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Zhang JZ, Li S, Zhu WH, Zhang DF. Microwave ablation combined with hepatectomy for treatment of neuroendocrine tumor liver metastases. World J Clin Cases 2021; 9:5064-5072. [PMID: 34307557 PMCID: PMC8283578 DOI: 10.12998/wjcc.v9.i19.5064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatectomy is the first choice for treating neuroendocrine tumor liver metastases. However, most patients with neuroendocrine tumor liver metastases are not suitable for hepatectomy. Ablation combined with hepatectomy can be an alternative to liver resection.
AIM To explore the clinical effect of microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases.
METHODS In this study, the data of patients who underwent microwave ablation combined with hepatectomy for the treatment of neuroendocrine tumor liver metastases from June 2015 to January 2018 were reviewed. Before the operation, the patients did not receive any treatment for liver neuroendocrine tumors. After a multidisciplinary expert group discussion, all patients were deemed unsuitable for liver resection. All patients were diagnosed with neuroendocrine tumors by pathology. The overall survival time and progression-free survival time were followed by telephone calls and outpatient visits after surgery.
RESULTS Eleven patients with neuroendocrine tumor liver metastases were treated by microwave ablation combined with hepatectomy between June 2015 and January 2018. The median number of liver metastatic nodules was 4 (range, 2 to 43). The median number of lesions resected was 1 (range, 1 to 18), and the median number of lesions ablated was 3 (range, 1 to 38). The mean operation time was 405.6 (± 39.4) min. The median intraoperative blood loss was 600 mL (range, 50 to 3000). Ten patients had a fever after surgery. The median duration of fever was 3 d (range, 0 to 21). Elevated bilirubin levels occurred in all patients after surgery. The median bilirubin on the first day after surgery was 28.5 (range, 10.7 to 98.9) µmol/L. One patient developed respiratory failure, renal insufficiency, and pneumonia after the operation. No patient died postoperatively during hospitalization. The mean overall survival time after surgery was 34.1 (± 3.7) mo, and the median progression-free survival time was 8 (range, 2 to 51) mo. One year after surgery, ten patients survived and five patients survived without progression. Three year after surgery, eight patients survived and two patients survived without progression.
CONCLUSION Microwave ablation combined with hepatectomy not only makes the patients obtain a survival rate similar to that of patients undergoing hepatectomy, but also has a low incidence of postoperative complications.
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Affiliation(s)
- Jin-Zhu Zhang
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Shu Li
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Wei-Hua Zhu
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Da-Fang Zhang
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing 100044, China
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Pan M, Yang Y, Teng T, Lu F, Chen Y, Huang H. Development and validation of a simple-to-use nomogram to predict liver metastasis in patients with pancreatic neuroendocrine neoplasms: a large cohort study. BMC Gastroenterol 2021; 21:101. [PMID: 33663420 PMCID: PMC7934499 DOI: 10.1186/s12876-021-01685-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
Background Liver metastasis is an important prognostic factor for pancreatic neuroendocrine neoplasms (pNENs), but the relationship between the clinical features of patients with pNEN and liver metastasis remains undetermined. The aim of this study was to establish and validate an easy-to-use nomogram to predict liver-metastasis in patients with pNEN. Methods We obtained the clinicopathologic data of 2960 patients with pancreatic neuroendocrine neoplasms from the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2016. Univariate and multivariate logistic regression were done to screen out independent influencing factors to establish the nomogram. The calibration plots and the area under the receiver operating characteristic curve (AUC) were used to evaluate the performance of nomogram. Decision curve analysis (DCA) was applied to compare the novel model with the conventional predictive methods. Results A total of 2960 patients with pancreatic neuroendocrine neoplasms were included in the study. Among these, 1974 patients were assigned to the training group and 986 patients to the validation group. Multivariate logistic regression identified, tumor size, grade, other site metastasis, T stage and N stage as independent risk factors. The calibration plot showed good discriminative ability in the training and validation groups, with C-indexes of 0.850 for the training cohort and 0.846 for the validation cohort. The AUC values were 0.850 (95% CI 0.830–0.869) and 0.839 (95% CI 0.812–0.866), respectively. The nomogram total points (NTP) had the potential to stratify patients into low risk, medium risk and high risk (P < 0.001). Finally, comparing the nomogram with traditional prediction methods, the DCA curve showed that the nomogram had better net benefit. Conclusions Our nomogram has a good ability to predict liver metastasis of pancreatic neuroendocrine neoplasms, and it can guide clinicians to provide suitable prevention and treatment measures for patients with medium- and high-risk liver metastasis. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01685-w.
