.5% and 98.7%, respectively, and they significantly increased as the mass size increased (P < 0.01, chi-squared test for trend). The diagnostic accuracies were 91.7%, 96.4%, 97.7%, 98.6% and 98.7%, respectively, and they also significantly increased as the mass size increased (P = 0.03). Multivariate analysis showed that pancreatic mass size was associated with diagnostic accuracy. The adverse event rates were not significantly different among the five groups. CONCLUSIONS The sensitivities and diagnostic accuracies of EUS-FNA for solid pancreatic lesions are higher for lesions ≥ 10 mm in size, and they are strongly correlated with mass size.
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Affiliation(s)
- Ryo Sugiura
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Masaki Kuwatani
- Division of Endoscopy, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan.
| | - Koji Hirata
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Itsuki Sano
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Shin Kato
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
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Ryan P, McBride A, Ray D, Pulgar S, Ramirez RA, Elquza E, Favaro JP, Dranitsaris G. Lanreotide vs octreotide LAR for patients with advanced gastroenteropancreatic neuroendocrine tumors: An observational time and motion analysis. J Oncol Pharm Pract 2019; 25:1425-1433. [PMID: 30924737 PMCID: PMC6643159 DOI: 10.1177/1078155219839458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lanreotide and octreotide acetate suspension for injectable (LAR) are both recommended for clinical use in patients with locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors. However, each agent possesses unique attributes in terms of their drug-delivery characteristics. The study objective was to compare overall drug-delivery efficiency between lanreotide and octreotide LAR in gastroenteropancreatic neuroendocrine tumor patients. METHODS This study employed an observational time and motion design among patients treated with lanreotide or octreotide LAR across five US cancer centers. Baseline patient data collection included age, disease grade and duration, prior therapies and performance status. Drug-delivery time (drug preparation and administration), total patient time and resource use data were collected for gastroenteropancreatic neuroendocrine tumors receiving lanreotide (n = 22) or octreotide LAR (n = 22). Following each administration, qualitative data on the drug-delivery experience was collected from patients and nurses. RESULTS Lanreotide was associated with a significant reduction in mean delivery time (2.5 min; 95% CI:2.0 to 3.1) compared to octreotide LAR (6.2 min; 95%CI: 4.4 to 7.9; p = 0.004). The mean total patient time for lanreotide and octreotide LAR was comparable between groups (32.1 vs. 36.6 minutes; p = 0.97). Nurses reported increased concerns with octreotide LAR related to needle clogging (p = 0.034) and device failures (p = 0.057). Overall, lanreotide had a median satisfaction score of 5.0 compared to a score of 4.0 with octreotide LAR (p = 0.03). CONCLUSIONS Lanreotide was associated with significant reductions in drug-delivery time compared to octreotide LAR, which contributed to an improvement in overall healthcare efficiency. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03017690.
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Affiliation(s)
- P Ryan
- 1 Ochsner Medical Center, Kenner, LA, USA
| | - A McBride
- 2 University of Arizona Cancer Center, Tucson, AZ, USA
| | - D Ray
- 3 Ipsen Biopharmaceuticals, Inc., Basking Ridge, NJ, USA
| | - S Pulgar
- 3 Ipsen Biopharmaceuticals, Inc., Basking Ridge, NJ, USA
| | | | - E Elquza
- 2 University of Arizona Cancer Center, Tucson, AZ, USA
| | - J P Favaro
- 4 Oncology Specialists of Charlotte, Charlotte, NC, USA
| | - G Dranitsaris
- 5 Augmentium Pharma Consulting Inc., Toronto, Canada
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Cha JH, Jung DH, Kim JH, Youn YH, Park H, Park JJ, Um YJ, Park SJ, Cheon JH, Kim TI, Kim WH, Lee HJ. Long-term outcomes according to additional treatments after endoscopic resection for rectal small neuroendocrine tumors. Sci Rep 2019; 9:4911. [PMID: 30894571 PMCID: PMC6426846 DOI: 10.1038/s41598-019-40668-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
The present study aimed to investigate treatment strategies determining additional treatment after endoscopic resection (ER) of rectal neuroendocrine tumor (NET)s and long-term outcomes of endoscopically resected rectal NETs. We analyzed a total of 322 patients medical records of patients who underwent ER for rectal NETs. Rectal NETs initially resected as polyps and treated with conventional endoscopic mucosal resection (EMR) were observed more frequently in the non-curative group (P = 0.041 and P = 0.012, respectively). After ER, only 44 of the 142 patients (31.0%) who did not meet the criteria for curative resection received additional salvage treatment. In multivariate analysis, lesions diagnosed via biopsies (OR, 0.096; P = 0.002) or suspected as NETs initially (OR, 0.04; P = 0.001) were less likely to undergo additional treatment. Positive lymphovascular invasion (OR 61.971; P < 0.001), positive (OR 75.993; P < 0.001), or indeterminate (OR 13.203; P = 0.001) resection margins were more likely to undergo additional treatment. Although lymph node metastasis was found in 6 patients, none experienced local or metastatic tumor recurrence during the median follow-up of 40.49 months. Long-term outcomes after ER for rectal NETs were excellent. The prognosis showed favorable outcomes regardless of whether patients receive additional salvage treatments.
