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Limbach KE, Mahuron KM, Scott AT, Ituarte PHG, Singh G. Liver-Directed Therapy in Neuroendocrine Neoplasms Metastatic to Both Liver and Bone. J Clin Med 2023; 12:7646. [PMID: 38137715 PMCID: PMC10744237 DOI: 10.3390/jcm12247646] [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: 10/19/2023] [Revised: 11/17/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Bone metastases from gastroenteropancreatic neuroendocrine neoplasms (GEPNENs) have been associated with poor prognosis, but it is unclear whether patients with concurrent bone metastases who receive liver-directed therapy (LDT) would derive survival benefit. The California Cancer Registry dataset, merged with data from the California Office of Statewide Health Planning and Development, was used to perform a retrospective study of GEPNENs metastatic to both liver and bone between 2000 and 2012. A total of 203 patients were identified. Of these, 14.8% underwent LDT after bone metastasis diagnosis, 22.1% received LDT prior to that diagnosis, and 63.1% never received LDT. The median overall survival from the time of bone metastasis diagnosis was significantly longer in those that received LDT after diagnosis when compared with those that never received LDT (p = 0.005) and was not significantly different from the median overall survival of those that had received LDT prior to diagnosis (p = 0.256). LDT may still be associated with improved survival even after a diagnosis of bone metastasis.
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Affiliation(s)
| | | | | | | | - Gagandeep Singh
- Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, USA; (K.E.L.); (K.M.M.); (A.T.S.); (P.H.G.I.)
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2
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Lacalle-González C, Estrella Santos A, Landaeta Kancev LC, Castellano VM, Macia Palafox E, Paniagua Ruíz A, Luna Tirado J, Martínez-Amores B, Martínez Dhier L, Lamarca A. Management of non-hepatic distant metastases in neuroendocrine neoplasms. Best Pract Res Clin Endocrinol Metab 2023; 37:101784. [PMID: 37270333 DOI: 10.1016/j.beem.2023.101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Neuroendocrine neoplasms represent an uncommon disease with an increasing incidence. Thanks to improvements in diagnostic and therapeutic methods, metastases previously considered uncommon, such as bone metastases, or even very rare, such as brain, orbital and cardiac metastases, are more frequently found in daily practice. Due to the great heterogeneity of these neoplasms, there is a lack of high-quality evidence on the management of patients with these types of metastases. The aim of this review is to provide the current state of the art, reviewing neuroendocrine neoplasm specific studies and useful information from other tumor types and to propose a treatment recommendation with algorithms to consider in daily clinical practice.
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Affiliation(s)
- C Lacalle-González
- Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - A Estrella Santos
- Department of Endocrinology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - L C Landaeta Kancev
- Deparment of Nuclear Medicine, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - V M Castellano
- Deparment of Pathology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - E Macia Palafox
- Deparment of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - A Paniagua Ruíz
- Department of Endocrinology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - J Luna Tirado
- Deparment of Radiation Oncology, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - B Martínez-Amores
- Medical Oncology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Spain.
| | - L Martínez Dhier
- Deparment of Nuclear Medicine, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
| | - A Lamarca
- Department of Medical Oncology, Fundación Jiménez Díaz University Hospital, Madrid, Spain; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Department of Medical Oncology, The Christie NHS Foundation, University of Manchester, Manchester, United Kingdom.
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3
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Lelièvre M, Triumbari EKA, Brixi H, Perrier M, Cadiot G, Deguelte S, Morland D. Bone metastases in midgut neuroendocrine tumors: imaging characteristics, distribution, and risk factors. Endocrine 2022; 78:380-386. [PMID: 36203032 DOI: 10.1007/s12020-022-03160-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Bone metastases (BM) affect 10-30% of patients with small intestine neuroendocrine tumors (siNET), but little descriptive data are available regarding their distribution throughout the skeleton or potential risk factors. Aim of the study is to better describe the imaging characteristics, distribution, and risk factors of siNET bone metastases using 18F-FDOPA PET/CT. METHODS All patients with well-differentiated siNET who underwent an 18F-DOPA PET/CT examination in our institution were retrospectively screened between October 2017 and February 2020. Location, SUVmax and CT density of each BM were collected. Sex, metabolic tumor volume (MTV) excluding bone, and metastatic sites other than bone were studied to determine risk factors of BM. RESULTS Among the 69 patients included, 11 patients (15.9%) presented BM on 18F-FDOPA (65 metastases). The most frequently involved sites were: thoracic spine, pelvic bones and ribs. About 64% of patients presented multiple BM. On coupled CT scan, 63% of BM were not visible. Using an optimal threshold of 19.2 ml, MTV was an independent predictor of BM (p = 0.004) with a derived sensitivity of 100% [65.0-100.0] and a specificity of 70.9% [57.7-81.2]. Hepatic metastatic involvement was also a significant predictor of BM (p = 0.044). CONCLUSION The development of BM in siNETs appears to be a late event, occurring in patients with a high tumor burden and hepatic involvement. They are often multiple and predominate in the axial skeleton.
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Affiliation(s)
- Maxime Lelièvre
- Service de Médecine Nucléaire, Institut Godinot, Reims, France
| | - Elizabeth Katherine Anna Triumbari
- Unità di Medicina Nucleare, TracerGLab, Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia
| | - Hedia Brixi
- Hépato-Gastroentérologie et Cancérologie digestive, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Marine Perrier
- Hépato-Gastroentérologie et Cancérologie digestive, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Guillaume Cadiot
- Hépato-Gastroentérologie et Cancérologie digestive, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Sophie Deguelte
- Chirurgie Générale, Digestive et Endocrinienne, Centre Hospitalier Universitaire de Reims, Reims, France
| | - David Morland
- Service de Médecine Nucléaire, Institut Godinot, Reims, France.
- Unità di Medicina Nucleare, TracerGLab, Dipartimento Diagnostica per Immagini, Radioterapia oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italia.
- Laboratoire de Biophysique, UFR de médecine, Université de Reims Champagne-Ardenne, Reims, France.
- CReSTIC (Centre de Recherche en Sciences et Technologies de l'Information et de la Communication), EA 3804, Université de Reims Champagne-Ardenne, Reims, France.
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4
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Pan Q, Yang W, Zhang Z, Shao Z. Rare Bone Metastasis of Neuroendocrine Tumors of Unknown Origin: A Case Report and Literature Review. Orthop Surg 2022; 14:2766-2775. [PMID: 35856167 PMCID: PMC9531072 DOI: 10.1111/os.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The neuroendocrine tumor (NET) is rare, accounting for about 0.5% of all tumors. NETs have the characteristics of metastasis, especially lymph nodes, liver, spleen, and bone. CASE PRESENTATION We report a 30-year-old man diagnosed with a NET with bone metastasis and presented with waist and leg pain. The imaging findings of this case showed multiple osteosclerosis and no apparent bone destruction. We collected the patient's previous examinations, including laboratory, imaging, and pathological examination to get a precise diagnosis. Given this case, we carried out symptomatic support treatment to relieve the patients' pain symptoms. CONCLUSION Bone metastases from NETs of unknown primary site are rare in both clinical and imaging manifestations. The disease is mainly manifested as multiple osteosclerosis, accompanied by muscle soreness and pain. It is recommended to try chemotherapy for this disorder.
