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Corti F, Rossi RE, Cafaro P, Passarella G, Turla A, Pusceddu S, Coppa J, Oldani S, Guidi A, Longarini R, Cortinovis DL. Emerging Treatment Options for Neuroendocrine Neoplasms of Unknown Primary Origin: Current Evidence and Future Perspectives. Cancers (Basel) 2024; 16:2025. [PMID: 38893145 PMCID: PMC11171242 DOI: 10.3390/cancers16112025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Among neuroendocrine neoplasms (NENs), a non-negligible proportion (9-22%) is represented by sufferers of NENs of unknown primary origin (UPO), a poor prognostic group with largely unmet clinical needs. In the absence of standard therapeutic algorithms, current guidelines suggest that the treatment of UPO-NENs should be based on tumor clinical-pathological characteristics, disease burden, and patient conditions. Chemotherapy represents the backbone for the treatment of high-grade poorly differentiated UPO-NENs, usually providing deep but short-lasting responses. Conversely, the spectrum of available systemic therapy options for well-differentiated UPO-NENs may range from somatostatin analogs in indolent low-grade tumors, to peptide receptor radioligand therapy, tyrosine kinase inhibitors (TKIs), or chemotherapy for more aggressive tumors or in case of high disease burden. In recent years, molecular profiling has provided deep insights into the molecular landscape of UPO-NENs, with both diagnostic and therapeutic implications. Although preliminary, interesting activity data have been provided about upfront chemoimmunotherapy, the use of immune checkpoint inhibitors (ICIs), and the combination of ICIs plus TKIs in this setting. Here, we review the literature from the last 30 years to examine the available evidence about the treatment of UPO-NENs, with a particular focus on future perspectives, including the expanding scenario of targeted agents in this setting.
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Affiliation(s)
- Francesca Corti
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Pietro Cafaro
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Gaia Passarella
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Antonella Turla
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Sara Pusceddu
- Gastro-Entero-Pancreatic and Neuroendocrine Unit 1, Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (S.P.); (S.O.)
| | - Jorgelina Coppa
- Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy;
| | - Simone Oldani
- Gastro-Entero-Pancreatic and Neuroendocrine Unit 1, Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (S.P.); (S.O.)
| | - Alessandro Guidi
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Raffaella Longarini
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Diego Luigi Cortinovis
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
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Shao L, Zhang H, He W, Wu J, Zhu D, Cheng H. Advanced gastric cancer with metachronous intracranial oligometastases without recurrence after multidisciplinary team discussion and comprehensive treatment: a case report. Front Oncol 2023; 13:1268199. [PMID: 38023261 PMCID: PMC10656673 DOI: 10.3389/fonc.2023.1268199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
This article describes the process of multidisciplinary team (MDT) discussion and comprehensive treatment of a case of advanced gastric cancer that tested positive for programmed death ligand 1 (PD-L1). During diagnosis, the patient presented with advanced gastric cancer and numerous unresectable metastases in the lesser omental lymph nodes, both lungs, liver, and left parietal occipital lobe. A meeting was arranged for the departments of oncology, gastrointestinal surgery, radiotherapy, imaging, and pathology to discuss the case. Initially, the patient had a partial response to the first-line treatment, which was a combination of pembrolizumab and chemotherapy. However, after nineteen months, the patient presented with a metachronous isolated lesion in the left frontal lobe. After mutual agreement among the oncology, brain surgery, gastrointestinal surgery, radiotherapy, imaging, and pathology departments, the intracranial lesion underwent resection. Following this, the operation was supplemented by stereotactic radiation therapy (SRT) and whole-brain radiation therapy (WBRT). The patient showed excellent signs of recovery after the operation, and her general condition remained favorable after 16 months of follow-up. Nonetheless, the outlook for patients facing advanced-stage gastric cancer remains distressing. Through multidisciplinary team (MDT) discussions, patients diagnosed with advanced gastric cancer can receive standardized diagnostic and treatment approaches to develop reasonable and personalized comprehensive treatment plans. Such plans help to improve the quality of life of patients and effectively prolong their survival time.
