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Bertani E, Mattana F, Collamati F, Ferrari ME, Bagnardi V, Frassoni S, Pisa E, Mirabelli R, Morganti S, Fazio N, Fumagalli Romario U, Ceci F. Radio-Guided Surgery with a New-Generation β-Probe for Radiolabeled Somatostatin Analog, in Patients with Small Intestinal Neuroendocrine Tumors. Ann Surg Oncol 2024; 31:4189-4196. [PMID: 38652200 DOI: 10.1245/s10434-024-15277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Radio-guided surgery (RGS) holds promise for improving surgical outcomes in neuroendocrine tumors (NETs). Previous studies showed low specificity (SP) using γ-probes to detect radiation emitted by radio-labeled somatostatin analogs. OBJECTIVE We aimed to assess the sensitivity (SE) and SP of the intraoperative RGS approach using a β-probe with a per-lesion analysis, while assessing safety and feasibility as secondary objectives. METHODS This prospective, single-arm, single-center, phase II trial (NCT05448157) enrolled 20 patients diagnosed with small intestine NETs (SI-NETs) with positive lesions detected at 68Ga-DOTA-TOC positron emission tomography/computed tomography (PET/CT). Patients received an intravenous injection of 1.1 MBq/Kg of 68Ga-DOTA-TOC 10 min prior to surgery. In vivo measurements were conducted using a β-probe. Receiver operating characteristic (ROC) analysis was performed, with the tumor-to-background ratio (TBR) as the independent variable and pathology result (cancer vs. non-cancer) as the dependent variable. The area under the curve (AUC), optimal TBR, and absorbed dose for the surgery staff were reported. RESULTS The intraoperative RGS approach was feasible in all cases without adverse effects. Of 134 specimens, the AUC was 0.928, with a TBR cut-off of 1.35 yielding 89.3% SE and 86.4% SP. The median absorbed dose for the surgery staff was 30 µSv (range 12-41 µSv). CONCLUSION This study reports optimal accuracy in detecting lesions of SI-NETs using the intraoperative RGS approach with a novel β-probe. The method was found to be safe, feasible, and easily reproducible in daily clinical practice, with minimal radiation exposure for the staff. RGS might potentially improve radical resection rates in SI-NETs. CLINICAL TRIALS REGISTRATION 68Ga-DOTATOC Radio-Guided Surgery with β-Probe in GEP-NET (RGS GEP-NET) [NCT0544815; https://classic. CLINICALTRIALS gov/ct2/show/NCT05448157 ].
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Affiliation(s)
- Emilio Bertani
- Neuroendocrine Surgery Tumor Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy.
- Division of Digestive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Francesco Mattana
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mahila E Ferrari
- Division of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Eleonora Pisa
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Riccardo Mirabelli
- Istituto Nazionale di Fisica Nucleare INFN, Sezione di Roma, Rome, Italy
- Department of Basic and Applied Sciences for Engineering, Sapienza University of Rome, Rome, Italy
| | - Silvio Morganti
- Istituto Nazionale di Fisica Nucleare INFN, Sezione di Roma, Rome, Italy
| | - Nicola Fazio
- Division of Gastrointestinal and Neuroendocrine Tumors Medical Treatment IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Francesco Ceci
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Bertani E, Mattana F, Collamati F, Ferrari ME, Bagnardi V, Frassoni S, Pisa E, Mirabelli R, Morganti S, Danieli M, Fazio N, Fumagalli Romario U, Ceci F. ASO Author Reflections: Radio-Guided Surgery in Small Intestine Neuroendocrine Tumors: New Probe, New Perspectives? Ann Surg Oncol 2024; 31:4199-4200. [PMID: 38722424 DOI: 10.1245/s10434-024-15390-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 06/14/2024]
Affiliation(s)
- Emilio Bertani
- Neuroendocrine Surgery Tumor Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy.
- Division of Digestive Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Francesco Mattana
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Mahila E Ferrari
- Division of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Eleonora Pisa
- Division of Pathology IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Riccardo Mirabelli
- Istituto Nazionale di Fisica Nucleare INFN, Sezione di Roma, Rome, Italy
- Department of Basic and Applied Sciences for Engineering, Sapienza University of Rome, Rome, Italy
| | - Silvio Morganti
- Istituto Nazionale di Fisica Nucleare INFN, Sezione di Roma, Rome, Italy
| | - Maria Danieli
- Division of Digestive Surgery IEO, European Institute of Oncology IRCCS, Milan, Italy
- Università Statale degli Studi di Milano, Milan, Italy
| | - Nicola Fazio
- Division of Gastrointestinal and Neuroendocrine Tumors Medical Treatment IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Francesco Ceci
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Kebebew E. Beta Probe for Radioguided Surgery in Gastrointestinal Neuroendocrine Tumors: A Move in the Right Direction. Ann Surg Oncol 2024; 31:4159-4160. [PMID: 38743279 DOI: 10.1245/s10434-024-15439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Electron Kebebew
- Division of General Surgery, Department of Surgery, Stanford University, School of Medicine, Stanford, CA, USA.
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Arabi H, Manesh AS, Zaidi H. Innovations in dedicated PET instrumentation: from the operating room to specimen imaging. Phys Med Biol 2024; 69:11TR03. [PMID: 38744305 DOI: 10.1088/1361-6560/ad4b92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/14/2024] [Indexed: 05/16/2024]
Abstract
This review casts a spotlight on intraoperative positron emission tomography (PET) scanners and the distinctive challenges they confront. Specifically, these systems contend with the necessity of partial coverage geometry, essential for ensuring adequate access to the patient. This inherently leans them towards limited-angle PET imaging, bringing along its array of reconstruction and geometrical sensitivity challenges. Compounding this, the need for real-time imaging in navigation systems mandates rapid acquisition and reconstruction times. For these systems, the emphasis is on dependable PET image reconstruction (without significant artefacts) while rapid processing takes precedence over the spatial resolution of the system. In contrast, specimen PET imagers are unburdened by the geometrical sensitivity challenges, thanks to their ability to leverage full coverage PET imaging geometries. For these devices, the focus shifts: high spatial resolution imaging takes precedence over rapid image reconstruction. This review concurrently probes into the technical complexities of both intraoperative and specimen PET imaging, shedding light on their recent designs, inherent challenges, and technological advancements.
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Affiliation(s)
- Hossein Arabi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva 4, Switzerland
| | - Abdollah Saberi Manesh
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva 4, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211 Geneva 4, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Department of Nuclear Medicine, University of Southern Denmark, 500 Odense, Denmark
- University Research and Innovation Center, Óbuda University, Budapest, Hungary
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Wang J, Yin Y, Ren X, Wang S, Zhu Y. Electrospun nanofibrous mats loaded with gemcitabine and cisplatin suppress bladder tumor growth by improving the tumor immune microenvironment. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2024; 35:21. [PMID: 38526656 DOI: 10.1007/s10856-024-06786-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
The perplexing issues related to positive surgical margins and the considerable negative consequences associated with systemic chemotherapy have posed ongoing challenges for clinicians, especially when it comes to addressing bladder cancer treatment. The current investigation describes the production of nanocomposites loaded with gemcitabine (GEM) and cisplatin (CDDP) through the utilization of electrospinning technology. In vitro and in vivo studies have provided evidence of the strong effectiveness in suppressing tumor advancement while simultaneously reducing the accumulation of chemotherapy drugs within liver and kidney tissues. Mechanically, the GEM and CDDP-loaded electrospun nanocomposites could effectively eliminate myeloid-derived suppressor cells (MDSCs) in tumor tissues, and recruit CD8+ T cells and NKp46+ NK cells to kill tumor cells, which can also effectively inhibit tumor microvascular formation. Our investigation into the impact of localized administration of chemotherapy through GEM and CDDP-loaded electrospun nanocomposites on the tumor microenvironment will offer novel insights for tackling tumors.