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Affiliation(s)
- Qing Pan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenbo Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhicai Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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5
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Randhawa DS, Shoucair S, McCarron E. Silent and formidable foe: neuroendocrine tumours of the gallbladder. BMJ Case Rep 2020; 13:13/12/e237063. [PMID: 33370977 PMCID: PMC7757469 DOI: 10.1136/bcr-2020-237063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Neuroendocrine neoplasms of the gallbladder occur infrequently, with the diagnosis being incidental in most cases. We present a case of an 81-year-old African American woman who initially presented with acute suppurative cholecystitis, found on pathology to have a moderately differentiated infiltrating adenocarcinoma. A partial hepatic resection with periportal lymph node dissection was planned which was subsequently aborted intraoperatively due to the presence of diffuse carcinomatosis. Pathology of the cancerous lesions revealed neuroendocrine carcinoma. Gallbladder neuroendocrine tumours demonstrate no specific clinical features. Given its often late presentation, neuroendocrine tumours of the gallbladder pose a therapeutic and prognostic challenge.
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Affiliation(s)
| | - Sami Shoucair
- Department of Surgery, MedStar Health, Columbia, Maryland, USA
| | - Edward McCarron
- Department of Surgery, MedStar Health, Columbia, Maryland, USA
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6
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Altieri B, Di Dato C, Martini C, Sciammarella C, Di Sarno A, Colao A, Faggiano A. Bone Metastases in Neuroendocrine Neoplasms: From Pathogenesis to Clinical Management. Cancers (Basel) 2019; 11:cancers11091332. [PMID: 31500357 PMCID: PMC6770134 DOI: 10.3390/cancers11091332] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/28/2019] [Accepted: 09/05/2019] [Indexed: 12/20/2022] Open
Abstract
Bone represents a common site of metastases for several solid tumors. However, the ability of neuroendocrine neoplasms (NENs) to localize to bone has always been considered a rare and late event. Thanks to the improvement of therapeutic options, which results in longer survival, and of imaging techniques, particularly after the introduction of positron emission tomography (PET) with gallium peptides, the diagnosis of bone metastases (BMs) in NENs is increasing. The onset of BMs can be associated with severe skeletal complications that impair the patient’s quality of life. Moreover, BMs negatively affect the prognosis of NEN patients, bringing out the lack of curative treatment options for advanced NENs. The current knowledge on BMs in gastro-entero-pancreatic (GEP) and bronchopulmonary (BP) NENs is still scant and is derived from a few retrospective studies and case reports. This review aims to perform a critical analysis of the evidence regarding the role of BMs in GEP- and BP-NENs, focusing on the molecular mechanisms underlining the development of BMs, as well as clinical presentation, diagnosis, and treatment of BMs, in an attempt to provide suggestions that can be used in clinical practice.
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Affiliation(s)
- Barbara Altieri
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital, University of Wuerzburg, 97080 Wuerzburg, Germany.
| | - Carla Di Dato
- Department of Clinical Medicine, Bufalini Hospital, 47521 Cesena, Italy.
| | - Chiara Martini
- Clinica Medica 3, Department of Medicine, DIMED, University of Padova, 35128 Padova, Italy.
| | - Concetta Sciammarella
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, 37126 Verona, Italy.
| | | | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy.
| | - Antongiulio Faggiano
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy.
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7
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Karamzade-Ziarati N, Manafi-Farid R, Ataeinia B, Langsteger W, Pirich C, Mottaghy FM, Beheshti M. Molecular imaging of bone metastases using tumor-targeted tracers. 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 2019; 63:136-149. [PMID: 31315347 DOI: 10.23736/s1824-4785.19.03206-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bone metastasis is a disastrous manifestation of most malignancies, especially in breast, prostate and lung cancers. Since asymptomatic bone metastases are not uncommon, early detection, precise assessment, and localization of them are very important. Various imaging modalities have been employed in the setting of diagnosis of bone metastasis, from plain radiography and bone scintigraphy to SPECT, SPECT/CT, PET/CT, MRI. However, each modality showed its own limitation providing accurate diagnostic performance. In this regard, various tumor-targeted radiotracers have been introduced for molecular imaging of bone metastases using modern hybrid modalities. In this article we review the strength of different cancer-specific radiopharmaceuticals in the detection of bone metastases. As shown in the literature, among various tumor-targeted tracers, 68Ga DOTA-conjugated-peptides, 68Ga PSMA, 18F DOPA, 18F galacto-RGD integrin, 18F FDG, 11C/18F acetate, 11C/18F choline, 111In octreotide, 123/131I MIBG, 99mTc MIBI, and 201Tl have acceptable capabilities in detecting bone metastases depending on the cancer type. However, different study designs and gold standards among reviewed articles should be taken into consideration.
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Affiliation(s)
- Najme Karamzade-Ziarati
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Ataeinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Werner Langsteger
- PET-CT Center Linz, Department of Nuclear Medicine, Ordensklinikum, St. Vincent's Hospital, Linz, Austria
| | - Christian Pirich
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mohsen Beheshti
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria - .,Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany
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8
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Alexandraki KI, Pizanias M, Uri I, Thomas D, Page T, Kolomodi D, Low CS, Adesanya O, Tsoli M, Gross DJ, Randeva H, Srirajaskanthan R, Grozinsky-Glasberg S, Kaltsas G, Weickert MO. The prognosis and management of neuroendocrine neoplasms-related metastatic bone disease: lessons from clinical practice. Endocrine 2019; 64:690-701. [PMID: 30635793 DOI: 10.1007/s12020-019-01838-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/02/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To study the evolution and optimal management of metastatic bone disease (mBD) in patients with neuroendocrine neoplasms (NENs). METHODS Seventy-four patients were recruited from four NEN centers in this observational multicenter study. RESULTS Pancreas and small bowel were the most common primaries (30 and 27%, respectively). Almost all gastrointestinal (GI)-NENs were grades 1 and 2, whereas bronchopulmonary-thymic were atypical carcinoids. Thirty-two (43%) patients had synchronous metastatic bone disease (mBD) and three patients reported bone-specific symptoms; metachronous mBD developed at a median of 35 (range: 4-395) months. Thirty-six (86%) of patients with metachronous mBD had stage IV disease at diagnosis. Somatostatin receptor functional imaging and computed tomography were the modalities mostly used for mBD identification. Fifty-two patients received assessable bone-related therapy (bisphosphonates, denosumab, local radiotherapy, and radionuclide treatment). Improvement in mBD was seen in 5, stable disease in 22, and deterioration in 25 patients. The presence of synchronous mBD and the negative outcome of bone-related therapy negatively affected overall survival (OS). In the multivariate analysis, the stronger predictor of OS was the outcome of bone-related therapy (HR: 4.753; 95% CI: 1.589-14.213). Bisphosphonates therapy was the mostly used bone-specific treatment but its monthly administration did not affect OS. At last follow-up, 39 patients were alive with OS 50 (14-463) months. CONCLUSIONS Early investigation for mBD offers a prognostic marker of patients with NENs, since synchronous mBD has a negative impact on survival. The outcome of bone-related therapy affects OS but the monthly administration of bisphosphonates did not show a benefit over less intense schemes.