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Affiliation(s)
- Jae Hwang Cha
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, 49201, Korea
| | - Da Hyun Jung
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 06273, Korea. .,Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, 13496, Korea.
| | - Jie-Hyun Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 06273, Korea
| | - Young Hoon Youn
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 06273, Korea
| | - Hyojin Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 06273, Korea
| | - Jae Jun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 06273, Korea
| | - Yoo Jin Um
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, 06273, Korea
| | - Soo Jung Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Tae Il Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Won Ho Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Hyun Jung Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, 03722, Korea. .,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, 03080, Korea.
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Abstract
PURPOSE OF REVIEW Adrenocortical carcinoma (ACC) is a rare endocrine malignancy typically with poor prognosis. This review aims to summarize the current knowledge regarding the clinical management of ACC. RECENT FINDINGS Surgery remains the cornerstone for localized ACC management. In more advanced cases, debulking surgery when feasible can help with hormonal control and may allow the initiation of systemic therapy. Over the last few years, our understanding of ACC molecular pathogenesis has expanded with no significant change in treatment options. Platinum-based chemotherapy is the gold standard in metastatic ACC despite suboptimal efficacy. Tyrosine kinase inhibitor use did not result in meaningful benefit in ACC patients. Multiple clinical trials are currently exploring the role of immunotherapy in ACC. Despite the remarkable improvement in our understanding of the molecular signature and pathways in ACC, this knowledge did not yield a major breakthrough in management of advanced ACC. Multi-institutional and international collaborations are needed to identify promising treatments and new therapeutic targets to improve the care of ACC patients.
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Affiliation(s)
- Sina Jasim
- Division of Endocrinology, Metabolism and Lipid Research, Washington University, in St. Louis, School of Medicine, 660 S. Euclid Ave., Campus Box 8127, St. Louis, MO, 63110, USA
| | - Mouhammed Amir Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1461, Houston, TX, 77030, USA.
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Subramaniam RM, Bradshaw ML, Lewis K, Pinho D, Shah C, Walker RC. ACR Practice Parameter for the Performance of Gallium-68 DOTATATE PET/CT for Neuroendocrine Tumors. Clin Nucl Med 2018; 43:899-908. [PMID: 30394933 DOI: 10.1097/RLU.0000000000002309] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Radiopharmaceuticals targeting cell surface expression of somatostatin receptors (SSTRs) are particularly useful in the evaluation of neuroendocrine tumors. Gallium-68 DOTA-Tyr-octreotatate (Ga-DOTATATE) primarily binds to SSTR type 2 receptors. Ga DOTATATE PET/CT is proven to have high impact on the management of neuroendocrine patients compared to traditional anatomical imaging as well as provides additional information over that of conventional nuclear medicine studies (indium-III DTPA-octreotide). It can result in change in management of approximately 75% of patients with neuroendocrine tumors. Ga DOTATATE and F FDG PET/CT imaging are complementary, with the degree of uptake varying depending on the degree of differentiation of the tumor. Well-differentiated tumors maintain their SSTRs and are positive on Ga DOTATATE PET/CT scan, while dedifferentiated tumors are less likely to demonstrate uptake of Ga DOTATATE but will demonstrate uptake with F FDG PET/CT. In addition, Ga DOTATATE PET/CT identifies patients with SSTR expression in their tumors, who have progressed on somatostatin analog therapy, for treatment with Lu DOTATATE.