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Affiliation(s)
- Lijuan Shao
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine Prevention and Treatment of Tumor, Nanjing, China
| | - Hongyu Zhang
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wenting He
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jun Wu
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Danxia Zhu
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Haibo Cheng
- The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine Prevention and Treatment of Tumor, Nanjing, China
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Becht R, Kiełbowski K, Żychowska J, Dembowska W, Król M, Birkenfeld B, Owsiak M, Lewandowska M, Kubrak J, Amernik K. Small cell carcinoma with neuroendocrine differentiation of subglottic larynx- a case report. Front Oncol 2023; 13:1222418. [PMID: 37817765 PMCID: PMC10560848 DOI: 10.3389/fonc.2023.1222418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/25/2023] [Indexed: 10/12/2023] Open
Abstract
Small cell cancer (SCC) is a neuroendocrine neoplasm, which is most frequently found in the lungs. Extrapulmonary location of SCC is rare and may involve 2.5-5% of SCCs. We present a case of a 31-year-old male patient with an extremely uncommon subglottic SCC. The patient was qualified for a radical sequential chemoradiotherapy. After treatment, patient's condition suggested complete remission. Recurrence was detected one year later, and the disease rapidly progressed, despite a second line chemotherapy. The patient died 29 months after initial diagnosis. This case aims to raise awareness on the aggressive laryngeal SCC and its good response to first line chemotherapy composed of cisplatin and etoposide, followed by radiotherapy.
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Affiliation(s)
- Rafał Becht
- Department of Clinical Oncology, Chemotherapy and Cancer Immunotherapy, Pomeranian Medical University, Szczecin, Poland
| | - Kajetan Kiełbowski
- Department of Clinical Oncology, Chemotherapy and Cancer Immunotherapy, Pomeranian Medical University, Szczecin, Poland
| | - Justyna Żychowska
- Department of Clinical Oncology, Chemotherapy and Cancer Immunotherapy, Pomeranian Medical University, Szczecin, Poland
| | - Wiktoria Dembowska
- Department of Clinical Oncology, Chemotherapy and Cancer Immunotherapy, Pomeranian Medical University, Szczecin, Poland
| | - Małgorzata Król
- Department of Clinical Oncology, Chemotherapy and Cancer Immunotherapy, Pomeranian Medical University, Szczecin, Poland
| | - Bożena Birkenfeld
- Department of Nuclear Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Mateusz Owsiak
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland
| | | | - Jadwiga Kubrak
- Department of Clinical Radiotherapy, West Pomeranian Oncology Center, Szczecin, Poland
| | - Katarzyna Amernik
- Department of Adult and Children Otolaryngology and Otolaryngological Oncology, Pomeranian Medical University, Szczecin, Poland
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Iqbal MS, Matthews S, Chambers A, Kelly C, Ahmed O, Adams J. Small cell neuroendocrine carcinoma of the alveolar process of maxilla. Oral Oncol 2018; 86:308-311. [PMID: 30297229 DOI: 10.1016/j.oraloncology.2018.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022]
MESH Headings
- Adult
- Alveolar Process/diagnostic imaging
- Alveolar Process/pathology
- Alveolar Process/surgery
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/therapy
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/pathology
- Carcinoma, Small Cell/therapy
- Chemotherapy, Adjuvant
- Fatal Outcome
- Female
- Humans
- Maxilla/diagnostic imaging
- Maxilla/pathology
- Maxilla/surgery
- Maxillary Neoplasms/diagnosis
- Maxillary Neoplasms/pathology
- Maxillary Neoplasms/therapy
- Maxillary Osteotomy
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Radiotherapy, Adjuvant
- Treatment Outcome
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Affiliation(s)
- Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Sarah Matthews
- Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anne Chambers
- Department of Pathology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Omar Ahmed
- Department of Plastic Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - James Adams
- Department of Maxillofacial Surgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Noonan C, James M. A case of isolated small cell carcinoma of the brain. Acta Oncol 2017; 56:1133-1135. [PMID: 28562202 DOI: 10.1080/0284186x.2017.1290273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Noonan
- Department of Oncology, Canterbury District Health Board, Christchurch, New Zealand
| | - M. James
- Department of Oncology, Canterbury District Health Board, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
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6
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Kim SB. Primary Hepatic Small-Cell Carcinoma Developed during Antiviral Treatment for Chronic Hepatitis B. Case Rep Gastroenterol 2016; 9:375-80. [PMID: 26951743 PMCID: PMC4777963 DOI: 10.1159/000442462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Previously reported cases of primary hepatic small-cell carcinoma were all detected at progressed state with associated symptoms. Therefore, the natural course of primary hepatic small-cell carcinoma remains unknown. This case shows the natural course of primary hepatic small-cell carcinoma. We detected a 1.2 cm hypodense nodule 6 months ago in a patient with cirrhosis who had been taking entecavir. It was suspected to be a regenerating or degenerating nodule. Three months later, liver computed tomography (CT) revealed that the mass was increased to 2.1 cm with the same characteristics. The patient wanted to do a follow-up CT scan after 3 months instead of a biopsy. Another 3 months later, the mass was markedly increased, involving the whole left lobe and was confirmed as small-cell carcinoma on biopsy. Here, we report the first case of primary hepatic small-cell carcinoma developed during treatment for chronic hepatitis B with cirrhosis.