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Affiliation(s)
- Krystallenia I Alexandraki
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece.
| | - Michail Pizanias
- Institute of Liver Studies, King's College Hospital, London, SE5 9RS, UK
| | - Inbal Uri
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Dimitrios Thomas
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
| | - Tristan Page
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Denise Kolomodi
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
| | - Chen Sheng Low
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Olu Adesanya
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Marina Tsoli
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
| | - David J Gross
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Harpal Randeva
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Coventry University, Centre for Applied Biological & Exercise Science, Coventry, UK
- Clinical Sciences Research Laboratories, Division of Translational Medicine, Warwick Medical School, University Hospital, University of Warwick, CV4 7AL, Coventry, UK
| | | | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel
| | - Gregory Kaltsas
- Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Athens, 11527, Greece
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Martin O Weickert
- The ARDEN NET Centre, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
- Coventry University, Centre for Applied Biological & Exercise Science, Coventry, UK
- Clinical Sciences Research Laboratories, Division of Translational Medicine, Warwick Medical School, University Hospital, University of Warwick, CV4 7AL, Coventry, UK
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9
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Heinemann F, Guhlke S, Muckle M, Willinek W, Biersack HJ, Ahmadzadehfar H, Sabet A, Ezziddin S. Osseous metastases of gastro- entero - pancreatic neuroendocrine tumours. Nuklearmedizin 2017; 51:95-100. [DOI: 10.3413/nukmed-0428-11-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 01/10/2012] [Indexed: 12/30/2022]
Abstract
SummaryAim: Peptide receptor radionuclide therapy with 177Lu-octreotate is an effective treatment option for metastatic gastroenteropancreatic neuroendocrine tumors (GEP NET) and allows intratherapeutic imaging through a 177Lu-octreotate scan (LuS). The diagnostic value of this treatment scan is not yet established. This study aims to compare the sensitivity of LuS and bone scintigraphy (BS) regarding bone metastases and investigate potential implications of functional imaging results. Patients, methods: We retrospectively analyzed 29 consecutive GEP NET patients with bone metastases and baseline BS treated with 177Lu-octreotate. A semi-quantitative scoring system was used for the comparative evaluation. Treatment outcome (time-to-progression of bone metastases) was correlated with the intra-individual imaging discrepancy (Kaplan- Meyer curves, log-rank test, p < 0.05). Results: In 19 of 29 patients (65.5%) LuS was superior (LuS > BS), whereas in 10 patients (34.5%) both modalities were comparable. BS showed no additional (LuS-negative) metastatic bone lesions in our cohort. None of the investigated baseline characteristics was associated with Imaging discrepancy. On the other hand, functional imaging discrepancy had no impact on treatment response (p = 0.43) or time-to-progression (p = 0.92). Conclusions: Intra-therapeutic 177Lu-octreotate imaging is superior over bone scintigraphy for detection of bone metastases in GEP NET. BS may help to distinguish osseous from non-osseous localization. The presence of an osteoblastic correlate in BS seems to have no impact on therapeutic outcome
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10
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Inayat F, Daly KP, Askarian F, Saif MW. Small Bowel Neuroendocrine Tumors with Inguinal Metastases: A Diagnostic and Therapeutic Dilemma. Cureus 2016; 8:e692. [PMID: 27555990 PMCID: PMC4980210 DOI: 10.7759/cureus.692] [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] [Indexed: 11/05/2022] Open
Abstract
Small bowel neuroendocrine tumors (NETs) are frequently characterized by a strong propensity to metastasize to the liver, mesentery, and peritoneum. However, only a few extra-abdominal metastatic sites have been reported in the published literature. The present paper implicates that primary small bowel NETs may unusually metastasize to the inguinal lymph nodes. Furthermore, we discuss the formidable diagnostic and therapeutic challenges associated with the metastatic NETs.
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Affiliation(s)
- Faisal Inayat
- Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College
| | - Kevin P Daly
- Department of Radiology, Tufts Medical Center, Tufts University School of Medicine
| | - Farhad Askarian
- Department of Pathology, Tufts Medical Center, Tufts University School of Medicine
| | - Muhammad W Saif
- Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine
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11
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Croome KP, Burns JM, G Que F, Nagorney DM. Hepatic Resection for Metastatic Neuroendocrine Cancer in Patients with Bone Metastases. Ann Surg Oncol 2016; 23:3693-3698. [PMID: 27188296 DOI: 10.1245/s10434-016-5274-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hepatic resection (HR) of metastatic neuroendocrine cancer has been associated with prolonged survival and durable symptom control for selected patients with metastatic neuroendocrine tumor (NET). The present study investigates the outcomes of this operative approach in selected patients with known bone metastases. METHODS All patients undergoing HR at Mayo Clinic Rochester and Mayo Clinic Florida for metastatic NET between January 1989 and August 2015 were identified, and were divided into two groups: those undergoing HR with a known diagnosis of bone metastases (HRmNET/LB) and those who had metastatic disease confined to the liver (HRmNET/L). RESULTS A total of 25 patients in the HRmNET/LB group were propensity matched with 100 patients in the HRmNET/L group. Major liver resection was performed in 60 % of patients in the HRmNET/LB group and 55 % of patients in the HRmNET/L group (p = 0.42). Median survival for the HRmNET/LB group was 54.0 months, compared with 97.7 months for the HRmNET/L group (p = 0.03). In the HRmNET/LB group, median survival was 73.3 months for patients with gastrointestinal NET(GNET), compared with 42.7 months for patients with pancreatic NET (PNET). The median number of bone metastases was 2 (range 1-10), and the sites of bone metastases were the spine (68 %), pelvis (24 %), and ribs (12 %). Bone metastases were treated with radiotherapy in ten (40 %) patients, by radiofrequency ablation in two (8 %) patients, and by resection in one (4 %) patient. CONCLUSIONS The present study is the first report to describe HR for patients with metastatic NET and known bone metastases. We demonstrated that in properly selected cases, excellent survival can be achieved with liver debulking in these patients.
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Affiliation(s)
- Kristopher P Croome
- Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Justin M Burns
- Mayo Clinic Collaborative in Transplant Research and Outcomes, Department of Transplantation, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Florencia G Que
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - David M Nagorney
- Division of Subspecialty General Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
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12
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Van Loon K, Zhang L, Keiser J, Carrasco C, Glass K, Ramirez MT, Bobiak S, Nakakura EK, Venook AP, Shah MH, Bergsland EK. Bone metastases and skeletal-related events from neuroendocrine tumors. Endocr Connect 2015; 4:9-17. [PMID: 25430999 PMCID: PMC4285767 DOI: 10.1530/ec-14-0119] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Neuroendocrine tumors (NETs) metastasize to bone; however, a multi-institution evaluation of the natural history and complications of bone metastases across multiple NET subtypes has not, to our knowledge, previously been conducted. At two tertiary academic centers, we identified patients with bone metastases from databases of patients with a diagnosis of NET between 2004 and 2008. Detection of bone metastases, occurrence of skeletal-related events (SREs), and interventions were analyzed using summary statistics and categorical methods. Time-to-event data were assessed using Kaplan-Meier estimates and log-rank tests. Between 2004 and 2008, 82 out of 691 NET patients (12%) were reported to have bone metastases. Of the 82 patients with bone metastases, 55% were men and their median age was 49. Bone metastases occurred in 25% of pheochromocytomas and paragangliomas, 20% of high-grade neuroendocrine carcinomas, 9% of carcinoid tumors, and 8% of pancreatic NETs. At time of detection of bone metastases, 60% reported symptoms, including pain; 10% developed cord compression, 9% suffered a pathological fracture, and 4% developed hypercalcemia. Occurrence of SREs did not differ significantly with regard to tumor histology. Of patients with bone metastases, 67 (82%) received at least one form of bone-directed treatment, 50% received radiation, 45% received a bisphosphonate, 18% underwent surgery, 11% received (131)I-MIBG, 5% received denosumab, and 46% were treated with more than one treatment modality. Bone metastases occur in a substantial number of patients diagnosed with NETs. Patients are often symptomatic and many develop SREs. Given the recent therapeutic advances and increasing life expectancy of patients with NETs, development of guidelines for surveillance and clinical care of bone metastases from NETs is needed.