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Affiliation(s)
- Maoen Pan
- Department of General Surgery, Fujian Medical University Union Hospital, No.29, Xinquan Road, Fuzhou, 350001, China
| | - Yuanyuan Yang
- Department of General Surgery, Fujian Medical University Union Hospital, No.29, Xinquan Road, Fuzhou, 350001, China
| | - Tianhong Teng
- Department of General Surgery, Fujian Medical University Union Hospital, No.29, Xinquan Road, Fuzhou, 350001, China
| | - Fengchun Lu
- Department of General Surgery, Fujian Medical University Union Hospital, No.29, Xinquan Road, Fuzhou, 350001, China
| | - Yanchan Chen
- Department of General Surgery, Fujian Medical University Union Hospital, No.29, Xinquan Road, Fuzhou, 350001, China
| | - Heguang Huang
- Department of General Surgery, Fujian Medical University Union Hospital, No.29, Xinquan Road, Fuzhou, 350001, China.
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3
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Nigri G, Petrucciani N, Debs T, Mangogna LM, Crovetto A, Moschetta G, Persechino R, Aurello P, Ramacciato G. Treatment options for PNET liver metastases: a systematic review. World J Surg Oncol 2018; 16:142. [PMID: 30007406 PMCID: PMC6046097 DOI: 10.1186/s12957-018-1446-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic neuroendocrine tumors (PNETs) are rare pancreatic neoplasms. About 40-80% of patients with PNET are metastatic at presentation, usually involving the liver (40-93%). Liver metastasis represents the most significant prognostic factor. The aim of this study is to present an up-to-date review of treatment options for patients with liver metastases from PNETs. METHODS A systematic literature search was performed using the PubMed database to identify all pertinent studies published up to May 2018. RESULTS The literature search evaluated all the therapeutic options for patients with liver metastases of PNETs, including surgical treatment, loco-regional therapies, and pharmacological treatment. All the different treatment options showed particular indications in different presentations of liver metastases of PNET. Surgery remains the only potentially curative therapeutic option in patients with PNETs and resectable liver metastases, even if relapse rates are high. Efficacy of medical treatment has increased with advances in targeted therapies, such as everolimus and sunitinib, and the introduction of radiolabeled somatostatin analogs. Several techniques for loco-regional control of metastases are available, including chemo- or radioembolization. CONCLUSIONS Treatment of patients with PNET metastases should be multidisciplinary and must be personalized according to the features of individual patients and tumors.
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Affiliation(s)
- Giuseppe Nigri
- Department of Medical and Surgical Science and Translational Medicine, St. Andrea Hospital Rome, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Niccolò Petrucciani
- Digestive Surgery, Hepatobiliopancreatic Surgery and Liver Transplantation, UPEC University, Henri Mondor Hospital, Creteil, France
| | - Tarek Debs
- Department of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Livia Maria Mangogna
- Department of Medical and Surgical Science and Translational Medicine, St. Andrea Hospital Rome, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Anna Crovetto
- Department of Medical and Surgical Science and Translational Medicine, St. Andrea Hospital Rome, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Giovanni Moschetta
- Department of Medical and Surgical Science and Translational Medicine, St. Andrea Hospital Rome, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Raffaello Persechino
- Department of Medical and Surgical Science and Translational Medicine, St. Andrea Hospital Rome, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Paolo Aurello
- Department of Medical and Surgical Science and Translational Medicine, St. Andrea Hospital Rome, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Giovanni Ramacciato
- Department of Medical and Surgical Science and Translational Medicine, St. Andrea Hospital Rome, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
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4
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Chiruvella A, Kooby DA. Surgical Management of Pancreatic Neuroendocrine Tumors. Surg Oncol Clin N Am 2016; 25:401-21. [DOI: 10.1016/j.soc.2015.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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5
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Gunawardane PTK, Grossman A. Phaeochromocytoma and Paraganglioma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:239-259. [PMID: 27888488 DOI: 10.1007/5584_2016_76] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Phaeochromocytomas and paragangliomas are relatively uncommon tumours which may be manifest in many ways, specifically as sustained or paroxysmal hypertension, episodes of palpitations, sweating, headache and anxiety, or increasingly as an incidental finding. Recent studies have shown that an increasing number are due to germline mutations. This review concentrates on the diagnosis, biochemistry and treatment of these fascinating tumours.