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40
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Savir-Baruch B, Banks KP, McConathy JE, Molchanova-Cook OP, Parent EE, Takalkar A, Tulchinsky M, Yu JQ, Subramaniam RM, Schuster DM. ACR-ACNM Practice Parameter for the Performance of Fluorine-18 Fluciclovine-PET/CT for Recurrent Prostate Cancer. Clin Nucl Med 2018; 43:909-17. [PMID: 30325827 DOI: 10.1097/RLU.0000000000002310] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The American College of Radiology (ACR) and American College of Nuclear Medicine (ACNM) collaborated to develop a clinical practice document for the performance of fluciclovine positron-emission tomography (PET) / computed tomography (CT) in the evaluation of patients with suspected prostate cancer recurrence based on the elevation of prostate-specific antigen (PSA) level (biochemical recurrence) after prior therapy. Prostate cancer is the third leading cause of cancer death in the United States. Up to 50% of patients diagnosed with prostate cancer will develop biochemical failure after initial therapy. The differentiation of local from extraprostatic recurrence plays a critical role in patient management. The use of functional imaging targeting features of cancer metabolism has proven highly useful in this regard. Amino acid transport is upregulated in prostate cancer. Fluciclovine (anti-1-amino-3-F-18-fluorocyclobutane-1-carboxylic acid, FACBC, Axumin™) is an artificial amino acid PET tracer which demonstrates utility in the diagnosis of recurrent prostate cancer with significant added value to conventional imaging.
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41
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Ausania F, Senra Del Rio P. Lymphadenectomy in pancreatic neuroendocrine neoplasms: Why are we still debating? Pancreatology 2018; 18:855-861. [PMID: 30253923 DOI: 10.1016/j.pan.2018.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 08/26/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023]
Abstract
Pancreatic Neuroendocrine Neoplasms (PNEN) are rare tumours exhibiting very heterogeneous behaviour. For these reasons, studies with high level of evidence are lacking. Whether lymphadenectomy should be performed for PNEN is a matter of debate. In this review, we perform a critical analysis of the available literature regarding the clinical significance of lymphnode metastases, the importance of lymphadenectomy, and the implications on disease-specific survival.
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Affiliation(s)
- F Ausania
- HPB Surgery, Hospital Alvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Spain.
| | - P Senra Del Rio
- HPB Surgery, Hospital Alvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Spain
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42
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Katz LH, Levi Z, Twig G, Kark JD, Leiba A, Derazne E, Liphshiz I, Keinan-Boker L, Eisenstein S, Afek A. Risk factors associated with gastroenteropancreatic neuroendocrine tumors in a cohort of 2.3 million Israeli adolescents. Int J Cancer 2018; 143:1876-1883. [PMID: 29744856 DOI: 10.1002/ijc.31589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 04/16/2018] [Indexed: 12/27/2022]
Abstract
We investigated whether obesity and sociodemographic factors at adolescence are associated with incident gastroenteropancreatic neuroendocrine tumors (GEP-NET).Our cohort included 2.3 million Israeli adolescents examined at ages 16 to 19 years between 1967 and 2010. The baseline database included sex, country of birth, residential socioeconomic status (SES), body-mass index (BMI) and height. Participants were followed through linkage with the National Cancer Registry up to 2012. We identified 221 cases of GEP-NET (66 pancreatic, 52 gastric, 39 rectal, 27 appendiceal, 23 small bowel and 14 colonic). Immigration from the Former Soviet Union (FSU) was associated with the risk of small bowel and rectal NET's, [Hazard Ratio (HR) 4.79, 95% Confidence Interval (CI) 1.37-16.76 and 3.43, 95% CI 1.20-9.83, respectively].Height >75th percentile and BMI ≥ 85th percentile were associated with increased risk of gastric NET (HR 2.25 95% CI 1.14-4.42 and HR 2.38, 95% CI 1.19-4.75, respectively). Female sex was associated with appendiceal NET (HR 2.30, 95% CI 1.06-4.96) while male gender was associated with an increased risk for NET of the small bowel [HR 4.72 (95% CI 1.10-20.41)].In conclusion, our findings suggest different risk factor associations with the various GEP-NETS: immigrants from the FSU were at increased risk for small bowel and rectal NET; increased height and weight were associated with the risk of gastric NET and females were at increased risk for appendiceal NET. Further focus on the FSU population is indicated in addition to studies verifying the association of BMI and height with gastric NET.