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Affiliation(s)
- Katherine Van Loon
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Li Zhang
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Jennifer Keiser
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Cendy Carrasco
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Katherine Glass
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Maria-Teresa Ramirez
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Sarah Bobiak
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Eric K Nakakura
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Alan P Venook
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Manisha H Shah
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
| | - Emily K Bergsland
- The UCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco, 1600 Divisadero Street, UCSF Box 1770, San Francisco, California 94143, USAThe Ohio State University Comprehensive Cancer CenterColumbus, Ohio 43210, USANational Comprehensive Cancer NetworkFort Washington, Pennsylvania 19034, USA
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Lecouvet FE, Talbot JN, Messiou C, Bourguet P, Liu Y, de Souza NM. Monitoring the response of bone metastases to treatment with Magnetic Resonance Imaging and nuclear medicine techniques: a review and position statement by the European Organisation for Research and Treatment of Cancer imaging group. Eur J Cancer 2014; 50:2519-31. [PMID: 25139492 DOI: 10.1016/j.ejca.2014.07.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 06/25/2014] [Accepted: 07/02/2014] [Indexed: 12/31/2022]
Abstract
Assessment of the response to treatment of metastases is crucial in daily oncological practice and clinical trials. For soft tissue metastases, this is done using computed tomography (CT), Magnetic Resonance Imaging (MRI) or Positron Emission Tomography (PET) using validated response evaluation criteria. Bone metastases, which frequently represent the only site of metastases, are an exception in response assessment systems, because of the nature of the fixed bony defects, their complexity, which ranges from sclerotic to osteolytic and because of the lack of sensitivity, specificity and spatial resolution of the previously available bone imaging methods, mainly bone scintigraphy. Techniques such as MRI and PET are able to detect the early infiltration of the bone marrow by cancer, and to quantify this infiltration using morphologic images, quantitative parameters and functional approaches. This paper highlights the most recent developments of MRI and PET, showing how they enable early detection of bone lesions and monitoring of their response. It reviews current knowledge, puts the different techniques into perspective, in terms of indications, strengths, weaknesses and complementarity, and finally proposes recommendations for the choice of the most adequate imaging technique.
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Affiliation(s)
- F E Lecouvet
- MRI Unit, Dept of Radiology, Centre du Cancer and Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
| | - J N Talbot
- Dept of Nuclear Medicine, Hôpital Tenon, AP-HP & Université Pierre et Marie Curie, Paris, France
| | - C Messiou
- Dept of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - P Bourguet
- Dept of Nuclear Medicine, Cancer Center Eugène Marquis and University of Rennes 1, Rennes, France
| | - Y Liu
- EORTC, TR, Radiotherapy and Imaging Department, EORTC Headquarters, Brussels, Belgium
| | - N M de Souza
- Dept of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom; MRI Unit, Institute of Cancer Research and Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
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Tewari A, Palaniswamy SS, Subramanyam P. Brain metastasis from neuroendocrine tumor of the gallbladder: a rare entity. South Asian J Cancer 2014; 2:120. [PMID: 24455579 PMCID: PMC3892519 DOI: 10.4103/2278-330x.114106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anshu Tewari
- Department of Nuclear Medicine and PET CT, Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | | | - Padma Subramanyam
- Department of Nuclear Medicine and PET CT, Amrita Institute of Medical Sciences, Cochin, Kerala, India
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Ayala-Ramirez M, Palmer JL, Hofmann MC, de la Cruz M, Moon BS, Waguespack SG, Habra MA, Jimenez C. Bone metastases and skeletal-related events in patients with malignant pheochromocytoma and sympathetic paraganglioma. J Clin Endocrinol Metab 2013; 98:1492-7. [PMID: 23436918 PMCID: PMC5393459 DOI: 10.1210/jc.2012-4231] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Bone metastases (BM) can cause severe pain, spinal cord compression, pathological fractures, and/or hypercalcemia. These skeletal-related events (SREs) may cause immobilization, loss of independence, poor quality of life, and reduced survival. There is limited information on the clinical effects of BM and SREs in patients with malignant pheochromocytoma or sympathetic paraganglioma (PHEO/sPGL). OBJECTIVES We studied the prevalence and clinical characteristics of BM and SREs in patients with PHEO/sPGL and investigated the risk factors for SRE development. DESIGN Using a large institutional database, we conducted a retrospective study of 128 patients with malignant PHEO/sPGL at The University of Texas MD Anderson Cancer Center from 1967 through 2011. RESULTS Of the patients, 91 (71%) had BM, and 57 of these (63%) developed metachronous BM at a median time of 3.4 years (range, 5 months to 23 years) after the primary tumor diagnosis. Metastatic disease was confined exclusively to the skeleton in 26 of 128 (20%) patients. Sufficient information to assess SRE occurrence was available for 67 patients, and 48 of 67 (72%) patients had at least 1 SRE. The median overall survival for the 128 patients was 12 years for patients with only BM, 7.5 years for patients with nonosseous metastases, and 5 years for patients with both BM and nonosseous metastases (log rank test P value = .005). We were unable to identify factors predictive of SRE development, but the occurrence of a first SRE was associated with the development of subsequent SREs in 48% of subjects. In responsive patients, the use of systemic therapy was associated with fewer SREs (P < .0001). CONCLUSIONS BM and SREs are frequent in patients with malignant PHEO/sPGL. SREs often develop shortly after the diagnosis of BM; severe pain is the most frequent SRE. These patients should be followed long-term by a multidisciplinary team to promptly identify the need for medical or surgical intervention.
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Affiliation(s)
- Montserrat Ayala-Ramirez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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Sisson JC, Yanik GA. Theranostics: evolution of the radiopharmaceutical meta-iodobenzylguanidine in endocrine tumors. Semin Nucl Med 2012; 42:171-84. [PMID: 22475426 DOI: 10.1053/j.semnuclmed.2011.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Since 1981, meta-iodobenzylguanidine (MIBG), labeled with (131)I and later (123)I, has become a valuable agent in the diagnosis and therapy of a number of endocrine tumors. Initially, the agent located pheochromocytomas and paragangliomas (PGLs), both sporadic and familial, in multiple anatomic sites; surgeons were thereby guided to excisional therapies, which were previously difficult and sometimes impossible. The specificity in diagnosis has remained above 95%, but sensitivity has varied with the nature of the tumor: close to 90% for intra-adrenal pheochromocytomas but 70% or less for PGLs. For patients with neuroblastoma, carcinoid tumors, and medullary thyroid carcinoma, imaging with radiolabeled MIBG portrays important diagnostic evidence, but for these neoplasms, use has been primarily as an adjunct to therapy. Although diagnosis by radiolabeled MIBG has been supplemented and sometimes surpassed by newer scintigraphic agents, searches by this radiopharmaceutical remain indispensable for optimal care of some patients. The radiation imparted by concentrations of (131)I-MIBG in malignant pheochromocytomas, PGLs, carcinoid tumors, and medullary thyroid carcinoma has reduced tumor volumes and lessened excretions of symptom-inflicting hormones, but its value as a therapeutic agent is being fulfilled primarily in attacks on neuroblastomas, which are scourges of children. Much promise has been found in tumor disappearance and prolonged survival of treated patients. The experiences with therapeutic (131)I-MIBG have led to development of new tactics and strategies and to well-founded hopes for elimination of cancers. Radiolabeled MIBG is an exemplar of theranostics and remains a worthy agent for both diagnosis and therapy of endocrine tumors.