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Affiliation(s)
- P T Kavinga Gunawardane
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.,Ministry of Health, Colombo, Sri Lanka
| | - Ashley Grossman
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
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6
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Expert consensus for the management of advanced or metastatic pancreatic neuroendocrine and carcinoid tumors. Cancer Chemother Pharmacol 2014; 75:1099-114. [DOI: 10.1007/s00280-014-2642-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/24/2014] [Indexed: 02/04/2023]
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Abstract
Paragangliomas (PGLs) are rare vascular, neuroendocrine tumors of paraganglia, which are associated with either sympathetic tissue in adrenal (pheochromocytomas (PCCs)) and extraadrenal (sympathetic paraganglioma (sPGLs)) locations or parasympathetic tissue of the head and neck paragangliomas (HNPGLs). As HNPGLs are usually benign and most tumors grow slowly, a wait-and-scan policy is often advised. However, their location in the close proximity to cranial nerves and vasculature may result in considerable morbidity due to compression or infiltration of the adjacent structures, necessitating balanced decisions between a wait-and-see policy and active treatment. The main treatment options for HNPGL are surgery and radiotherapy. In contrast to HNPGLs, the majority of sPGL/PCCs produces catecholamines, in advanced cases resulting in typical symptoms and signs such as palpitations, headache, diaphoresis, and hypertension. The state-of-the-art diagnosis and localization of sPGL/PCCs are based on measurement of plasma and/or 24-h urinary excretion of (fractionated) metanephrines and methoxytyramine (MT). sPGL/PCCs can subsequently be localized by anatomical (computed tomography and/or magnetic resonance imaging) and functional imaging studies (123I-metaiodobenzylguanidine-scintigraphy, 111In-pentetreotide scintigraphy, or positron emission tomography with radiolabeled dopamine or dihydroxyphenylalanine). Although most PGL/PCCs are benign, factors such as genetic background, tumor size, tumor location, and high MT levels are associated with higher rates of metastatic disease. Surgery is the only curative treatment. Treatment options for patients with metastatic disease are limited. PGL/PCCs have a strong genetic background, with at least one-third of all cases linked with germline mutations in 11 susceptibility genes. As genetic testing becomes more widely available, the diagnosis of PGL/PCCs will be made earlier due to routine screening of at-risk patients. Early detection of a familial PGL allows early detection of potentially malignant PGLs and early surgical treatment, reducing the complication rates of this operation.
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Affiliation(s)
- Eleonora P Corssmit
- Department of EndocrinologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment and Division of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Romijn
- Department of EndocrinologyLeiden University Medical Center, PO Box 9600, 2300 RC Leiden, The NetherlandsDepartment and Division of MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Ito T, Igarashi H, Uehara H, Berna MJ, Jensen RT. Causes of death and prognostic factors in multiple endocrine neoplasia type 1: a prospective study: comparison of 106 MEN1/Zollinger-Ellison syndrome patients with 1613 literature MEN1 patients with or without pancreatic endocrine tumors. Medicine (Baltimore) 2013; 92:135-181. [PMID: 23645327 PMCID: PMC3727638 DOI: 10.1097/md.0b013e3182954af1] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Multiple endocrine neoplasia type 1 (MEN1) is classically characterized by the development of functional or nonfunctional hyperplasia or tumors in endocrine tissues (parathyroid, pancreas, pituitary, adrenal). Because effective treatments have been developed for the hormone excess state, which was a major cause of death in these patients in the past, coupled with the recognition that nonendocrine tumors increasingly develop late in the disease course, the natural history of the disease has changed. An understanding of the current causes of death is important to tailor treatment for these patients and to help identify prognostic factors; however, it is generally lacking.To add to our understanding, we conducted a detailed analysis of the causes of death and prognostic factors from a prospective long-term National Institutes of Health (NIH) study of 106 MEN1 patients with pancreatic endocrine tumors with Zollinger-Ellison syndrome (MEN1/ZES patients) and compared our results to those from the pooled literature data of 227 patients with MEN1 with pancreatic endocrine tumors (MEN1/PET patients) reported in case reports or small series, and to 1386 patients reported in large