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Affiliation(s)
- Suk Bae Kim
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, South Korea
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Oda E, Hashimoto D, Shiomi Y, Ohnishi K, Hayashi H, Chikamoto A, Takeya M, Baba H. A case of occult intrahepatic cholangiocarcinoma diagnosed by autopsy. Surg Case Rep 2016; 1:101. [PMID: 26943425 PMCID: PMC4605921 DOI: 10.1186/s40792-015-0106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/06/2015] [Indexed: 11/25/2022] Open
Abstract
Cancer of unknown primary is associated with unknown biology and dismal prognosis. The most common primary sites of cancer of unknown primary were usually the lungs in autopsy studies, and intrahepatic cholangiocarcinoma is rare. We describe the case of a 57-year-old male patient with systemic lymph node metastasis. Imaging examination failed to reveal primary cancer; however, immunostaining of cytokeratins 7, 19, and 20 of a metastatic axillary lymph node suggested a pancreaticobiliary cancer as a primary lesion. He died of liver abscess and sepsis, and then, autopsy indicated occult intrahepatic cholangiocarcinoma. We discuss the clinical course of this rare cholangiocarcinoma including the diagnostic procedure and also present a review of the English literature regarding patients with cancer of unknown primary.
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Affiliation(s)
- Eri Oda
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Daisuke Hashimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Yuko Shiomi
- Division of Surgical Pathology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan. .,Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Koji Ohnishi
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Motohiro Takeya
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Dai W, Liu M, Zhuang X, Li Q, Wang D. Mediastinal small cell carcinoma: a unique clinical entity? Clin Transl Oncol 2015; 18:515-20. [PMID: 26329297 DOI: 10.1007/s12094-015-1398-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/19/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Mediastinal small cell carcinoma (MSCC) is a rare tumor with limited published literature. In view of diagnostic confusion pertaining to this tumor, we investigated its origin, clinical features, management and survival. METHODS Clinical data of MSCC patients were retrospectively reviewed. Eligible patients showed pathologically proven small cell carcinoma (SCC) with the primary lesions confined to the mediastinum. Survival information was collected through follow-up studies. RESULTS Among 25 MSCC patients identified, 22 were classified to have limited disease (LD), while 3 were with extensive disease (ED). The 5 patients (20%) underwent surgery and 20 patients (80%) underwent non-surgical treatment. The 4 patients with LD MSCC received chemotherapy alone, while 13 of them received chemoradiotherapy. Overall median survival time (MST) of all patients was 22 months, and the 1-, 3- and 5-year overall survival rates were 67.4, 16.8, and 8.4%, respectively. The MST of LD and ED patients separately was 23 and 8 months, respectively, with significant difference (P = 0.005). But, the MST of patients who received surgical and non-surgical treatment was 25 and 21 months, respectively, with no significant difference (P = 0.757). The MST of LD patients receiving chemotherapy and chemoradiotherapy was 12 and 29 months, respectively, but somehow did not show significant difference (P = 0.482). CONCLUSIONS Our data suggested that MSCC may be a separate clinical entity like extrapulmonary small cell carcinomas (EPSCCs). Despite, multimodal treatment is currently the main treatment option, but for patients with LD MSCC, chemoradiotherapy is recommended to be preferred treatment modality.