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Affiliation(s)
- James C Sisson
- Division of Nuclear Medicine, Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48103-5028, USA.
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17
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HORI TAKESHI, YASUDA TAKETOSHI, SUZUKI KAYO, KANAMORI MASAHIKO, KIMURA TOMOATSU. Skeletal metastasis of carcinoid tumors: Two case reports and review of the literature. Oncol Lett 2012; 3:1105-1108. [PMID: 22783400 PMCID: PMC3389625 DOI: 10.3892/ol.2012.622] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 02/10/2012] [Indexed: 01/25/2023] Open
Abstract
Carcinoid tumors are neuroendocrine neoplasms derived from enterochromaffin cells. Skeletal metastases from carcinoid tumors are considered to be extremely rare. In this study, we present two cases of carcinoid tumors that metastasized to the bone. Furthermore, we review 50 published case reports and reveal the features of skeletal metastasis of carcinoid tumors. The first case involved a 59-year-old man with a history of multiple metastases of a lung carcinoid tumor. The patient complained of back pain and numbness in the lower limbs. Magnetic resonance imaging revealed metastases in the thoracic spine. A spinal decompression was performed and the symptoms were resolved. The second case involved a 74-year-old man had been diagnosed with a lung carcinoid tumor 15 years previously and complained of left thigh pain. A radiograph showed osteolytic lesions in the shaft of the left femur. We repaired the femur using an intramedullary nail following curettage of the tumor. A radiograph of the femur revealed a callus on the pathological fracture. The patient was able to walk using a crutch 3 months after surgery. We reviewed 50 cases that described skeletal metastasis from carcinoid tumors. The average age of the patients was 54.9 years and 33 patients (66%) were male. The most common site of skeletal metastasis was the spine. We also investigated the survival rate of patients who developed skeletal metastasis from carcinoid tumors. The findings showed that survival of patients who developed osteolytic skeletal metastasis was worse than that of patients who developed osteosclerotic skeletal metastasis.
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Affiliation(s)
- TAKESHI HORI
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - TAKETOSHI YASUDA
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - KAYO SUZUKI
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - MASAHIKO KANAMORI
- Department of Human Science, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - TOMOATSU KIMURA
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
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Delle Fave G, Kwekkeboom DJ, Van Cutsem E, Rindi G, Kos-Kudla B, Knigge U, Sasano H, Tomassetti P, Salazar R, Ruszniewski P. ENETS Consensus Guidelines for the management of patients with gastroduodenal neoplasms. Neuroendocrinology 2012; 95:74-87. [PMID: 22262004 DOI: 10.1159/000335595] [Citation(s) in RCA: 206] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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19
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Mezi S, Petrozza V, Schillaci O, La Torre V, Cimadon B, Leopizzi M, Orsi E, La Torre F. Neuroendocrine tumors of the gallbladder: a case report and review of the literature. J Med Case Rep 2011; 5:334. [PMID: 21801379 PMCID: PMC3169492 DOI: 10.1186/1752-1947-5-334] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 07/29/2011] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Primary gallbladder neuroendocrine tumors are extremely rare, representing 0.2% of all neuroendocrine tumors. The diagnosis is incidental in most cases. CASE PRESENTATION We describe the case of a 57-year-old Caucasian man who underwent laparoscopic cholecystectomy for the evaluation of a gallbladder polyp that had been incidentally detected by ultasonography. Histologically, his lesion was composed of monomorphic cells that contained small round nuclei and that were organized in small nodular, trabecular, and acinar structures. His cells were positive for chromogranin A and synaptophysin, and a diagnosis of "typical" carcinoid of the gallbladder was made. His post-operative computerized axial tomography, 111In-pentetreotide scintigraphy, and hormone-specific marker results were negative. He is disease-free 45 months after surgical treatment. CONCLUSIONS Characteristic pathological findings of the gallbladder neuroendocrine tumors predict the prognosis. Whereas classical carcinoids of the gallbladder only rarely have a metastatic or invasive phenotype, the "atypical" variants are more aggressive and are associated with a poorer prognosis. Given the difficulty in distinguishing between benign and malignant lesions in the pre-surgical setting, we tend to consider each polypoid-like lesion of the gallbladder to be a high-risk lesion if it is larger than 1 cm and, as a result, to emphasize the need for cholecystectomy in all cases, relying on the pathological and immunohistochemistry analyses for the final diagnosis.
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Affiliation(s)
- Silvia Mezi
- Department of Radiology, Oncology and Human Pathology, Division of Oncology B, "Sapienza" University of Rome, Rome, Italy.
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Bombardieri E, Giammarile F, Aktolun C, Baum RP, Bischof Delaloye A, Maffioli L, Moncayo R, Mortelmans L, Pepe G, Reske SN, Castellani MR, Chiti A. 131I/123I-metaiodobenzylguanidine (mIBG) scintigraphy: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging 2011; 37:2436-46. [PMID: 20644928 DOI: 10.1007/s00259-010-1545-7] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The aim of this document is to provide general information about mIBG scintigraphy in cancer patients. The guidelines describe the mIBG scintigraphy protocol currently used in clinical routine, but do not include all existing procedures for neuroendocrine tumours. The guidelines should therefore not be taken as exclusive of other nuclear medicine modalities that can be used to obtain comparable results. It is important to remember that the resources and facilities available for patient care may vary from one country to another and from one medical institution to another. The present guidelines have been prepared for nuclear medicine physicians and intend to offer assistance in optimizing the diagnostic information that can currently be obtained from mIBG scintigraphy. The corresponding guidelines of the Society of Nuclear Medicine (SNM) and the Dosimetry, Therapy and Paediatric Committee of the EANM have been taken into consideration, and partially integrated into this text. The same has been done with the most relevant literature on this topic, and the final result has been discussed within a group of distinguished experts.
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21
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Cakir M, Grossman A. The molecular pathogenesis and management of bronchial carcinoids. Expert Opin Ther Targets 2011; 15:457-91. [DOI: 10.1517/14728222.2011.555403] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Arnold PM, Floyd HE, Anderson KK, Newell KL. Surgical management of carcinoid tumors metastatic to the spine: Report of three cases. Clin Neurol Neurosurg 2010; 112:443-5. [PMID: 20207070 DOI: 10.1016/j.clineuro.2010.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 01/15/2010] [Accepted: 01/22/2010] [Indexed: 10/19/2022]
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Abstract
The gastrointestinal tract is the largest neuroendocrine system in the body. Carcinoid tumors are amine precursor uptake decarboxylase (APUD) omas that arise from enterochromaffin cells throughout the gut. These tumors secrete discrete bioactive substances producing characteristic immunohistochemical patterns. Most tumors are asymptomatic and detected at late stages. Hepatic metastases are commonly responsible for carcinoid syndrome. The small bowel is the most common location of carcinoids. Computed tomography scan and magnetic resonance imaging are useful in the detection of these tumors. The measurement of bioactive amines is the initial diagnostic test. Various treatment options, including somatostatin analogs, interferon, chemotherapy, surgery, hepatic artery chemoembolization, and surgery have emerged in the past two decades. However, the incidence and prevalence of carcinoid tumors has increased, while mean survival time has not changed significantly. The lack of standardized classification, federal support, and an incomplete understanding of the complications of this disease are some of the impediments to progress in treatment.