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Affiliation(s)
- Lior H Katz
- The Gastroenterology Department, Sheba Medical Center, Tel-Hashomer, Israel
| | - Zohar Levi
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,The Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel
| | - Gilad Twig
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,The Israel Defense Forces Medical Corps.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center.,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Jeremy D Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel
| | - Adi Leiba
- The Israel Defense Forces Medical Corps
| | | | | | | | - Sapir Eisenstein
- Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | - Arnon Afek
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,The general manager office, Tel Hashomer, Israel
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43
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Abstract
INTRODUCTION Recently, there have been a number of advances in imaging pancreatic neuroendocrine tumors (panNETs), as well as other neuroendocrine tumors (NETs), which have had a profound effect on the management and treatment of these patients, but in some cases are also associated with controversies. Areas covered: These advances are the result of numerous studies attempting to better define the roles of both cross-sectional imaging, endoscopic ultrasound, with or without fine-needle aspiration, and molecular imaging in both sporadic and inherited panNET syndromes; the increased attempt to develop imaging parameters that correlate with tumor classification or have prognostic value; the rapidly increasing use of molecular imaging in these tumors and the attempt to develop imaging parameters that correlate with treatment/outcome results. Each of these areas and the associated controversies are reviewed. Expert commentary: There have been numerous advances in all aspects of the imaging of panNETs, as well as other NETs, in the last few years. The advances are leading to expanded roles of imaging in the management of these patients and the results being seen in panNETs/GI-NETs with these newer techniques are already being used in more common tumors.
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Affiliation(s)
- Lingaku Lee
- a Department of Medicine and Bioregulatory Science , Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
- b Digestive Diseases Branch , NIDDK, NIH , Bethesda , MD , USA
| | - Tetsuhide Ito
- c Neuroendocrine Tumor Centra, Fukuoka Sanno Hospital International University of Health and Welfare 3-6-45 Momochihama , Sawara-Ku, Fukuoka , Japan
| | - Robert T Jensen
- b Digestive Diseases Branch , NIDDK, NIH , Bethesda , MD , USA
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44
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Abstract
BACKGROUND Neuroendocrine tumors found in skin or soft tissues usually represent metastasis from other organs and are considered late manifestations of disease. Therefore, primary cutaneous and soft tissue neuroendocrine tumors are extremely rare. CASE REPORT We report a case of a 48-year-old male with a neuroendocrine tumor occurring in the subcutaneous abdominal fat, which had an echographic appearance of a vascular malformation. The finding was diagnosed as compatible with neuroendocrine tumor based on histopathological and immunohistochemical studies. No other sites of possible internal origin were detected on supplementary investigations. CONCLUSIONS Soft tissue neuroendocrine tumors may have an appearance on imaging studies that challenge physicians to make a correct diagnosis. Despite the rarity of these tumors, they should be included in the differential diagnosis of other soft tissue masses.
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Affiliation(s)
- Nadejda Cojocari
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Leonard David
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania
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45
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Lu WJ, Cai HL, Ye MD, Wu YL, Xu B. Enucleation of non-invasive tumors in the proximal pancreas: indications and outcomes compared with standard resections. J Zhejiang Univ Sci B 2018; 18:906-916. [PMID: 28990381 DOI: 10.1631/jzus.b1600597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficiency of enucleation (EU) for proximal pancreatic non-invasive neoplasms. METHODS Patients with solitary non-invasive neoplasms in the proximal pancreas from January 1998 to April 2014 at the Second Affiliated Hospital of Zhejiang University, Hangzhou, China were included. Different operations and outcomes were analyzed. RESULTS A total of 123 patients were enrolled. Forty patients (32.5%) underwent EU including 18 patients who had tumors close to the main pancreatic duct (MPD). Sixty-one patients (49.6%) had pancreaticoduodenectomy (PD) performed and 22 (17.9%) underwent central pancreatectomy (CP). Pathological outcomes included neuroendocrine tumors, cystic lesions, and solid pseudopapillary tumors. Operation time, intra-operative blood loss, and duration of hospital stay were significantly reduced in the EU group. PD was associated with the greatest complication rate (55.7%), followed by EU (50%) and CP (40.9%), though the pancreatic fistula rate after EU was the highest (50%), especially in patients with tumors larger than 3 cm and tumors close to the MPD. EU had advantages in the preservation of pancreatic parenchyma and endocrine and exocrine function. CONCLUSIONS EU can be carried out safely and effectively for tumors in the proximal pancreas with improved outcomes compared with standard resections, even if the tumor is larger than 3 cm and close to the MPD.