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Affiliation(s)
- W Dai
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - M Liu
- Department of Thoracic Surgery, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - X Zhuang
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - Q Li
- Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, China
| | - D Wang
- Department of Thoracic Surgery, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100021, China.
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Small cell neuroendocrine carcinoma of larynx: case series and literature review. The Journal of Laryngology & Otology 2015; 129:910-5. [DOI: 10.1017/s0022215115001668] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Primary small cell neuroendocrine carcinoma of larynx is a rare, aggressive type of malignancy. As only about 200 cases worldwide have been reported, any larger institutional experience is valuable. This study reports our experience in managing this rare entity.Methods:Of the nine patients identified, three had metastatic cancer at the time of diagnosis. Four patients underwent radical treatment: one was managed surgically followed by adjuvant chemotherapy and consolidation radiotherapy; the remaining three were treated with neoadjuvant chemotherapy and definitive radiotherapy.Results:Of the 4 patients treated with radical intent, 1 was alive and disease free after 99 months, 2 died of metastatic disease after 22 and 26 months, and 1 was alive after 20 months with a diagnosis of recurrent disease.Conclusion:Our relatively small number of patients confirms other centres' experiences. This cancer has a poorer prognosis than most other head and neck cancers. Although the logistics would be challenging, there is a need for international multicentre trials for this disease modelled on those performed for other cancers, as has been done for paediatric malignancies.
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Joyce EA, Kavanagh J, Sheehy N, Beddy P, O'Keeffe SA. Imaging features of extrapulmonary small cell carcinoma. Clin Radiol 2013; 68:953-61. [PMID: 23790688 DOI: 10.1016/j.crad.2013.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 03/30/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
Small cell carcinoma accounts for approximately 20% of lung cancers; however, it rarely occurs at other sites. Extrapulmonary small cell carcinoma (EPSCC) is notoriously aggressive with a strong propensity for both regional and distant spread. The majority of the literature on these uncommon tumours is from a clinicopathological viewpoint with a relative paucity of detail regarding the radiological findings. This review will focus on the imaging features of EPSCC in its predominant sites of origin: the gastrointestinal tract, genitourinary tract, head, neck, and breast. We will also discuss the role of positron-emission tomography (PET)/computed tomography (CT) in the staging of EPSCC.
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Affiliation(s)
- E A Joyce
- Department of Radiology, St James's Hospital and Trinity College Dublin, Dublin, Ireland.
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12
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Nakano K, Takahashi S, Yuasa T, Nishimura N, Mishima Y, Sakajiri S, Yokoyama M, Tsuyama N, Ishikawa Y, Hatake K. Feasibility and efficacy of combined cisplatin and irinotecan chemotherapy for poorly differentiated neuroendocrine carcinomas. Jpn J Clin Oncol 2012; 42:697-703. [PMID: 22701038 DOI: 10.1093/jjco/hys085] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE No standard treatment has been established for poorly differentiated neuroendocrine carcinoma; the usual recommended treatment is based on the strategy for small cell lung carcinoma. The aim of this study was to evaluate the response of poorly differentiated neuroendocrine carcinoma to the combination of irinotecan and cisplatin in one institution. METHODS We retrospectively reviewed 50 poorly differentiated neuroendocrine carcinoma patients treated from September 2005 to April 2011 in our institution. Patients were divided into two stages: limited disease or extensive disease. Forty-four patients received the combination chemotherapy of irinotecan and cisplatin, consisting of 4-week cycles of 60 mg/m(2) irinotecan on days 1, 8, 15 and 60 mg/m(2) cisplatin on day 1. RESULTS AND CONCLUSION Median age was 60 years. Median follow-up time was 11.4 months. Overall survival did not reach the median, and 1-year overall survival was 67%. The response rate was 50% (64% at first line), and progression-free survival was 4.8 months (7.3 months at first line). Grade 3-4 hematologic adverse events were seen in 29 patients (66%) and Grade 3-4 non-hematologic adverse events were seen in 20 patients (45%), but no patients died of adverse events. Multivariate analysis showed a statistically significant relationship with neuron-specific enolase elevation and poor overall survival (P= 0.016, hazard ratio 6.261, 95% confidence interval). The combination chemotherapy of irinotecan and cisplatin is moderately effective and feasible, and it should be considered as a treatment option for poorly differentiated neuroendocrine carcinoma.