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Chua S, Gnanasegaran G, Cook GJ. Miscellaneous Cancers (Lung, Thyroid, Renal Cancer, Myeloma, and Neuroendocrine Tumors): Role of SPECT and PET in Imaging Bone Metastases. Semin Nucl Med 2009; 39:416-30. [DOI: 10.1053/j.semnuclmed.2009.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dujardin F, Beaussart P, de Muret A, Rosset P, Waynberger E, Mulleman D, de Pinieux G. Primary neuroendocrine tumor of the sacrum: case report and review of the literature. Skeletal Radiol 2009; 38:819-23. [PMID: 19360403 DOI: 10.1007/s00256-009-0693-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 03/20/2009] [Accepted: 03/23/2009] [Indexed: 02/02/2023]
Abstract
Primary carcinoid tumor (well-differentiated neuroendocrine tumor) of the bone involving the sacrum is extremely rare. We report the case of a 72-year-old man who presented with a 20-year history of intermittent low back pain and was found to have an intraosseous sacral mass on imaging. A needle biopsy revealed that this lesion was a well-differentiated neuroendocrine tumor. Workup did not show any primary tumor or other metastatic disease. There was no associated tailgut cyst or sacrococcygeal teratoma. The lesion was treated with radiation therapy because a surgical approach was rejected. The patient is free of metastatic disease after 28 years evolution of the lesion, retrospectively seen to be present on a conventional radiography performed in 1980. A review of the literature revealed 20 case reports of neuroendocrine tumors arising from the presacral region (with or without associated tailgut cyst or sacrococcygeal teratoma) and sometimes extending to the sacrum. One additional case was located within the neural canal and involved the sacrum, the presacral region, and the rectal wall. Our case is the only tumor arising primarily from the sacrum. The long evolution of this lesion without any other location makes metastatic disease very improbable and this case appears to be a unique example of primary intraosseous sacral carcinoid tumor.
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Affiliation(s)
- Fanny Dujardin
- Department of Pathology, Hôpital Trousseau, CHRU de Tours, 37042 Tours Cedex 09, France
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Han JY, Zhao JX, Kang JW, Wang Y. Diagnosis and treatment of colorectal carcinoid tumors with endoscopy: an analysis of 51 cases. Shijie Huaren Xiaohua Zazhi 2009; 17:950-953. [DOI: 10.11569/wcjd.v17.i9.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study endoscopic diagnosis and management of colorectal carcinoid tumors.
METHODS: Fifty one patients were certified by colonoscopy and pathology during April 1986 to August 2008. Morphologic characteristics, trans-endoscopic treatment and prognosis were documented for further analysis.
RESULTS: Male patients significantly outnumbered female patients with a ratio of 1.83. The average age was 53.0 ± 13.2 years. The most frequent occurrence location was rectum with almost 86.3 percents. Most carcinoid tumors, about 74.5%, were smaller than 1.0 cm in diameter. The classic characters were submucosal tumor with yellow color and rigid or tough texture, and always were lack of activities. There was metastasis of tumor when it was bigger than 2.0 cm, and there was no recurrence for smaller ones (≤ 1.0 cm) after EMR. Six patients had undergone endoscopic ultrasonic examination and it was very helpful for EMR.
CONCLUSION: Understanding the endoscopic characters of colorectal carcinoid tumors was helpful for correct diagnosis. Deep biopsy and EMR can help improve the correct diagnosis rate. EMR is safe and effective for carcinoid tumors with a diameter less than 1.0 cm.
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Kobashi Y, Shimizu H, Mouri K, Irei T, Oka M. Clinical usefulness of fluoro-2-deoxy-D-glucose PET in a case with multiple bone metastases of carcinoid tumor after ten years. Intern Med 2009; 48:1919-23. [PMID: 19881247 DOI: 10.2169/internalmedicine.48.2407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a peculiar case in an 80-year-old man with multiple bone metastases due to the recurrence of thymic carcinoid tumor after surgical resection and radiation therapy ten years earlier. He was admitted to our hospital with a complaint of lumbago. Fluoro-2-deoxy-D-glucose (FDG) PET was useful for recognition of multiple bone metastases due to the recurrence of thymic carcinoid tumor, while (201)Tl-whole body scintigraphy and by (99)mTc-methylene diphosphonate ((99)mTc-MDP) bone scintigraphy did not reveal the metastases. Finally, we performed a CT-guided bone biopsy from lumbar vertebra and could obtain the diagnosis of metastases of carcinoid tumor histologically. As evident in this case, it is important to consider the recurrence of carcinoid tumor even if a long time has passed after the surgical resection and radiation therapy; also FDG-PET may be a useful diagnostic imaging modality to detect metastases from thymic carcinoid tumor to other organs.
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Affiliation(s)
- Yoshihiro Kobashi
- Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki, Japan.
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Glaudemans A, Lam M, Veltman N, Dierckx R, Signore A. The Contribution Of Nuclear Medicine In The Diagnosis Of Bone Metastases. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/978-1-4020-9819-2_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
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Tanabe M, Akatsuka K, Umeda S, Shomori K, Taniura S, Okamoto H, Kamitani H, Watanabe T. Metastasis of carcinoid to the arch of the axis in a multiple endocrine neoplasia patient: a case report. Spine J 2008; 8:841-4. [PMID: 18037349 DOI: 10.1016/j.spinee.2007.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 04/19/2007] [Accepted: 06/26/2007] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Carcinoid tumors eventually metastasize to the spine, and epidural spinal cord compression is a relatively frequent neurologic complication of carcinoid. However, a case of multiple endocrine neoplasia type 1 (MEN1) presenting with spinal cord compression as a result of a metastatic carcinoid tumor has not been reported previously. PURPOSE To report an extremely rare case of MEN1 presenting with spinal cord compression by metastatic carcinoid tumor. STUDY DESIGN Case report. METHODS A 51-year-old man, with a past history of thymoma, insulinoma, and gastric carcinoid presented with neck pain. Neuroradiological examination revealed that a tumor around the arch of the axis compressed the spinal cord with osteoblastic changes. RESULTS After hemilaminectomy of the axis and removal of the tumor followed by irradiation, the patient returned to his previous job. Histological examination confirmed metastatic carcinoid tumor. CONCLUSIONS Spinal metastasis of carcinoid tumor occurred in a multiple endocrine neoplasia patient, and it is significant to note that carcinoid metastasis is one of differential diagnoses for osteoblastic lesions.
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Affiliation(s)
- Michiharu Tanabe
- Department of Neurosurgery, Gamma-Knife Center, Takashima Hospital, Yonago 6830826, Japan.