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Affiliation(s)
- Wen-Jie Lu
- Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Hao-Lei Cai
- Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Ma-Dong Ye
- Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Yu-Lian Wu
- Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Bin Xu
- Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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46
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Strosberg J, Wolin E, Chasen B, Kulke M, Bushnell D, Caplin M, Baum RP, Kunz P, Hobday T, Hendifar A, Oberg K, Sierra ML, Thevenet T, Margalet I, Ruszniewski P, Krenning E. Health-Related Quality of Life in Patients With Progressive Midgut Neuroendocrine Tumors Treated With 177Lu-Dotatate in the Phase III NETTER-1 Trial. J Clin Oncol 2018; 36:2578-2584. [PMID: 29878866 DOI: 10.1200/jco.2018.78.5865] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Neuroendocrine tumor (NET) progression is associated with deterioration in quality of life (QoL). We assessed the impact of 177Lu-Dotatate treatment on time to deterioration in health-related QoL. Methods The NETTER-1 trial is an international phase III study in patients with midgut NETs. Patients were randomly assigned to treatment with 177Lu-Dotatate versus high-dose octreotide. European Organisation for Research and Treatment of Cancer quality-of-life questionnaires QLQ C-30 and G.I.NET-21 were assessed during the trial to determine the impact of treatment on health-related QoL. Patients completed the questionnaires at baseline and every 12 weeks until tumor progression. QoL scores were converted to a 100-point scale according to European Organisation for Research and Treatment of Cancer instructions, and individual changes from baseline scores were assessed. Time to QoL deterioration (TTD) was defined as the time from random assignment to the first QoL deterioration ≥ 10 points for each patient in the corresponding domain scale. All analyses were conducted on the intention-to-treat population. Patients with no deterioration were censored at the last QoL assessment date. Results TTD was significantly longer in the 177Lu-Dotatate arm (n = 117) versus the control arm (n = 114) for the following domains: global health status (hazard ratio [HR], 0.406), physical functioning (HR, 0.518), role functioning (HR, 0.580), fatigue (HR, 0.621), pain (HR, 0.566), diarrhea (HR, 0.473), disease-related worries (HR, 0.572), and body image (HR, 0.425). Differences in median TTD were clinically significant in several domains: 28.8 months versus 6.1 months for global health status, and 25.2 months versus 11.5 months for physical functioning. Conclusion This analysis from the NETTER-1 phase III study demonstrates that, in addition to improving progression-free survival, 177Lu-Dotatate provides a significant QoL benefit for patients with progressive midgut NETs compared with high-dose octreotide.
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Affiliation(s)
- Jonathan Strosberg
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Edward Wolin
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Beth Chasen
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Matthew Kulke
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - David Bushnell
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Martyn Caplin
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Richard P Baum
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Pamela Kunz
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Timothy Hobday
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Andrew Hendifar
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Kjell Oberg
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Maribel Lopera Sierra
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Thomas Thevenet
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Ines Margalet
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Philippe Ruszniewski
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
| | - Eric Krenning
- Jonathan Strosberg, Moffitt Cancer Center, Tampa, FL; Edward Wolin, Montefiore Einstein Center for Cancer Care, Bronx, NY; Beth Chasen, University of Texas MD Anderson Cancer Center, Houston, TX; Matthew Kulke, Dana-Farber Cancer Institute, Boston, MA; David Bushnell, University of Iowa, Iowa City, IA; Martyn Caplin, Royal Free Hospital, London, United Kingdom; Richard P. Baum, Zentralklinik, Bad Berka, Germany; Pamela Kunz, Stanford University Medical Center, Stanford; Andrew Hendifar, Cedars Sinai Medical Center, Los Angeles, CA; Timothy Hobday, Mayo Clinic College of Medicine, Rochester, MN; Kjell Oberg, University Hospital, Uppsala University, Uppsala, Sweden; Maribel Lopera Sierra, Thomas Thevenet, and Ines Margalet, Advanced Accelerator Applications, Geneva, Switzerland; Philippe Ruszniewski, Hopital Beaujon and Paris Diderot University, Clichy, France; and Eric Krenning, Erasmus Medical Center, Rotterdam, Netherlands
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Kim J, Kim JH, Lee JY, Chun J, Im JP, Kim JS. Clinical outcomes of endoscopic mucosal resection for rectal neuroendocrine tumor. BMC Gastroenterol 2018; 18:77. [PMID: 29866049 PMCID: PMC5987588 DOI: 10.1186/s12876-018-0806-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/23/2018] [Indexed: 02/08/2023] Open