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Affiliation(s)
- Jing Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yisheng Yin
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Ren
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunpeng Zhu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Bonomi A, Fumagalli Romario U, Funicelli L, Conti G, Realis Luc M, Ceci F, Pozzi S, Radice D, Fazio N, Bertani E. Diagnosis and staging of small intestinal neuroendocrine tumors with CT enterography and PET with Gallium-68: preoperative risk stratification protocol. Langenbecks Arch Surg 2024; 409:63. [PMID: 38363374 DOI: 10.1007/s00423-024-03254-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Pre-operative diagnosis and staging of small intestine neuroendocrine tumors (SI-NETs) remain sub-optimal, with open palpation during surgery still considered the gold standard. This limits a standardized implementation of minimally invasive surgery (MIS). The aim of this single-center retrospective study was to assess a tailored diagnostic work-up to identify candidates at low risk of undetected disease who may benefit from MIS. METHODS Patients diagnosed with SI-NETs between 2013 and 2022 who underwent contrast-enhanced computed tomography enterography (CTE) and Ga68-DOTATOC-positron emission tomography-CT (68 Ga DOTATATE PET/CT) preoperatively and subsequently underwent open surgical resection were included. Imaging studies were reassessed by two radiologists. Combined use of CTE and 68 Ga DOTATATE PET/CT in determining primary lesion disease burden (number of lesions) and LN disease stage (distal and proximal relative to superior mesenteric vessels) was assessed, using surgical reports and pathology as gold standard. RESULTS Overall, 56 patients were included. Sensitivity of CTE and 68 Ga DOTATATE PET/CT for at least one primary SI-NET was 100% and 94%, respectively. In the presence of concordance between studies, combined use of CTE and 68 Ga DOTATATE PET/CT for detection of single primary tumors improved specificity to 89% (n = 25/28) with a positive predictive value of 87.5% (n = 21/24). Distal LN disease was identified in 89.2% of cases (n = 33/37). The association of single lesion and distal LN disease was found pre-operatively in 32% of patients (n = 18). CONCLUSION Combined use of CTE and 68 Ga DOTATATE PET/CT enables identifying low-risk surgical candidates (single SI-NET lesions with distal LN disease).
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Affiliation(s)
- Alessandro Bonomi
- General Surgery Residency Program, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy.
- Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy.
| | | | - Luigi Funicelli
- Division of Medical Imaging and Radiation Sciences, European Institute of Oncology, IEO, IRCCS, Milan, Italy
- Italian Society of Medical and Interventional Radiology, SIRM, Italian College of Computed Tomography, Milan, Italy
| | - Guglielmo Conti
- Division of Medical Imaging and Radiation Sciences, European Institute of Oncology, IEO, IRCCS, Milan, Italy
- Radiodiagnostics Residency Program, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Marco Realis Luc
- General Surgery Residency Program, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
- Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | - Simonetta Pozzi
- Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Davide Radice
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Emilio Bertani
- Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
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Collarino A, Florit A, Bizzarri N, Lanni V, Morganti S, De Summa M, Vizzielli G, Fanfani F, Mirabelli R, Ferrandina G, Scambia G, Rufini V, Faccini R, Collamati F. Radioguided surgery with β decay: A feasibility study in cervical cancer. Phys Med 2023; 113:102658. [PMID: 37603908 DOI: 10.1016/j.ejmp.2023.102658] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/07/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023] Open
Abstract
PURPOSE Radioguided surgery (RGS) is a technique that helps the surgeon to achieve a tumour resection as complete as possible, by means of the intraoperative detection of particles emitted by a radiotracer that bounds to tumoural cells. This study aimed to investigate the applicability of β-RGS for tumour resection and margin assessment in cervical cancer patients preoperatively injected with [18F]FDG, by means of Monte Carlo simulations. METHODS Patients were retrospectively included if they had a recurrent or persistent cervical cancer, underwent preoperative PET/CT to exclude distant metastases and received radical surgery. All PET/CT images were analysed extracting tumour SUVmax, background SUVmean and tumour-to-non-tumour ratio. These values were used to obtain the expected count rate in a realistic surgical scenario by means of a Monte Carlo simulation of the β probe, assuming the injection of 2 MBq/kg of [18F]FDG 60 min before surgery. RESULTS Thirty-eight patients were included. A measuring time of ∼2-3 s is expected to be sufficient for discriminating the tumour from background in a given lesion, being this the time the probe has to be over the sample in order to be able to discriminate tumour from healthy tissue with a sensitivity of ∼99% and a specificity of at least 95%. CONCLUSION This study presents the first step towards a possible application of our β-RGS technique in cervical cancer. Results suggest that this approach to β-RGS could help surgeons distinguish tumour margins from surrounding healthy tissue, even in a setting of high radiotracer background activity.
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Affiliation(s)
- Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Anita Florit
- Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicolò Bizzarri
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valerio Lanni
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvio Morganti
- National Institute of Nuclear Physics (INFN), Section of Rome, Rome, Italy
| | - Marco De Summa
- PET/CT Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Vizzielli
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Mirabelli
- National Institute of Nuclear Physics (INFN), Section of Rome, Rome, Italy; Department of Basic and Applied Sciences for Engineering, Sapienza Università di Roma, Rome, Italy.
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vittoria Rufini
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Section of Nuclear Medicine, University Department of Radiological Sciences and Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Faccini
- National Institute of Nuclear Physics (INFN), Section of Rome, Rome, Italy; Physics Department, Sapienza Università di Roma, Rome, Italy
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Mirabelli R, Morganti S, Cartoni A, De Simoni M, Faccini R, Fischetti M, Giordano A, Scotognella T, Solfaroli-Camillocci E, Collamati F. Characterization and optimization of a β detector for 18F radio-guided surgery. Phys Med 2023; 108:102545. [PMID: 37021607 DOI: 10.1016/j.ejmp.2023.102545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 03/11/2023] Open
Abstract
Radio-Guided Surgery (RGS) is a nuclear medicine technique to support the surgeon during surgery towards a complete tumor resection. It is based on intraoperative detection of radiation emitted by a radio-pharmaceutical that bounds selectively to tumoral cells. In the past years, an approach that exploits β- emitting radiotracers has been pursued to overtake some limitations of the traditional RGS based on γ emission. A particle detector dedicated to this application, demonstrating very high efficiency to β- particles and remarkable transparency to photons, has been thus developed. As a by-product, its characteristics suggested the possibility to utilize it with β+ emitting sources, more commonly in use in nuclear medicine. In this paper, performances of such detector on 18F liquid sources are estimated by means of Monte Carlo simulations (MC) and laboratory measurements. The experimental setup with a 18F saline solution comprised a "positron signal" spot (a 7 × 10 mm cylinder representing the tumor residual), and a surrounding "far background" volume, that represented for the detector an almost isotropic source of annihilation photons. Experimental results show good agreement with MC predictions, thus confirming the expected performances of the detector with 18F, and the validity of the developed MC simulation as a tool to predict the gamma background determined by a diffuse source of annihilation photons.