MEN1 literature series. In the NIH series over a mean follow-up of 24.5 years, 24 (23%) patients died (14 MEN1-related and 10 non-MEN1-related deaths). Comparing the causes of death with the results from the 227 patients in the pooled literature series, we found that no patients died of acute complications due to acid hypersecretion, and 8%-14% died of other hormone excess causes, which is similar to the results in 10 large MEN1 literature series published since 1995. In the 2 series (the NIH and pooled literature series), two-thirds of patients died from an MEN1-related cause and one-third from a non-MEN1-related cause, which agrees with the mean values reported in 10 large MEN1 series in the literature, although in the literature the causes of death varied widely. In the NIH and pooled literature series, the main causes of MEN1-related deaths were due to the malignant nature of the PETs, followed by the malignant nature of thymic carcinoid tumors. These results differ from the results of a number of the literature series, especially those reported before the 1990s. The causes of non-MEN1-related death for the 2 series, in decreasing frequency, were cardiovascular disease, other nonendocrine tumors > lung diseases, cerebrovascular diseases. The most frequent non-MEN1-related tumor deaths were colorectal, renal > lung > breast, oropharyngeal. Although both overall and disease-related survival are better than in the past (30-yr survival of NIH series: 82% overall, 88% disease-related), the mean age at death was 55 years, which is younger than expected for the general population.Detailed analysis of causes of death correlated with clinical, laboratory, and tumor characteristics of patients in the 2 series allowed identification of a number of prognostic factors. Poor prognostic factors included higher fasting gastrin levels, presence of other functional hormonal syndromes, need for >3 parathyroidectomies, presence of liver metastases or distant metastases, aggressive PET growth, large PETs, or the development of new lesions.The results of this study have helped define the causes of death of MEN1 patients at present, and have enabled us to identify a number of prognostic factors that should be helpful in tailoring treatment for these patients for both short- and long-term management, as well as in directing research efforts to better define the natural history of the disease and the most important factors determining long-term survival at present.
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Affiliation(s)
- Tetsuhide Ito
- From the Department of Medicine and Bioregulatory Science (TI, HI), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Digestive Diseases Branch (TI, HI, HU, MJB, RTJ), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; and Hôpital Kirchberg (MJB), Luxembourg, Luxembourg
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9
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Taner T, Atwell TD, Zhang L, Oberg TN, Harmsen WS, Slettedahl SW, Kendrick ML, Nagorney DM, Que FG. Adjunctive radiofrequency ablation of metastatic neuroendocrine cancer to the liver complements surgical resection. HPB (Oxford) 2013; 15:190-5. [PMID: 23374359 PMCID: PMC3572279 DOI: 10.1111/j.1477-2574.2012.00528.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Resection of liver metastases from neuroendocrine cancer (NEC) prolongs survival and provides durable symptom relief. Not all hepatic lesions are amenable to resection, particularly when there is multifocal involvement. In this study, it was hypothesized that ablation of concomitant non-resectable NEC liver metastases is safe and salvages patients who would not have been selected for cytoreductive surgery. METHODS Patients who underwent adjuvant ablation of NEC liver metastases between 1995 and 2008 were reviewed. NEC was classified by patient and tumour characteristics. Regression and Kaplan-Meier models were used to compare variables and generate survival curves. RESULTS Ninety-four patients underwent hepatic resection and intra-operative ablation of metastatic NEC. The median number of lesions ablated was 3, and median size was 1.4 cm. One abscess occurred at an ablation site. Local recurrence was detected in four patients (3.8%). Overall survival was 80% and 59% at 5 and 10 years. Age, gender, tumour type, grade, primary site and need for repeat ablation had no significant association with survival. The Ki67 proliferative index was a significant predictor of decreased survival. Symptom-free survival was 34% at 3 years and 16% at 5 years, independent of the tumour grade. CONCLUSION Concurrent ablation of NEC metastases to the liver not amenable to resection is safe and increases the candidacy of patients for cytoreductive surgery. Ablation performed intra-operatively and repeated post-operatively as needed provides significant symptom control regardless of the tumour grade.