Abstract
Background The incidence of rectal neuroendocrine tumors (NETs) is rapidly increasing because of the frequent use of endoscopic screening for colorectal cancers. However, the clinical outcomes of endoscopic resection for rectal NETs are still unclear. The aim of this study was to assess the rates of histologically complete resection (H-CR) and recurrence after endoscopic mucosal resection (EMR) for rectal NETs. Methods A retrospective analysis was performed on patients who underwent EMR for rectal NETs between January 2002 and March 2015 at Seoul National University Hospital. Primary outcomes were H-CR and recurrence rates after endoscopic resection. H-CR was defined as the absence of tumor invasion in the lateral and deep margins of resected specimens. Results Among 277 patients, 243 (88%) were treated with conventional EMR, 23 (8%) with EMR using a dual-channel endoscope, and 11 (4%) with EMR after precutting. The median tumor size was 4.96 mm (range, 1–22) in diameter, and 264 (95%) lesions were confined to the mucosa and submucosal layer. The en-bloc resection rate was 99% and all patients achieved endoscopically complete resection. The H-CR rates were 75, 74, and 73% for conventional EMR, EMR using a dual-channel endoscope, and EMR after precutting, respectively. Multivariate analysis showed that H-CR was associated with tumor size regardless of endoscopic treatment modalities (p = 0.023). Of the 277 patients, 183 (66%) underwent at least 1 endoscopic follow-up. Three (2%) of these 183 patients had tumor recurrence, which was diagnosed at a median of 62.5 months (range 19–98) after endoscopic resection. There was 1 case of disease-related death, which occurred 167 months after endoscopic treatment because of bone marrow failure that resulted from tumor metastasis. Conclusions Although the en-bloc resection rate was 99% in rectal NETs, H-CR rates were 72–74% for various EMR procedures. H-CR may be associated with tumor size regardless of endoscopic treatment modalities.
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Affiliation(s)
- Jihye Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Republic of Korea
| | - Jee Hyun Kim
- Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, 07061, Republic of Korea
| | - Joo Young Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Republic of Korea
| | - Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Republic of Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Republic of Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 03080, Republic of Korea.
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Abstract
Neuroendocrine tumors (NETs) comprise a complex and highly heterogeneous group of neoplasms that can arise all over the body, originating from neuroendocrine cells. NETs are characterized by a general lack of symptoms until they are in advanced phase, and early biomarkers are not as available and useful as required. Heterogeneity is an intrinsic, pivotal feature of NETs that derives from diverse causes and ultimately shapes tumor fate. The different layers that conform NET heterogeneity include a wide range of distinct characteristics, from the mere location of the tumor to its clinical and functional features, and from its cellular properties, to the core signaling and (epi)genetic components defining the molecular signature of the tumor. The importance of this heterogeneity resides in that it translates into a high variability among tumors and, hence, patients, which hinders a more precise diagnosis and prognosis and more efficacious treatment of these diseases. In this review, we highlight the significance of this heterogeneity as an intrinsic hallmark of NETs, its repercussion on clinical approaches and tumor management, and some of the possible factors associated to such heterogeneity, including epigenetic and genetic elements, post-transcriptional regulation, or splicing alterations. Notwithstanding, heterogeneity can also represent a valuable and actionable feature, towards improving medical approaches based on personalized medicine. We conclude that NETs can no longer be viewed as a single disease entity and that their diagnosis, prognosis and treatment must reflect and incorporate this heterogeneity.
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Affiliation(s)
- Sergio Pedraza-Arévalo
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, Edificio IMIBIC, 14004, Córdoba, Spain
- Department of Cell Biology, Physiology, and Immunology, Universidad de Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
- Agrifood Campus of International Excellence (ceiA3), Córdoba, Spain
| | - Manuel D Gahete
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, Edificio IMIBIC, 14004, Córdoba, Spain
- Department of Cell Biology, Physiology, and Immunology, Universidad de Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
- Agrifood Campus of International Excellence (ceiA3), Córdoba, Spain
| | - Emilia Alors-Pérez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, Edificio IMIBIC, 14004, Córdoba, Spain
- Department of Cell Biology, Physiology, and Immunology, Universidad de Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain
- Agrifood Campus of International Excellence (ceiA3), Córdoba, Spain
| | - Raúl M Luque
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, Edificio IMIBIC, 14004, Córdoba, Spain.