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Khan MU, Coleman RE. Diagnosis and therapy of carcinoid tumors—current state of the art and future directions. Nucl Med Biol 2008. [DOI: 10.1016/j.nucmedbio.2008.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Leboulleux S, Dromain C, Vataire AL, Malka D, Aupérin A, Lumbroso J, Duvillard P, Elias D, Hartl DM, De Baere T, Guigay J, Schlumberger M, Ducreux M, Baudin E. Prediction and diagnosis of bone metastases in well-differentiated gastro-entero-pancreatic endocrine cancer: a prospective comparison of whole body magnetic resonance imaging and somatostatin receptor scintigraphy. J Clin Endocrinol Metab 2008; 93:3021-8. [PMID: 18522978 DOI: 10.1210/jc.2008-0459] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
PURPOSE Our purpose was to compare the sensitivity of whole body (WB) magnetic resonance imaging (MRI) and somatostatin receptor scintigraphy (SRS) for the diagnosis of bone metastases (BMs) in patients with well-differentiated gastro-entero-pancreatic endocrine cancer (WD-GEP-EC) and to determine predictive factors of BM. PATIENTS AND METHODS WB-MRI and SRS were prospectively performed in 79 patients with bronchial (11), thymic (five), gastric (two), duodeno-pancreatic (24), ileal (26), colic (one), or unknown primary (10) WD-GEP-EC. RESULTS A total of 36 patients (46%) had 333 BMs involving 119 skeletal segments. WB-MRI and SRS were equally sensitive for detecting patients with BM (86 vs. 81%; P = 0.56), with 33% of the patients diagnosed with only one procedure. WB-MRI detected more BMs than SRS (80 vs. 57%; P = 0.017). Compared with SRS, WB-MRI detected more spine BMs (96 vs. 45%; P < 0.001) and tended to detect more pelvic and lower limb BMs (P = 0.054 and P = 0.06, respectively). Compared with WB-MRI, SRS detected more skull BMs (100 vs. 0%; P < 0.001) and tended to detect more rib BMs (P = 0.08). Sternal and upper-limb BMs were equally detected with WB-MRI and SRS (P = 0.32 and P = 0.46, respectively). Bone staging with SRS and spine MRI rather than WB-MRI would have detected 92% of the patients with BMs and 83% of all BMs. The extent of liver involvement and bronchial-thymic primary tumors were independent predictive factors for BM. CONCLUSIONS We recommend bone staging with SRS and spine MRI in all patients with bronchial-thymic or unknown primary WD-GEP-EC. In case of duodeno-pancreatic or ileal primary, bone imaging may be restricted to patients with liver metastases.
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Affiliation(s)
- S Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, 39 Rue Camille Desmoulins, 94805 Villejuif Cedex, France.
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Abstract
Gastric carcinoid tumors are uncommon, but their percentage among all gastric malignancies has increased to 1.8%. Although they are most often discovered incidentally during endoscopy, gastric carcinoids can present with abdominal pain, bleeding, or symptoms related to the secretion of bioactive substances, most commonly histamine. Gastric carcinoids originate from the foregut and are derived from histamine-containing enterochromaffin-like (ECL) cells. Type I gastric carcinoid, the most common, exhibits slow growth and benign behavior. It occurs within the setting of chronic atrophic gastritis with achlorhydria-induced hypergastrinemia. Gastrin acts directly on ECL cells to induce hyperplasia, dysplasia, and, eventually, neoplasia. Type II gastric carcinoid, the least common type, occurs in patients with gastrinoma-associated multiple endocrine neoplasia syndrome-type 1 (MEN-1). The overall survival is related more to the underlying MEN-1 syndrome than to the gastric carcinoid. Rodents readily develop gastric carcinoid tumors in response to hypergastrinemia. However, in humans, other factors in addition to hypergastrinemia, such as pernicious anemia or MEN-1, must be present, implying that a genetic predisposition is necessary for the development of these tumors. Type III or sporadic gastric carcinoids exhibit a more malignant behavior, with overall 5-year survival rates of less than 50% and normal serum gastrin concentrations. Treatment of all types of gastric carcinoids is predicated upon accurate classification and staging. Radiolabeled somatostatin analogues are superior to conventional radiologic imaging techniques in detecting both primary and metastatic lesions. Treatment of choice for localized disease is excision, either endoscopically or surgically. Antrectomy, by eliminating the trophic effect of gastrin, can be useful for select type I carcinoids. Long-acting somatostatin analogues are excellent palliative agents.
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Affiliation(s)
- Babs G Taal
- Department of Gastroenterology and Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands.
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FUJISHITA T, KISHIDA M, TAKI H, SHINODA C, MIYABAYASHI K, FUJISHITA M, MARUYAMA M, MIZUSHIMA Y, KOBAYASHI M. Detection of primary and metastatic lesions by [18F]fluoro-2-deoxy-D-glucose PET in a patient with thymic carcinoid. Respirology 2007; 12:928-30. [DOI: 10.1111/j.1440-1843.2007.01161.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gellissen J, Kapsimalakou S, Begum N, Krueger A, Stoeckelhuber BM, Lubienski A, Helmberger T. Bildgebungsverfahren bei neuroendokrinen und mesenchymalen Tumoren des Gastrointestinaltrakts. Visc Med 2007. [DOI: 10.1159/000102019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Scarsbrook AF, Ganeshan A, Statham J, Thakker RV, Weaver A, Talbot D, Boardman P, Bradley KM, Gleeson FV, Phillips RR. Anatomic and functional imaging of metastatic carcinoid tumors. Radiographics 2007; 27:455-77. [PMID: 17374863 DOI: 10.1148/rg.272065058] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Carcinoid tumors are a fascinating group of neuroendocrine neoplasms that develop either sporadically or as part of an inheritable syndrome. Many tumors arise in the bronchopulmonary or gastrointestinal tract, but a neuroendocrine tumor can arise in almost any organ. The tumors have varied malignant potential depending on the site of their origin, and the clinical manifestations often are nonspecific. Metastases may be present at the time of diagnosis, which often occurs at a late stage of the disease. Imaging plays a pivotal role in the localization and staging of neuroendocrine tumors and in monitoring the treatment response. Imaging is often challenging, and a combination of anatomic and functional techniques is usually required, depending on the tumor type and location. Techniques include ultrasonography, barium studies, endoscopy, computed tomography, magnetic resonance imaging, somatostatin receptor scintigraphy, iobenguane scintigraphy, and, in select cases, positron emission tomography. Coregistration of structural and functional images is often of incremental value for accurate localization of the primary tumor and any meta-static disease. Radiologists must understand the contribution of each imaging modality in the assessment of different neuroendocrine tumors. In addition, knowledge of the optimal technique for each radiologic and radionuclide imaging examination is essential. Familiarity with the protean imaging appearances of both primary and metastatic disease is essential for accurate staging, treatment monitoring, and surveillance. Finally, an understanding of the wide variety of treatment options for patients with carcinoid tumors is vital for optimal management.
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Affiliation(s)
- Andrew F Scarsbrook
- Department of Radiology, Churchill Hospital, Oxford Radcliffe Hospitals NHS Trust, Headington, Oxford, England, UK.