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Affiliation(s)
- R Mirabelli
- Department of Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy; Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy
| | - S Morganti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy
| | - A Cartoni
- Department of Chemistry, Sapienza Università di Roma, Rome, Italy
| | - M De Simoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Department of Medical Physics Ludwig-Maximilians- Universität München (LMU) Munich, Germany
| | - R Faccini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Department of Physics, Sapienza Università di Roma, Rome, Italy
| | - M Fischetti
- Department of Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy
| | - A Giordano
- Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istitute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Scotognella
- Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - F Collamati
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy.
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Te Beek ET, Burggraaf J, Teunissen JJM, Vriens D. Clinical Pharmacology of Radiotheranostics in Oncology. Clin Pharmacol Ther 2023; 113:260-274. [PMID: 35373336 DOI: 10.1002/cpt.2598] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/23/2022] [Indexed: 01/27/2023]
Abstract
The combined use of diagnostic and therapeutic radioligands with the same molecular target, also known as theranostics, enables accurate patient selection, targeted therapy, and prediction of treatment response. Radioiodine, bone-seeking radioligands and norepinephrine analogs have been used for many years for diagnostic imaging and radioligand therapy of thyroid carcinoma, bone metastases, pheochromocytoma, paraganglioma, and neuroblastoma, respectively. In recent years, radiolabeled somatostatin analogs and prostate-specific membrane antigen ligands have shown clinical efficacy in the treatment of neuroendocrine tumors and prostate cancer, respectively. Several candidate compounds are targeting novel theranostic targets such as fibroblast activation protein, C-X-C chemokine receptor 4, and gastrin-releasing peptide receptor. In addition, several strategies to improve efficacy of radioligand therapy are being evaluated, including dosimetry-based dose optimization, multireceptor targeting, upregulation of target receptors, radiosensitization, pharmacogenomics, and radiation genomics. Design and evaluation of novel radioligands and optimization of dose and dose schedules, within the complex context of individualized multimodal cancer treatment, requires a multidisciplinary approach that includes clinical pharmacology. Significant increases in the use of these radiopharmaceuticals in routine oncological practice can be expected, which will have major impact on patient care as well as (radio)pharmacy utilization.
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Affiliation(s)
- Erik T Te Beek
- Department of Nuclear Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | | | - Jaap J M Teunissen
- Department of Nuclear Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Predictors and Outcomes of Minimally Invasive Surgery for Small Bowel Neuroendocrine Tumors : Minimally Invasive Surgery for SBNETs. J Gastrointest Surg 2022; 26:1252-1265. [PMID: 35132564 DOI: 10.1007/s11605-022-05264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/22/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Open surgical resection with regional lymphadenectomy is the standard of care for small bowel neuroendocrine tumors (SBNETs). There is no consensus on the role of minimally invasive surgery (MIS). This study aims to evaluate the current national trends for MIS in treating SBNETs and its association with lymph node (LN) yield. METHODS The National Cancer Database was queried for patients with Stage I-III SBNETs who underwent surgery from 2010-2017. Time trends were examined using the Cochran-Armitage test. Chi-square tests, t test, and multivariable logistic regression assessed associations of surgical approach with patient, clinical, and facility characteristics. Kaplan-Meier curves and propensity score weighted Cox proportional hazards model were used to examine survival. RESULTS Of the 11,367 patients with Stage I-III SBNETs, 46.5% (N = 5,298) underwent MIS. From 2010-2017, the proportion of MIS increased from 35.6% to 57.7% (P < 0.001). Patients of Stage I disease (OR = 1.23), Caucasian race (OR = 1.18), private insurance (OR = 1.29), and higher volume centers (OR = 1.29) were more likely to undergo MIS (all P < 0.02). The average number of LN harvested in the MIS cohort was greater than in the open surgery cohort (13.3 vs 11.8 LN, P < 0.001). MIS patients had shorter length of stay by 2 days compared to open surgery (5.4 vs 7.6 days, P < 0.001). LN yield ≥ 8 was associated with better survival (HR = 0.77, P < 0.001). CONCLUSION The utilization of a MIS approach to treat Stage I-III SBNETs has increased, especially at higher volume centers. We did not observe an inferior LN harvest with the MIS cohort compared to the open surgery cohort.
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Li AY, Visser BC, Dua MM. Surgical Indications and Outcomes of Resection for Pancreatic Neuroendocrine Tumors with Vascular Involvement. Cancers (Basel) 2022; 14:cancers14092312. [PMID: 35565442 PMCID: PMC9103421 DOI: 10.3390/cancers14092312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Pancreatic neuroendocrine tumors (pNETs) are a heterogenous group of rare epithelial neoplasms. For most patients, surgery remains the only treatment modality to cure pNETs, and is recommended for patients with surgically resectable disease. Many of these tumors are non-functional tumors and do not produce clinical symptoms, so patients may present with locally advanced tumors, which invade surrounding organs or neighboring blood vessels. The presence of vascular involvement had previously been considered a contraindication to surgery, but, in recent years, at centers with considerable experience, aggressive surgery to remove pNETs with vascular reconstruction has been performed safely and with good long-term survival. In this review, we will discuss the considerations for resectability, review novel surgical approaches, and present the available evidence on the immediate and long-term postoperative outcomes. Abstract Complete surgical resection of pancreatic neuroendocrine tumors (pNETs) has been suggested as the only potentially curative treatment. A proportion of these tumors will present late during disease progression, and invade or encase surrounding vasculature; therefore, surgical treatment of locally advanced disease remains controversial. The role of surgery with vascular reconstruction in pNETs is not well defined, and there is considerable variability in the use of aggressive surgery for these tumors. Accurate preoperative assessment is critical to evaluate individual considerations, such as anatomical variants, areas and lengths of vessel involvement, proximal and distal targets, and collateralization secondary to the degree of occlusion. Surgical approaches to address pNETs with venous involvement may include thrombectomy, traditional vein reconstruction, a reconstruction-first approach, or mesocaval shunting. Although the amount of literature on pNETs with vascular reconstruction is limited to case reports and small institutional series, the last two decades of studies have demonstrated that aggressive resection of these tumors can be performed safely and with acceptable long-term survival.
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12
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Billmann F, Nießen A, Hackert T. [Importance of surgery in distant metastatic pancreatic neuroendocrine neoplasms]. Chirurg 2022; 93:758-764. [PMID: 35403909 DOI: 10.1007/s00104-022-01630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
The majority of patients with pancreatic neuroendocrine neoplasms (pNEN) already present with distant metastases at diagnosis. The heterogeneity of pNEN and the broad spectrum of treatment options make adequate patient selection and an evidence-based strategy essential. In metastatic pNEN both primary resection and resection of liver metastases have been shown to improve overall survival. Surgical treatment of liver metastases can also be carried out with palliative intent, especially for symptomatic pNEN and can have a positive effect on disease-free survival and overall survival. Classical hepatectomy techniques and innovative techniques (two-stage resections, liver transplantation) are available to the surgeon. In complex growth types of liver metastases, there is increasing evidence for a combination of surgery and ablative methods. Due to a relevant risk of recurrence following liver resection, pNEN patients need to be included in multimodal treatment concepts. Current areas of interest in the treatment of metastatic pNEN are the use of adjuvant/neoadjuvant chemotherapy and surgery in G3-NEN and G3-NEC patients. The aim of this review is to give an overview on the impact of surgery in the situation of distant metastatic NEN of the pancreas.