- Department of Cell Biology, Physiology, and Immunology, Universidad de Córdoba, Córdoba, Spain.
- Reina Sofia University Hospital, Córdoba, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain.
- Agrifood Campus of International Excellence (ceiA3), Córdoba, Spain.
| | - Justo P Castaño
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Avenida Menéndez Pidal s/n, Edificio IMIBIC, 14004, Córdoba, Spain.
- Department of Cell Biology, Physiology, and Immunology, Universidad de Córdoba, Córdoba, Spain.
- Reina Sofia University Hospital, Córdoba, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Córdoba, Spain.
- Agrifood Campus of International Excellence (ceiA3), Córdoba, Spain.
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Abstract
Recent advances in the molecular pathogenesis and the natural history of Cushing's syndrome have improved the understanding of the management of this disease. The long-term efficacy of several cortisol-lowering medical treatments is currently under evaluation. However, adrenalectomy is a safe option for the treatment of patients affected by Cushing's syndrome. Unilateral adrenalectomy is the gold standard for treatment of adrenocortical adenomas associated with hypercortisolism. Bilateral adrenalectomy has been widely used in the past as definitive treatment of bilateral macronodular hyperplasia and persistent or recurrent Cushing's disease. The indication and the potential applications of this technique have been recently critically analyzed.
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Affiliation(s)
- Guido Di Dalmazi
- Division of Endocrinology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, Bologna 40138, Italy
| | - Martin Reincke
- Department of Medicine IV, Klinikum der Universität, Ludwig-Maximilians-Universität München, Ziemssenstraße 1, München 80336, Germany.
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Zhou B, Zhan C, Ding Y, Yan S, Zheng S. Role of palliative resection of the primary pancreatic neuroendocrine tumor in patients with unresectable metastatic liver disease: a systematic review and meta-analysis. Onco Targets Ther 2018; 11:975-982. [PMID: 29503572 PMCID: PMC5827741 DOI: 10.2147/ott.s158171] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Treatment for pancreatic neuroendocrine tumors (PNETs) in patients with unresectable metastatic liver disease has long been a controversial issue. This systematic review aims to summarize the existing evidence concerning the value of primary tumor resection in this group of patients. METHODS A systematic review of the literature and a meta-analysis were performed. The PubMed and Cochrane databases were searched to identify articles that compared palliative primary tumor resection and nonsurgical regimens in patients with PNETs and unresectable liver metastases. Relevant articles were identified in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was overall survival. The included studies were evaluated for heterogeneity and publication bias. RESULTS Overall, 10 studies were included in the analysis. No randomized controlled trials (RCTs) were identified. These studies included 1,226 patients who underwent a resection of the primary tumor and 1,623 patients who did not undergo surgery. The median overall survival was 36-137 and 13.2-65 months in the surgical and nonsurgical groups, respectively, and the 5-year overall survival rate was 35.7-83 and 5.4%-50%, respectively, in these two groups. The meta-analysis demonstrated that there was no significant difference in liver tumor burden (odds ratio [OR] =1.51, 95% CI: 0.59-3.89, P=0.39) or tumor grade (OR =2.88, 95% CI: 0.92-9.04, P=0.07) among patients who underwent surgery and nonsurgical therapy. Furthermore, patients who underwent an aggressive surgical approach appeared to have a higher tumor grade. However, the meta-analysis demonstrated that patients who underwent primary tumor resection had better overall survival (P<0.001), with a pooled hazard ratio of 0.36 (95% CI: 0.30-0.45). No publication bias was detected. CONCLUSION This meta-analysis demonstrates that the palliative resection of the primary tumor in patients with PNETs and unresectable liver metastases can increase survival, although a bias toward a more aggressive surgical approach in patients with better performance status, less advanced disease, or a tumor located in the body or tail of the pancreas appears likely. RCTs with longer follow-up periods are required to confirm the advantages of palliative primary tumor resection for PNETs.
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Affiliation(s)
- Bo Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital
| | - Canyang Zhan
- Department of Neonatology, Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Yuan Ding
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital
| | - Sheng Yan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital
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