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Affiliation(s)
- Kenji Nakano
- Department of Hematology and Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Tokyo, Japan
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Stoyianni A, Pentheroudakis G, Pavlidis N. Neuroendocrine carcinoma of unknown primary: a systematic review of the literature and a comparative study with other neuroendocrine tumors. Cancer Treat Rev 2011; 37:358-65. [PMID: 21481536 DOI: 10.1016/j.ctrv.2011.03.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 03/01/2011] [Accepted: 03/13/2011] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Neuroendocrine carcinomas of unknown primary (NCUP) represent a specific subset with relatively favorable prognosis. Data on biology, management and outcome of NCUP patients have not been systematically reviewed neither compared to those of neuroendocrine tumors of known primary. PATIENTS AND METHODS We systematically reviewed all publications studying neuroendocrine CUP patients and presented a single center retrospective patient series. In addition, we analyzed and specified the similarities and/or differences between NCUP and other neuroendocrine malignancies. RESULTS Five hundred patients with NCUP constituted a heterogeneous cohort in terms of histology, grade, anatomic site and tumor biology in published series and were managed mostly with platinum-based regimens. Among 294 patients with available outcome data, a median survival of 15.5 months (range 11.6-40) was observed. Comparative analysis with neuroendocrine solid tumors (NET) revealed that poorly-differentiated NCUP share an aggressive natural history and a dismal prognosis similar to high grade pulmonary and extrapulmonary neuroendocrine carcinomas (Large Cell Neuroendocrine bronchial Carcinomas, LCNEC and poorly differentiated gastroenteropancreatic tumors, GEP-NET). Well differentiated NCUP reveal a more indolent course with a survival range resembling that of typical and atypical pulmonary carcinoids, well differentiated gastrointestinal NETs and limited small cell lung carcinomas. CONCLUSION No evidence for distinct biology or outcome of NCUP patients emerged when histological grade was matched for known primary NETs. The high heterogeneity of the NCUP subgroup limits the potential for identification of reliable prognosticators and hinders development of novel targeted therapies.
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Cusack JC, Clark JW, Curley SA, Sahani DV, Zukerberg LR. Case records of the Massachusetts General Hospital: Case 3-2011: a 58-year-old woman with a mass in the liver. N Engl J Med 2011; 364:362-70. [PMID: 21268729 DOI: 10.1056/nejmcpc1000965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- James C Cusack
- Division of Surgical Oncology,the Department of Surgery, Massachusetts GeneralHospital, Boston, USA
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Small cell carcinoma originating from the cavernous sinus. Acta Neurochir (Wien) 2010; 152:493-500. [PMID: 19434364 DOI: 10.1007/s00701-009-0389-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We report a rare case of small cell carcinoma originating from the right cavernous sinus in a 55-year-old male. The patient had sudden onset of right abducens palsy following right oculomotor palsy. METHODS Post-contrast T1-weighted MRI revealed a mass lesion of 3-cm maximum size occupying the right cavernous sinus and extending to the right middle cranial fossa. After biopsy via the frontozygomatic approach, one radiosurgery treatment was followed by four cycles of chemotherapy (cisplatin together with VP-16 therapy), after which the lesion diminished dramatically in size. RESULTS Complete remission has currently been achieved. The patient recovered from the extraocular muscle paresis and returned to his previous work. Although it is considered possible that small cell carcinoma can occur wherever neuroendocrine cells exist, a lesion originating in the cranium is extremely rare. To the best of our knowledge, this is the first report of small cell carcinoma of intracranial origin.