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Affiliation(s)
- F Billmann
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
| | - A Nießen
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - T Hackert
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
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13
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Collamati F, Faccini R, Mancini-Terracciano C, Camillocci ES. Mono-channel probes for beta emission. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Cockburn KC, Toumi Z, Mackie A, Julyan P. Radioguided Surgery for Gastroenteropancreatic Neuroendocrine Tumours: a Systematic Literature Review. J Gastrointest Surg 2021; 25:3244-3257. [PMID: 34506015 PMCID: PMC8654712 DOI: 10.1007/s11605-021-05115-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/07/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Radioguided surgery (RGS) for gastroenteropancreatic neuroendocrine tumours (GEP-NETs) has been suggested as a way to improve intraoperative lesion detection. This systematic literature review of reports of the use of RGS for GEP-NETs was performed to determine if there is a benefit. METHODS A literature search was conducted using Google Scholar and PubMed, and snowballing from any relevant literature. Full-text studies were included if they were published in the English language and reported outcomes of RGS on human subjects with GEP-NETs. Qualitative data synthesis was performed. RESULTS Twenty-six papers including a total of 209 patients were included. The tracers used were predominantly indium-111 pentetreotide, gallium-68 DOTA-peptides, and technetium-99m EDDA/HYNIC-peptides. Heterogeneous protocols make comparisons difficult, but most papers reported a benefit from the use of RGS in tumours in the gastrointestinal tract; utility in localisation of pancreatic tumours was less clear. Time between tracer administration and operation varied: from 16 h to 8 days with indium-111, 0-24 h with technetium-99m, and 19-193 min with gallium-68. Eight teams reported the thresholding technique used for discrimination-four used a ratio, four statistical methods, and one looked at the sensitivity and specificity of different cut-offs. Six teams performed follow-up of 24 patients (three pancreas, eight gastrinoma, 13 gastrointestinal tract) for between 3 months and 3 years. Two patients relapsed (one pancreas, one gastrinoma) between 6 and 12 months post-surgery. CONCLUSIONS RGS appears to aid in localisation of gastrointestinal NETs, but the benefit is more equivocal in pancreatic NETs. Further work into outcomes is warranted.
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Affiliation(s)
- Katrina Clair Cockburn
- Northern Medical Physics and Clinical Engineering, County Durham and Darlington NHS Foundation Trust, Hollyhurst Road, Darlington, DL3 6HX, UK.
| | - Zaher Toumi
- Department of General Surgery, County Durham and Darlington NHS Foundation Trust, Hollyhurst Road, Darlington, DL3 6HX, UK
| | - Alison Mackie
- Northern Medical Physics and Clinical Engineering, County Durham and Darlington NHS Foundation Trust, Hollyhurst Road, Darlington, DL3 6HX, UK
| | - Peter Julyan
- Department of Nuclear Medicine, The Christie Hospital NHS Foundation Trust, Manchester, UK
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15
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Badenes Romero Á, Orozco Cortés J, Balaguer Muñoz D, Abreu Sánchez P, Mut Dólera T, Gómez Abril SÁ, Dolz Gaitón R, Caballero Calabuig E, Cueto Cañadas B, Latorre Agraz I, Reyes Ojeda MD, Plancha Mansanet C, Esteban Hurtado Á. Radioguided detection of a non-palpable occult lesion (ROLL) in a case of abdominal metastasis of a neuroendocrine tumor. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:768-771. [PMID: 33023293 DOI: 10.17235/reed.2020.6926/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neuroendocrine tumors (NET) are a heterogeneous group of neoplasms that originate in tissues derived from the neural crest, whose characteristic feature is the expression of neuroendocrine markers and somatostatin receptors. Here, we present the case of a patient with a surgically intervened small bowel NET. Focal uptake was identified in the unresected mesentery in the scintigraphy of somatostatin receptors (99mTc-Tektrotyd). A second intervention was performed with intraoperative radio-guided detection with a gamma probe and a handheld SPECT. An intraoperative radioguided technique allowed the detection of a lesion that was confirmed by histology to be a lymph node metastasis of the NET and a nodule of NET in the anastomosis of the first surgical intervention.
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16
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Boekestijn I, Azargoshasb S, Schilling C, Navab N, Rietbergen D, van Oosterom MN. PET- and SPECT-based navigation strategies to advance procedural accuracy in interventional radiology and image-guided surgery. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:244-260. [PMID: 34105338 DOI: 10.23736/s1824-4785.21.03361-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Nuclear medicine has a crucial role in interventional strategies where a combination between the increasing use of targeted radiotracers and intraprocedural detection modalities enable novel, but often complex, targeted procedures in both the fields of interventional radiology and surgery. 3D navigation approaches could assist the interventional radiologist or surgeon in such complex procedures. EVIDENCE ACQUISITION This review aimed to provide a comprehensive overview of the current application of computer-assisted navigation strategies based on nuclear imaging to assist in interventional radiology and image-guided surgery. This work starts with a brief overview of the typical navigation workflow from a technical perspective, which is followed by the different clinical applications organized based on their anatomical organ of interest. EVIDENCE SYNTHESIS Although many studies have proven the feasibility of PET- and SPECT-based navigation strategies for various clinical applications in both interventional radiology and surgery, the strategies are spread widely in both navigation workflows and clinical indications, evaluated in small patient groups. Hence, no golden standard has yet been established. CONCLUSIONS Despite that the clinical outcome is yet to be determined in large patient cohorts, navigation seems to be a promising technology to translate nuclear medicine findings, provided by PET- and SPECT-based molecular imaging, to the intervention and operating room. Interventional Nuclear Medicine (iNM) has an exciting future to come using both PET- and SPECT-based navigation.
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Affiliation(s)
- Imke Boekestijn
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Samaneh Azargoshasb
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Clare Schilling
- Head and Neck Academic Center, Department of Head and Neck Surgery, University College London Hospital, London, UK
| | - Nassir Navab
- Computer Aided Medical Procedures, Technical University of Munich, Munich, Germany.,Computer Aided Medical Procedures, Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Daphne Rietbergen
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands - .,Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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17
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Fishbein L, Del Rivero J, Else T, Howe JR, Asa SL, Cohen DL, Dahia PLM, Fraker DL, Goodman KA, Hope TA, Kunz PL, Perez K, Perrier ND, Pryma DA, Ryder M, Sasson AR, Soulen MC, Jimenez C. The North American Neuroendocrine Tumor Society Consensus Guidelines for Surveillance and Management of Metastatic and/or Unresectable Pheochromocytoma and Paraganglioma. Pancreas 2021; 50:469-493. [PMID: 33939658 DOI: 10.1097/mpa.0000000000001792] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT This manuscript is the result of the North American Neuroendocrine Tumor Society consensus conference on the medical management and surveillance of metastatic and unresectable pheochromocytoma and paraganglioma held on October 2 and 3, 2019. The panelists consisted of endocrinologists, medical oncologists, surgeons, radiologists/nuclear medicine physicians, nephrologists, pathologists, and radiation oncologists. The panelists performed a literature review on a series of questions regarding the medical management of metastatic and unresectable pheochromocytoma and paraganglioma as well as questions regarding surveillance after resection. The panelists voted on controversial topics, and final recommendations were sent to all panel members for final approval.