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Affiliation(s)
- Timucin Taner
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Lizhi Zhang
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Trynda N. Oberg
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William S. Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Seth W. Slettedahl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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10
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Parenti G, Zampetti B, Rapizzi E, Ercolino T, Giachè V, Mannelli M. Updated and new perspectives on diagnosis, prognosis, and therapy of malignant pheochromocytoma/paraganglioma. JOURNAL OF ONCOLOGY 2012; 2012:872713. [PMID: 22851969 PMCID: PMC3407645 DOI: 10.1155/2012/872713] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 06/05/2012] [Indexed: 12/31/2022]
Abstract
Malignant pheochromocytomas/paragangliomas are rare tumors with a poor prognosis. Malignancy is diagnosed by the development of metastases as evidenced by recurrences in sites normally devoid of chromaffin tissue. Histopathological, biochemical, molecular and genetic markers offer only information on potential risk of metastatic spread. Large size, extraadrenal location, dopamine secretion, SDHB mutations, a PASS score higher than 6, a high Ki-67 index are indexes for potential malignancy. Metastases can be present at first diagnosis or occur years after primary surgery. Measurement of plasma and/or urinary metanephrine, normetanephrine and metoxytyramine are recommended for biochemical diagnosis. Anatomical and functional imaging using different radionuclides are necessary for localization of tumor and metastases. Metastatic pheochromocytomas/paragangliomas is incurable. When possible, surgical debulking of primary tumor is recommended as well as surgical or radiosurgical removal of metastases. I-131-MIBG radiotherapy is the treatment of choice although results are limited. Chemotherapy is reserved to more advanced disease stages. Recent genetic studies have highlighted the main pathways involved in pheochromocytomas/paragangliomas pathogenesis thus suggesting the use of targeted therapy which, nevertheless, has still to be validated. Large cooperative studies on tissue specimens and clinical trials in large cohorts of patients are necessary to achieve better therapeutic tools and improve patient prognosis.
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Affiliation(s)
- Gabriele Parenti
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Benedetta Zampetti
- Department of Clinical Pathophysiology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Elena Rapizzi
- Department of Clinical Pathophysiology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
- Istituto Toscano Tumori, Via Taddeo Alderotti 26N, 50139 Florence, Italy
| | - Tonino Ercolino
- Endocrinology Unit, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Valentino Giachè
- Department of Clinical Pathophysiology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Massimo Mannelli
- Department of Clinical Pathophysiology, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
- Istituto Toscano Tumori, Via Taddeo Alderotti 26N, 50139 Florence, Italy
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11
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Gaujoux S, Gonen M, Tang L, Klimstra D, Brennan MF, D’Angelica M, DeMatteo R, Allen PJ, Jarnagin W, Fong Y. Synchronous Resection of Primary and Liver Metastases for Neuroendocrine Tumors. Ann Surg Oncol 2012; 19:4270-7. [DOI: 10.1245/s10434-012-2462-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Indexed: 12/11/2022]
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12
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Tonelli F, Giudici F, Fratini G, Brandi ML. Pancreatic endocrine tumors in multiple endocrine neoplasia type 1 syndrome: review of literature. Endocr Pract 2012; 17 Suppl 3:33-40. [PMID: 21550956 DOI: 10.4158/ep10376.ra] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To analyze the surgical approach to multiple endocrine neoplasia type 1 (MEN 1)-related pancreatic endocrine tumors (PETs). METHODS We reviewed selected publications and our personal experience with MEN 1-associated PETs to delineate their general characteristics, current practice and controversies, preoperative imaging and intraoperative assessment, and appropriate therapeutic strategies including radical surgical procedures. RESULTS The penetrance of PETs in the setting of MEN 1 is similar to that of parathyroid tumors, even though hyperparathyroidism is usually the first manifestation of MEN 1 syndrome. In contrast with the sporadic counterparts, MEN 1-related PETs are characterized by an early onset, multiplicity of lesions, variable expression of the tumors, and propensity for malignant degeneration. Both the histologic type and the size of these tumors correlate with malignant potential. CONCLUSION The rationale for surgical considerations for these tumors is to curtail the malignant progression of the disease and to cure or aid in management of the associated biochemical syndromes. A surgical procedure is often the treatment of choice for PETs in patients with MEN 1. Monitoring of pancreatic peptides and use of diagnostic imaging allow an early pancreatic resection, in conjunction with prevention of metastatic PETs and improvement of long-term survival. Hepatic metastatic lesions can be successfully treated by surgical resection.