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Walenkamp AME, Sonke GS, Sleijfer DT. Clinical and therapeutic aspects of extrapulmonary small cell carcinoma. Cancer Treat Rev 2008; 35:228-36. [PMID: 19068273 DOI: 10.1016/j.ctrv.2008.10.007] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 10/22/2008] [Accepted: 10/29/2008] [Indexed: 12/17/2022]
Abstract
Extrapulmonary small cell carcinoma (EPSCC) is usually treated similarly to small cell lung cancer. Differences in aetiology, clinical course, frequency of brain metastases, and survival, however, warrant a differential therapeutic approach. In this review, we focus on the treatment of the most predominant sites of origin of EPSCC; the gastrointestinal tract, the genitourinary tract, the head and neck region, and small cell carcinoma of unknown primary. Furthermore we review the available data concerning the controversial issue of prophylactic cranial irradiation (PCI) after optimal treatment of EPSCC. We found in the literature a significant lower incidence of brain metastases in EPSCC as compared to pulmonary small cell carcinoma when PCI is omitted and therefore we do not recommend PCI. An exception is EPSCC originating from the head and neck region which is associated with a higher incidence of brain metastasis, justifying addition of PCI.
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Affiliation(s)
- Annemiek M E Walenkamp
- Department of Medical Oncology, University Medical Centre Groningen and University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
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Hueser CN, Nguyen NC, Osman M, Havlioglu N, Patel AJ. Extrapulmonary small cell carcinoma: involvement of the brain without evidence of extracranial malignancy by serial PET/CT scans. World J Surg Oncol 2008; 6:102. [PMID: 18817561 PMCID: PMC2564932 DOI: 10.1186/1477-7819-6-102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 09/25/2008] [Indexed: 11/11/2022] Open
Abstract
Background Extrapulmonary small cell carcinoma (EPSCC) involving the brain is a rare manifestation of an uncommon tumor type. Case presentation We report a 59 year-old Caucasian female diagnosed with an EPSCC involving the left parietal lobe without detectable extracranial primary tumor followed by serial positron emission tomography/computed tomography (PET/CT) imaging. Histopathological examination at both initial presentation and recurrence revealed small cell carcinoma. Serial PET/CT scans of the entire body failed to reveal any extracranial [18F]2-fluoro-2-deoxy-D-glucose (FDG) avid lesions at either diagnosis or follow-up. Conclusion Chemotherapy may show a transient response in the treatment of EPSCC. Further studies are needed to help identify optimal treatment strategies. Combination PET/CT technology may be a useful tool to monitor EPSCC and assess for an occult primary malignancy.
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Affiliation(s)
- Christopher N Hueser
- Department of Internal Medicine, Division of Hematology and Oncology, St, Louis University Hospital, St Louis, MO 63110, USA.
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Ferlito A, Rinaldo A. Primary and secondary small cell neuroendocrine carcinoma of the larynx: A review. Head Neck 2008; 30:518-24. [DOI: 10.1002/hed.20797] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Shin DW, Choi MH, Park SS, Park SW, Kim KU, Jang AS, Park CS, Lim CW, Ko ES, Paik SH, Kim DJ. A Case of Extensive Stage Small Cell Lung Cancer Presenting as an Acute Appendicitis with Perforation. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.65.3.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Dong Won Shin
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Moon Han Choi
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Seung Sik Park
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Sung Woo Park
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Ki Up Kim
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - An Soo Jang
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Choon-Sik Park
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Cheol Wan Lim
- Department of Surgery, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Eun Suk Ko
- Department of Pathology, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Sang Hyun Paik
- Department of Radiology, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Do Jin Kim
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
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Cho SY, Kang SY, Lee JJ, Lim SJ, Lee WI. A Case of Small Cell Carcinoma of Unknown Primary. THE KOREAN JOURNAL OF HEMATOLOGY 2007. [DOI: 10.5045/kjh.2007.42.4.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sun Yong Cho
- Department of Laboratory Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - So Young Kang
- Department of Laboratory Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jae Jin Lee
- Department of Internal Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sung Jig Lim
- Department of Pathology, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| | - Woo In Lee
- Department of Laboratory Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
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