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Affiliation(s)
- Lauren Fishbein
- From the Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jaydira Del Rivero
- Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tobias Else
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - James R Howe
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center and University Health Network, Toronto, Case Western Reserve University, Cleveland, OH
| | - Debbie L Cohen
- Renal Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Patricia L M Dahia
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Douglas L Fraker
- Division of Endocrine and Oncologic Surgery, Department of Surgery, University of Pennsylvania and Abramson Cancer Center, Philadelphia, PA
| | - Karyn A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Pamela L Kunz
- Division of Oncology, Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Kimberly Perez
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Nancy D Perrier
- Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel A Pryma
- Department of Radiology and Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mabel Ryder
- Endocrine Oncology Tumor Group, Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Aaron R Sasson
- Division of Surgical Oncology, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY
| | - Michael C Soulen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX
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18
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Frilling A, Clift AK, Frampton AE, Bomanji J, Kaemmerer D, Al-Nahhas A, Alsafi A, Kidd M, Modlin IM, Hoersch D, Baum RP. A combination of surgery, theranostics, and liquid biopsy - a personalised oncologic approach to treatment of patients with advanced metastatic neuroendocrine neoplasms. Int J Med Sci 2021; 18:2166-2175. [PMID: 33859524 PMCID: PMC8040427 DOI: 10.7150/ijms.51740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/14/2021] [Indexed: 01/29/2023] Open
Abstract
Rationale: Neuroendocrine neoplasia (NEN) of small bowel (SBNEN) frequently present with metastatic disease. Theranostics (molecular imaging followed by targeting therapy) allow for personalised medicine. Liquid biopsies enable precise identification of residual disease and real-time monitoring of therapeutic response. Our aim was to determine the clinical utility of a combination of surgery, theranostics, and a multigene blood measurement in metastasised SBNEN. Methods: Inclusion criteria were SBNEN, G1/G2 NEN, initial tumour diagnosis, stage IV NEN, positivity on 68Ga somatostatin analogue PET/CT, eligible for surgery, and 177Lu peptide receptor radionuclide therapy (PRRT). Blood samples for NETest were collected longitudinally. Progression-free survival (PFS) and overall survival (OS) were calculated. NETest results were assessed prior to surgery and during clinical follow-up. Results: A surgical cohort of 39 SBNEN patients met eligibility criteria. Thirty-two patients underwent ileal resection and 7 right hemicolectomy. The mean number of 177Lu PRRT cycles was 4. Mortality was nil. Surgical morbidity was 10.3%. Transient grade 1/2 toxicity occurred in 41% (PRRT). NETest scores (n=9 patients) decreased in 100% following treatment and correlated with diminished tumour volume and disease stabilization following surgery and PRRT. Median follow-up: 78 months. Median PFS and OS: 42.7 and 110 months, respectively. Progression-free survival at 1-, 3-, and 5-years was 79.4%, 57.1% and 40.5%, respectively. Overall survival at 1-, 3-, and 5-years was 97.4%, 97.4%, and 94.1%, respectively. Conclusions: Surgery combined with 177Lu PRRT is safe and provides favourable PFS and OS in selected patients with advanced SBNEN. Liquid biopsy (NETest) has the potential to accurately delineate disease status.
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Affiliation(s)
- Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ashley K. Clift
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adam E. Frampton
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jamshed Bomanji
- Department of Nuclear Medicine, University College London Hospitals, London, UK
| | - Daniel Kaemmerer
- Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Adil Al-Nahhas
- Department of Imaging and Nuclear Medicine, Imperial College London, London, UK
| | - Ali Alsafi
- Department of Imaging and Nuclear Medicine, Imperial College London, London, UK
| | | | - Irvin M. Modlin
- Gastroenterological and Endoscopic Surgery, Yale University School of Medicine, New Haven, USA
| | - Dieter Hoersch
- Department of Gastroenterology/Endocrinology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Richard P. Baum
- CURANOSTICUM Wiesbaden-Frankfurt at DKD Helios Klinik, Wiesbaden, Germany
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19
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Bertani E, Collamati F, Colandrea M, Faccini R, Fazio N, Ferrari ME, Fischetti M, Fumagalli Romario U, Funicelli L, De Simoni M, Mancini-Terracciano C, Mirabelli R, Morganti S, Papi S, Pisa E, Solfaroli-Camillocci E, Spada F, Cremonesi M, Grana CM. First Ex Vivo Results of β --Radioguided Surgery in Small Intestine Neuroendocrine Tumors with 90Y-DOTATOC. Cancer Biother Radiopharm 2021; 36:397-406. [PMID: 33601932 DOI: 10.1089/cbr.2020.4487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: In neuroendocrine tumor (NET), complete surgery could better the prognosis. Radioguided surgery (RGS) with β--radioisotopes is a novel approach focused on developing a new probe that, detecting electrons and operating with low background, provides a clearer delineation of the lesions with low radiation exposition for surgeons. As a first step to validate this procedure, ex vivo specimens of tumors expressing somatostatin receptors, as small intestine neuroendocrine tumor (SI-NET), were tested. Materials and Methods: SI-NET presents a high uptake of a beta-emitting radiotracer, 90Y-DOTATOC. Five SI-NET patients were enrolled after performing a 68Ga-DOTATOC positron emission tomography/computed tomography (CT) and a CT enterography; 24 h before surgery, they received 5 mCi of 90Y-DOTATOC. Results: Surgery was performed as routine. Tumors and surrounding tissue were sectioned in different samples and examined ex vivo with the beta-detecting probe. All the tumor samples showed high counts of radioactivity that was up to a factor of 18 times higher than the corresponding cutoff value, with a sensitivity of 96% and a specificity of 100%. Conclusions: These first ex vivo RGS tests showed that this probe can discriminate very effectively between tumor and healthy tissues by the administration of low activities of 90Y-DOTATOC, allowing more precise surgery.
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Affiliation(s)
- Emilio Bertani
- Division of Digestive Surgery, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | | | - Marzia Colandrea
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Riccardo Faccini
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Nicola Fazio
- Division of Gastrointestinal and Neuroendocrine Tumors Medical Treatment, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Mahila E Ferrari
- Medical Physics, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Marta Fischetti
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Scienze di Base Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy
| | | | - Luigi Funicelli
- Division of Radiology, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Micol De Simoni
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Carlo Mancini-Terracciano
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Riccardo Mirabelli
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Dipartimento di Fisica, Università di Roma Sapienza, Roma, Italy
| | - Silvio Morganti
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy
| | - Stefano Papi
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Eleonora Pisa
- Division of Pathology, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Elena Solfaroli-Camillocci
- Sezione di Roma, Istituto Nazionale di Fisica Nucleare, Roma, Italy.,Scuola di specializzazione in Fisica Medica, Sapienza Università di Roma, Roma, Italy
| | - Francesca Spada
- Division of Gastrointestinal and Neuroendocrine Tumors Medical Treatment, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Marta Cremonesi
- Medical Physics, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Chiara M Grana
- Division of Nuclear Medicine, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
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20
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Rietbergen DD, VAN Oosterom MN, Kleinjan GH, Brouwer OR, Valdes-Olmos RA, VAN Leeuwen FW, Buckle T. Interventional nuclear medicine: a focus on radioguided intervention and surgery. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2021; 65:4-19. [PMID: 33494584 DOI: 10.23736/s1824-4785.21.03286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Within interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of clinical indications (e.g. lymphatic mapping, local tumor demarcation and/or tumor receptor targeted applications) have been adopted into routine care. The clinical integration is further strengthened by technical innovations in chemistry and engineering that enhance the translational potential of radioguided procedures in iNM. Together, these features not only ensure ongoing expansion of iNM but also warrant a lasting clinical impact for the sub-discipline of radioguided surgery.