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Affiliation(s)
- Francesco Tonelli
- Department of Clinical Physiopathology, Surgical Unit, University of Florence Medical School, Viale G B Morgagni 85, Florence, Italy.
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13
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Schreiter NF, Nogami M, Steffen I, Pape UF, Hamm B, Brenner W, Röttgen R. Evaluation of the potential of PET-MRI fusion for detection of liver metastases in patients with neuroendocrine tumours. Eur Radiol 2011; 22:458-67. [DOI: 10.1007/s00330-011-2266-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/10/2011] [Accepted: 08/31/2011] [Indexed: 01/28/2023]
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14
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Jiang TY, Wang XL, Suo W, He QH, Xiao HY. Radiofrequency ablation technique eradicating palpebral margin neoplasm. Int J Ophthalmol 2011; 4:186-9. [PMID: 22553639 DOI: 10.3980/j.issn.2222-3959.2011.02.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 02/28/2011] [Indexed: 11/02/2022] Open
Abstract
AIM To report the study on radiofrequency ablation technique for eradication of palpebral margin neoplasm and its clinical effects. METHODS One hundred and six cases with the palpebral margin neoplasm were performed surgical removal with radiofrequency ablation technique. The 1-2 months postoperative follow-up was investigated and the lost cases were excluded from statistics. The continuing follow-up lasted about 6-16months. RESULTS One hundred cases underwent one treatment and 6 cases underwent two treatments. Six cases were missed. All the cases followed up healed well without pigmentation or scar left, nor eyelash loss or palpebral margin deformation. No case was recurrent. CONCLUSION Radiofrequency ablation has significant efficiency in eradicating the palpebral margin neoplasm.
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Affiliation(s)
- Tian-Yu Jiang
- Department of Physical Therapy, Chinese PLA General Hospital, Beijing, 100853, China
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15
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Gamblin TC, Christians K, Pappas SG. Radiofrequency ablation of neuroendocrine hepatic metastasis. Surg Oncol Clin N Am 2010; 20:273-9, vii-viii. [PMID: 21377583 DOI: 10.1016/j.soc.2010.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neuroendocrine cancer commonly metastasizes to the liver and often presents as unresectable disease. Liver resection or debulking most of the tumor provides a survival advantage for patients. Whether used alone or in combination with resection, radiofrequency ablation provides a unique tool to destroy metastases to the liver and spare hepatic parenchyma. Although randomized trials are lacking, retrospective series provide promising data to consider radiofrequency ablation in the management of hepatic neuroendocrine metastases.
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Affiliation(s)
- T Clark Gamblin
- Medical College of Wisconsin, Division of Surgical Oncology, 9200 West Wisconsin Avenue, Milwaukee, WI 53226-3596, USA.
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16
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Boleslawski E, Dharancy S, Truant S, Pruvot FR. Surgical management of liver metastases from gastrointestinal endocrine tumors. ACTA ACUST UNITED AC 2010; 34:274-82. [PMID: 20347242 DOI: 10.1016/j.gcb.2010.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 01/27/2010] [Accepted: 02/02/2010] [Indexed: 02/07/2023]
Abstract
Liver metastases from endocrine tumors can reduce 5-year survival from 90% to 40% and, in cases of functional gastrointestinal endocrine tumors, lead to a carcinoid syndrome. Complete resection of cancerous disease should be considered in all cases. Indeed, after hepatectomy, prolonged survival (41-86% at five years) can be achieved, with low rates of surgery-related mortality (0-6.7%). Extended liver resection is required in most cases. Percutaneous portal embolization increases the volumetric feasibility of resection, and sequential hepatectomy techniques enable a two-stage resection of both bilobar metastases and the primary tumor. For carcinoid syndrome that does not respond to medical therapy, incomplete resection of liver metastases, by reducing tumor volume, may be indicated to reduce symptoms and halt the progression of carcinoid heart disease. In cases of non-resectable liver metastases in selected patients, liver transplantation can lead to 5-year survival rates as high as 77%.
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Affiliation(s)
- E Boleslawski
- Service de Chirurgie Digestive et de Transplantation, Hôpital Huriez, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France.
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