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Affiliation(s)
- Daphne D Rietbergen
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N VAN Oosterom
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Gijs H Kleinjan
- Department of Urology, Leiden University Medical Center, Leiden, the Netherlands
| | - Oscar R Brouwer
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Renato A Valdes-Olmos
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W VAN Leeuwen
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Tessa Buckle
- Department of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, the Netherlands - .,Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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21
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Hu Y, Ye Z, Wang F, Qin Y, Xu X, Yu X, Ji S. Role of Somatostatin Receptor in Pancreatic Neuroendocrine Tumor Development, Diagnosis, and Therapy. Front Endocrinol (Lausanne) 2021; 12:679000. [PMID: 34093445 PMCID: PMC8170475 DOI: 10.3389/fendo.2021.679000] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/27/2021] [Indexed: 12/02/2022] Open
Abstract
Pancreatic neuroendocrine tumors (pNETs) are rare and part of the diverse family of neuroendocrine neoplasms (NENs). Somatostatin receptors (SSTRs), which are widely expressed in NENs, are G-protein coupled receptors that can be activated by somatostatins or its synthetic analogs. Therefore, SSTRs have been widely researched as a diagnostic marker and therapeutic target in pNETs. A large number of studies have demonstrated the clinical significance of SSTRs in pNETs. In this review, relevant literature has been appraised to summarize the most recent empirical evidence addressing the clinical significance of SSTRs in pNETs. Overall, these studies have shown that SSTRs have great value in the diagnosis, treatment, and prognostic prediction of pNETs; however, further research is still necessary.
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Affiliation(s)
- Yuheng Hu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Zeng Ye
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Fei Wang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Yi Qin
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Xiaowu Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
- *Correspondence: Xianjun Yu, ; Shunrong Ji,
| | - Shunrong Ji
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Shanghai Pancreatic Cancer Institute, Shanghai, China
- Pancreatic Cancer Institute, Fudan University, Shanghai, China
- *Correspondence: Xianjun Yu, ; Shunrong Ji,
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Sentinel Node Imaging and Radioguided Surgery in the Era of SPECT/CT and PET/CT: Toward New Interventional Nuclear Medicine Strategies. Clin Nucl Med 2020; 45:771-777. [PMID: 32701805 DOI: 10.1097/rlu.0000000000003206] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We review recent technological advances and new clinical indications for sentinel node (SN) and radioguided surgery in order to delineate future tendencies of interventional nuclear medicine in this field. A literature research was performed in PubMed to select relevant articles to be used as key references for analysis of the current approaches and tendencies in SN and radioguided surgery, as well as the evolving contribution of nuclear medicine intervention techniques to the various clinical applications. For classic indications such as melanoma and breast cancer, the incorporation of the SN approach based on the combined use of existing and new preoperative and intraoperative technologies in high-risk patient categories is becoming an emerging area of clinical indication. For SN biopsy staging in other malignancies with more complex lymphatic drainage, the incorporation of sophisticated tools is most helpful. The consecutive use of PET/CT and the SN procedure is increasing as a potential combined approach for the management of specific areas such as the axilla and the pelvis in patients at high risk of regional dissemination. Also, for the management of locoregional metastasis and oligometastatic disease, interventional nuclear medicine techniques are becoming valuable alternatives. The extended experience with SN biopsy is leading to technological advances facilitating the incorporation of this procedure to stage other malignancies with complex lymphatic drainage. New nuclear medicine-based approaches, incorporating SPECT/CT and PET/CT to guide resection of SNs and occult metastases, have recently been gaining ground.
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23
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Howe JR. Carcinoid Tumors: Past, Present, and Future. Indian J Surg Oncol 2020; 11:182-187. [DOI: 10.1007/s13193-020-01079-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/07/2020] [Indexed: 01/25/2023] Open
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24
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Cloyd JM, Wiseman JT, Pawlik TM. Surgical management of pancreatic neuroendocrine liver metastases. J Gastrointest Oncol 2020; 11:590-600. [PMID: 32655938 PMCID: PMC7340805 DOI: 10.21037/jgo.2019.11.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/13/2019] [Indexed: 12/12/2022] Open
Abstract
Pancreatic neuroendocrine tumors (PNET) are a heterogeneous group of neoplasms that vary in their clinical presentation, behavior and prognosis. The most common site of metastasis is the liver. Surgical resection of neuroendocrine liver metastases (NELM) is thought to afford the best long-term outcomes when feasible. Initial preoperative workup should include surveillance for carcinoid syndrome, screening for evidence of liver insufficiency, and performance of imaging specific to neuroendocrine tumors such as a somatostatin receptor positron emission tomography scan. Standard surgical principles apply to hepatic surgery for NELM, namely prioritizing low central venous pressure anesthesia, minimizing blood loss, knowledge of liver anatomy, generous use of intraoperative ultrasound, as well as safe parenchymal transection techniques and practices to avoid bile leakage. Knowledge of established prognostic factors may assist with patient selection, which is important for optimizing short- and long-term outcomes of hepatic resection. Adjunct therapies such as concomitant liver ablation are used frequently and are generally safe when used appropriately. For patients with synchronous resectable NELM, resection of the primary either in a staged or combined fashion is recommended. Primary tumor resection in the setting of unresectable metastatic disease is more controversial, however generally recommended if morbidity is acceptable. For patients who are not surgical candidates, due to either patient performance status or burden of liver disease, several liver-directed therapies such as transarterial embolization, chemoembolization, and radioembolization are available to assist with locoregional control, extend progression-free survival (PFS), and improve symptoms of carcinoid syndrome. Multiple systemic therapy options exist for patients with metastatic PNET which are often prioritized for those patients with advanced or progressive disease. A systematic approach in a multi-disciplinary setting is likely to result in the best long-term outcomes for patients with pancreatic NELM. Ongoing research is needed to determine the optimal patient selection for hepatic surgery as well as the ideal treatment sequencing for those patients with NELM.
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Affiliation(s)
- Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, Columbus, OH, USA
| | - Jason T Wiseman
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, Columbus, OH, USA
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25
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Tella SH, Jha A, Taïeb D, Horvath KA, Pacak K. Comprehensive review of evaluation and management of cardiac paragangliomas. Heart 2020; 106:1202-1210. [PMID: 32444502 DOI: 10.1136/heartjnl-2020-316540] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/04/2020] [Accepted: 03/15/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiac paraganglioma (PGL) is a rare neuroendocrine tumour causing significant morbidity primarily due to norepinephrine secretion potentially causing severe hypertension, palpitations, lethal tachyarrhythmias, stroke and syncope. Cardiologists are faced with two clinical scenarios. The first is the elevated norepinephrine, whose actions must be properly counteracted by adrenoceptor blockade to avoid catastrophic consequences. The second is to evaluate the precise location of a cardiac PGL and its spread since compression of cardiovascular structures may result in ischaemia, angina, non-noradrenergic-induced arrhythmia, cardiac dysfunction or failure. Thus, appropriate assessment of elevated norepinephrine by its metabolite normetanephrine is a gold biochemical standard at present. Furthermore, dedicated cardiac CT, MRI and transthoracic echocardiogram are necessary for the precise anatomic information of cardiac PGL. Moreover, a cardiologist needs to be aware of advanced functional imaging using 68Ga-DOTA(0)-Tyr(3)-octreotide positron emission tomography/CT, which offers the best cardiac PGL-specific diagnostic accuracy and helps to stage and rule out metastasis, determining the next therapeutic strategies. Patients should also undergo genetic testing, especially for mutations in genes encoding succinate dehydrogenase enzyme subunits that are most commonly present as a genetic cause of these tumours. Curative surgical resection after appropriate α-adrenoceptor and β-adrenoceptor blockade in norepinephrine-secreting tumours is the primary therapeutic strategy. Therefore, appropriate and up-to-date knowledge about early diagnosis and management of cardiac PGLs is paramount for optimal outcomes in patients where a cardiologist is an essential team member of a multidisciplinary team in its management.
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Affiliation(s)
- Sri Harsha Tella
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Abhishek Jha
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - David Taïeb
- Biophysics and Nuclear Medicine, La Timone University Hospital, European Center for Research in Medical Imaging, Aix-Marseille University, Marseille, France
| | - Keith A Horvath
- Clinical Transformation, Association of American Medical Colleges, Washington, District of Columbia, USA
| | - Karel Pacak
- Section on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
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26
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Morganti S, Bertani E, Bocci V, Colandrea M, Collamati F, Cremonesi M, De Simoni M, Ferrari E, Fischetti M, Funicelli L, Grana CM, Mancini-Terracciano C, Mirabelli R, Papi S, Pisa E, Solfaroli-Camillocci E, Traini G, Faccini R. Tumor-non-tumor discrimination by a β - detector for Radio Guided Surgery on ex-vivo neuroendocrine tumors samples. Phys Med 2020; 72:96-102. [PMID: 32247965 DOI: 10.1016/j.ejmp.2020.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 01/06/2023] Open
Abstract
This paper provides a first insight of the potential of the β- Radio Guided Surgery (β--RGS) in a complex surgical environment like the abdomen, where multiple sources of background concur to the signal at the tumor site. This case is well reproduced by ex-vivo samples of 90Y-marked Gastro-Entero-Pancreatic Neuroendocrine Tumors (GEP NET) in the bowel. These specimens indeed include at least three wide independent sources of background associated to three anatomical districts (mesentery, intestine, mucose). The study is based on the analysis of 37 lesions found on 5 samples belonging to 5 different patients. We show that the use of electrons, a short range particle, instead of γ particles, allows to limit counts read on a lesion to the sum of the tumor signal plus the background generated by the sole hosting district.The background on adjacent districts in the same specimen/patient is found to differ up to a factor 4, showing how the specificity and sensitivity of the β--RGS technique can be fully exploited only upon a correct measurement of the contributing background. This locality has been used to set a site-specific cut-off algorithm to discriminate tumor and healthy tissue with a specificity of 100% and a sensitivity, on this test data sample, close to 100%. Factors influencing the sensitivity are also discussed. One of the specimens set allowed us evaluate the volume of the lesions, thus concluding that the probe was able to detect lesions as small as 0.04 mL in that particular case.
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Affiliation(s)
- S Morganti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy
| | - E Bertani
- Division of Digestive Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - V Bocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy
| | - M Colandrea
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - F Collamati
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy.
| | - M Cremonesi
- Radiation Research Unit, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M De Simoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
| | - E Ferrari
- Division of Medical Physics, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - M Fischetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy
| | - L Funicelli
- Division of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C M Grana
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Mancini-Terracciano
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
| | - R Mirabelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy; Dipartimento Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy; Museo Storico della Fisica e Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - S Papi
- Division of Nuclear Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Pisa
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - E Solfaroli-Camillocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Scuola di Specializzazione in Fisica Medica, Sapienza Università di Roma, Rome, Italy
| | - G Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy; Dipartimento Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Rome, Italy; Museo Storico della Fisica e Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - R Faccini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Rome, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Rome, Italy
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27
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(Radio)Theranostic Patient Management in Oncology Exemplified by Neuroendocrine Neoplasms, Prostate Cancer, and Breast Cancer. Pharmaceuticals (Basel) 2020; 13:ph13030039. [PMID: 32151049 PMCID: PMC7151671 DOI: 10.3390/ph13030039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 12/18/2022] Open
Abstract
The role of nuclear medicine in the management of oncological patients has expanded during last two decades. The number of radiopharmaceuticals contributing to the realization of theranostics/radiotheranostics in the context of personalized medicine is increasing. This review is focused on the examples of targeted (radio)pharmaceuticals for the imaging and therapy of neuroendocrine neoplasms (NENs), prostate cancer, and breast cancer. These examples strongly demonstrate the tendency of nuclear medicine development towards personalized medicine.
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28
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Collamati F, Maccora D, Alfieri S, Bocci V, Cartoni A, Collarino A, Simoni MD, Fischetti M, Fratoddi I, Giordano A, Mancini-Terracciano C, Mirabelli R, Morganti S, Quero G, Rotili D, Scotognella T, Solfaroli Camillocci E, Traini G, Venditti I, Faccini R. Radioguided surgery with β - radiation in pancreatic Neuroendocrine Tumors: a feasibility study. Sci Rep 2020; 10:4015. [PMID: 32132632 PMCID: PMC7055212 DOI: 10.1038/s41598-020-61075-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/13/2020] [Indexed: 01/06/2023] Open
Abstract
The possibility to use β- decaying isotopes for radioguided surgery (RGS) has been recently proposed, and first promising tests on ex-vivo samples of Meningioma and intestinal Neuroendocrine Tumor (NET) have been published. This paper reports a study of the uptake of 68Ga-DOTATOC in pancreatic NETs (pNETs) in order to assess the feasibility of a new RGS approach using 90Y-DOTATOC. Tumor and healthy pancreas uptakes were estimated from 68Ga-DOTATOC PET/CT scans of 30 patients with pNETs. From the obtained SUVs (Standardised Uptake Value) and TNRs (Tumor Non tumor Ratio), an analysis algorithm relying on a Monte Carlo simulation of the detector has been applied to evaluate the performances of the proposed technique. Almost all considered patients resulted to be compatible with the application of β--RGS assuming to administer 1.5 MBq/kg of activity of 90Y-DOTATOC 24 h before surgery, and a sampling time of few seconds. In just 2 cases the technique would have required a mildly increased amount of activity or of sampling time. Despite a high physiological uptake of 68Ga-DOTATOC in the healthy pancreas, the proposed RGS technique promises to be effective. This approach allows RGS to find application also in pancreatic diseases, where traditional techniques are not viable.
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Affiliation(s)
| | - Daria Maccora
- Nuclear Medicine Unit, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit CRMPG, A. Gemelli Hospital IRCCS of Rome, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Valerio Bocci
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
| | - Antonella Cartoni
- Chemistry Dep of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Micol De Simoni
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Marta Fischetti
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- SBAI Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Ilaria Fratoddi
- Chemistry Dep of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Alessandro Giordano
- Nuclear Medicine Unit, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Carlo Mancini-Terracciano
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy.
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy.
| | - Riccardo Mirabelli
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
- Centro Studi e Ricerche E. Fermi, Rome, Italy
| | | | - Giuseppe Quero
- Digestive Surgery Unit CRMPG, A. Gemelli Hospital IRCCS of Rome, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy
| | - Dante Rotili
- Department of Chemistry and Technologies of Drugs of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Teresa Scotognella
- Nuclear Medicine Unit, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Elena Solfaroli Camillocci
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
- Specialty School of Medical Physics of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
| | - Giacomo Traini
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
- Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - Iole Venditti
- Sciences Dep. of "Roma Tre" University, Viale G. Marconi 446, 00146, Rome, Italy
| | - Riccardo Faccini
- INFN Sec. of Rome, P.le A. Moro 2, 00185, Rome, Italy
- Physics Dep. of "Sapienza" University, P.le A. Moro 2, 00185, Rome, Italy
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29
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Ambrosini V, Fanti S. Radioguided surgery with 68Ga-DOTATATE for patients with neuroendocrine tumors. Hepatobiliary Surg Nutr 2020; 9:67-69. [PMID: 32140481 DOI: 10.21037/hbsn.2019.06.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Valentina Ambrosini
- Nuclear Medicine, DIMES, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, DIMES, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
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30
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RAYO-MADRID JI, MARTÍNEZ-ESTEVE A, INFANTE DE LA TORRE JR, JIMÉNEZ-GRANERO P, COBO-RODRIGUEZ A, SERRANO-VICENTE J. Cirugía radioguiada de paratiroides. REVISTA ORL 2019. [DOI: 10.14201/orl.21693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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31
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Collamati F, Moretti R, Alunni-Solestizi L, Bocci V, Cartoni A, Collarino A, De Simoni M, Faccini R, Fischetti M, Giordano A, Maccora D, Mancini-Terracciano C, Mirabelli R, Scotognella T, Solfaroli-Camillocci E, Traini G, Morganti S. Characterisation of a β detector on positron emitters for medical applications. Phys Med 2019; 67:85-90. [PMID: 31704391 DOI: 10.1016/j.ejmp.2019.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/02/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Radio Guided Surgery (RGS) is a technique that helps the surgeon to achieve an as complete as possible tumor resection, thanks to the intraoperative detection of particles emitted by a radio tracer that bounds to tumoral cells. In the last years, a novel approach to this technique has been proposed that, exploiting β- emitting radio tracers, overtakes some limitations of established γ-RGS. In this context, a first prototype of an intraoperative β particle detector, based on a high light yield and low density organic scintillator, has been developed and characterised on pure β- emitters, like 90Y. The demonstrated very high efficiency to β- particles, together with the remarkable transparency to photons, suggested the possibility to use this detector also with β+ emitting sources, that have plenty of applications in nuclear medicine. In this paper, we present upgrades and optimisations performed to the detector to reveal such particles. METHODS Laboratory measurement have been performed on liquid Ga68 source, and were used to validate and tune a Monte Carlo simulation. RESULTS The upgraded detector has an ~80% efficiency to electrons above ~110keV, reaching a plateau value of ~95%. At the same time, the probe is substantially transparent to photons below ~200keV, reaching a plateau value of ~3%. CONCLUSIONS The new prototype seems to have promising characteristics to perform RGS also with β+ emitting isotopes.
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Affiliation(s)
- F Collamati
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - R Moretti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
| | - L Alunni-Solestizi
- Istituto Nazionale di Fisica Nucleare, Sezione di Perugia, Perugia, Italy
| | - V Bocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
| | - A Cartoni
- Dipartimento di Chimica, Sapienza Università di Roma, Roma, Italy
| | - A Collarino
- Unità di Medicina Nucleare, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, Roma, Italy
| | - M De Simoni
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
| | - R Faccini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy
| | - M Fischetti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento Scienze di Base e Applicate per l'Ingegneria, Sapienza Università di Roma, Roma, Italy
| | - A Giordano
- Unità di Medicina Nucleare, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, Roma, Italy; Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Roma, Italy
| | - D Maccora
- Unità di Medicina Nucleare, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, Roma, Italy; Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Roma, Italy
| | | | - R Mirabelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy; Museo Storico della Fisica e Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - T Scotognella
- Unità di Medicina Nucleare, Fondazione Policlinico Gemelli IRCCS, L.go A. Gemelli 8, Roma, Italy
| | - E Solfaroli-Camillocci
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy; Scuola di Specializzazione in Fisica Medica, Sapienza Università di Roma, Roma, Italy.
| | - G Traini
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy; Dipartimento di Fisica, Sapienza Università di Roma, Roma, Italy; Museo Storico della Fisica e Centro Studi e Ricerche E. Fermi, Rome, Italy
| | - S Morganti
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, Roma, Italy
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32
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Abstract
Since Felix Fränkel's account of pheochromocytoma in 1886, great discoveries and vast advancements in the diagnosis, genetics, anatomical and functional imaging techniques, and surgical management of pheochromcytoma and paraganglioma (P-PGL) have been made. The improved insight in the pathophysiology of P-PGL and more accurate detection methods enable physicians to tailor the treatment plan to an individual based on the genetic profile and tumor behavior. This review will cover briefly the clinical features, diagnosis, genetic mutations, and imaging modalities that are used to guide current surgical management of these rare and interesting endocrinopathies.
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Affiliation(s)
- Douglas Wiseman
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mustapha El Lakis
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Naris Nilubol
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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33
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Ivanidze J, Roytman M, Sasson A, Skafida M, Fahey TJ, Osborne JR, Dutruel SP. Molecular imaging and therapy of somatostatin receptor positive tumors. Clin Imaging 2019; 56:146-154. [PMID: 31121520 DOI: 10.1016/j.clinimag.2019.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/13/2019] [Indexed: 01/28/2023]
Abstract
Somatostatin receptors (SSTR) are upregulated in the cells of origin that define numerous neuroendocrine neoplasms. PET imaging with 68Ga-DOTATATE allows specific targeting of SSTR2A, a single species of SSTR receptor, which is commonly overexpressed in a variety of gastroenteropancreatic neuroendocrine tumors, as well as pulmonary carcinoid and head and neck tumors. Due to more specific targeting of SSTR2 as well as lower radiation dose, shorter study length, ability to quantify uptake, and lower cost, 68Ga-DOTATATE has demonstrated superior imaging attributes when compared to 111In-pentetreotide. As with any novel imaging modality, dedicated training, increasing experience and staying up-to-date with scientific publications are required to provide optimal patient care. The purpose of this review is to summarize the current state of the art in SSTR-targeted molecular imaging and discuss ongoing and future potential diagnostic and therapeutic applications.
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Affiliation(s)
- Jana Ivanidze
- New York-Presbyterian Hospital/Weill Cornell Medical Center, United States of America
| | - Michelle Roytman
- New York-Presbyterian Hospital/Weill Cornell Medical Center, United States of America
| | | | - Myrto Skafida
- New York-Presbyterian Hospital/Weill Cornell Medical Center, United States of America
| | - Thomas J Fahey
- New York-Presbyterian Hospital/Weill Cornell Medical Center, United States of America
| | - Joseph R Osborne
- New York-Presbyterian Hospital/Weill Cornell Medical Center, United States of America
| | - Silvina P Dutruel
- New York-Presbyterian Hospital/Weill Cornell Medical Center, United States of America.
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