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Modlin IM, Latich I, Zikusoka M, Kidd M, Eick G, Chan AKC. Gastrointestinal carcinoids: the evolution of diagnostic strategies. J Clin Gastroenterol 2006; 40:572-82. [PMID: 16917396 DOI: 10.1097/00004836-200608000-00003] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Carcinoid tumors are rare, often insidious neoplasms arising from neuroendocrine cells. The majority arise in the gastrointestinal system, and are often incidentally found during investigation, although some may present as an emergency bleed or perforation. The prosaic symptoms of flushing, diarrhea, and sweating are often overlooked; thus, the diagnosis is usually much delayed and the tumor is advanced at presentation. This diagnostic delay renders effective management difficult and adversely affects outcome. This overview provides a current assessment of the evolution of the diagnostic techniques available to establish an accurate biochemical (5-hydroxyindole-3-acetic acid and chromogranin A) and topographic diagnosis (octreoscan, radio-labeled metaidobenzylguanidine, computerized tomography, magnetic resonance imaging, positron emission tomography, enteroclysis, endoscopic ultrasound, enteroscopy, capsule endoscopy, and angiography) of carcinoid tumors. The utility and shortcomings of the respective modalities available are evaluated. Although considerable advances have been made in establishing the diagnosis of carcinoid tumors and in defining the topography of metastatic disease, the major limitation is the inability to establish an early and timely diagnosis before the advent of metastatic disease.
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Affiliation(s)
- Irvin M Modlin
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
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38
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Niederhuber JE, Fojo T. Treatment of Metastatic Disease in Patients with Neuroendocrine Tumors. Surg Oncol Clin N Am 2006; 15:511-33, viii. [PMID: 16882495 DOI: 10.1016/j.soc.2006.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gastroenteropancreatic neuroendocrine tumors (GENTs) compromise a heterogeneous group of relatively uncommon neoplasms with a yearly incidence rate of 1.2 to 3.0 per 100,000 population. These tumors share numerous histologic and biologic features, allowing their consideration as a common entity. They are postulated to arise from neuroendocrine cells, but most are not from neural crest origin. Their predominant site of origin is the gastrointestinal tract, where most involve the small intestine and appendix, but are also found in the adrenal medulla, bronchopulmonary system, pancreas, thyroid, parathyroid, and paraganglia cells. A common feature is their often indolent course, but some tumors are poorly differentiated and behave aggressively. This article addresses the surgical management of endocrine malignancies and the treatment of metastatic disease in patients with neuroendocrine tumors.
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Affiliation(s)
- John E Niederhuber
- National Cancer Institute, 31 Center Drive, Room 11A48, Bethesda, MD 20892, USA.
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39
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Abstract
Gastro-intestinal carcinoids are slow growing tumors arising from enterochromaffin or Kulchitsky cells. Their clinical presentation depends on what combination of bioactive substances is secreted. Midgut carcinoid can present with the carcinoid syndrome in the presence of liver metastases. Its most typical clinical manifestations include cutaneous flushing and diarrhea. A nonspecific biochemical tumor marker for carcinoid tumors is serum chromogranin A and a specific marker for the carcinoid syndrome is the increased urinary excretion of 5-hydroxy indole acetic acid (5-HIAA). Localizing studies in carcinoid tumors/syndrome are: transabdominal ultrasonography (US), endoscopy, endoscopic US, videocapsule endoscopy, computerized tomography, magnetic resonance imaging, selective abdominal angiography, 111In-pentetreotide scintigraphy (and intraoperative radionuclide probe), 123I (131I)-metaiodobenzylguanidine (MIBG) scintigraphy, bone scintigraphy and 11C-5-HT positron emission tomography (PET). Therapies for carcinoid tumors/syndrome are: surgery, somatostatin analogs, interferon-alpha, radiotherapy, liver dearterialization, liver (chemo, or radio)-embolization, alcohol sclerotherapy of liver metastases, radiofrequency ablation of liver metastases, cryosurgery of liver metastases, occasionally liver transplantation, radiotherapy-coupled somatostatin analogs, 131I-MIBG and occasionally chemotherapy.
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40
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Jensen RT, Rindi G, Arnold R, Lopes JM, Brandi ML, Bechstein WO, Christ E, Taal BG, Knigge U, Ahlman H, Kwekkeboom DJ, O'Toole D. Well-differentiated duodenal tumor/carcinoma (excluding gastrinomas). Neuroendocrinology 2006; 84:165-72. [PMID: 17312376 DOI: 10.1159/000098008] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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41
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Plöckinger U, Wiedenmann B. Endocrine tumours of the gastrointestinal tract. Management of metastatic endocrine tumours. Best Pract Res Clin Gastroenterol 2005; 19:553-76. [PMID: 16183527 DOI: 10.1016/j.bpg.2005.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Gastroenteropancreatic tumours are rare. They compromise a heterogenous class of neoplasm. If there is no hypersecretion syndrome, symptoms may be uncharacteristic and thus diagnosis occurs rather late after the first manifestations of the disease. The most important prognostic parameters are histological classification, the localisation of the primary, the tumour size and stage at diagnosis, and the presence or absence of metachronous or synchronous neoplasia. The article will focus on the importance of each of these parameters for the various treatment options in patients with metastatic disease.
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Affiliation(s)
- U Plöckinger
- Interdisziplinäres Stoffwechsel-Centrum: Endokrinologie, Diabetes und Stoffwechsel, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Charité Universitätsmedizin Berlin, Campus-Virchow-Klinikum, Germany.
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42
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Banzo J, Abós MD, Prats E, Razola P, García S, Alonso V, Velilla J, García F, Ubieto MA, Tardín L. [Carcinoid tumor and bone metastases: diagnosis by somatostatin receptor scintigraphy]. ACTA ACUST UNITED AC 2005; 23:394-402. [PMID: 15625056 DOI: 10.1016/s0212-6982(04)72328-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study has been to retrospectively assess the usefulness of 111In-DTPAOC scintigraphy in the detection of bone metastases (BM) in patients diagnosed of carcinoid tumour (CaT). MATERIALS AND METHODS Between June 1995 and April 2003 78 111In-DTPAOC studies were consecutively performed in 58 patients, 31 females and 27 males, 28 to 73 years old, with a histological diagnosis of CaT. Moreover, whole body bone scans (BS) using 99mTc-MDP were performed in 13 of these patients. The patients were classified into three groups: Group A: Initial CaT staging (n = 23); Group B: CaT staging after surgery (n = 14); and Group C: Post-treatment CaT re-staging (n = 29). In this last group, 6 patients of group A and 2 patients of group B were included. In only 2 patients the diagnoses of bone metastases were established before the 111In-DTPAOC scan. RESULTS Twenty six (44.8 %9 of the 58 patients with CaT had metastatic disease: 15 patients with hepatic metastases, associated with BM in 4 of them, 10 patients with hepatic and extra-hepatic metastases, abdominal and/or thoracic, associated with BM in 4 and in one patient, the BMs were the only metastases detected. The global incidence of BM in patients diagnosed with CaT was 15.5 % (9/58), whereas the incidence of BM in patients with metastasic disease was 34.6 % (9/26). Significant differences (p = 0.0035) were found on the incidence of BM in patients with or without hepatic metastases. In 4 patients, BMs were detected during the initial staging (group A), whereas in 5 patients, BMs were detected during the post-treatment re-staging (group C). During diagnosis, 4 of the 9 patients with BM had bone pain. BM were multiples in 8 patients, affecting axial skeleton in 4 and axial and appendicular skeleton in 4. One patient had a diffuse infiltration of bone marrow. BS was positive in 8 of the 9 patients with BM. In these 8 patients with abnormal BS, 111In-DTPAOC scintigraphy provides similar information to the BS in one patient, shows a greater number of bone lesions in 3, whereas BS was superior in 5 patients. Four of the patients with BM died between 6 and 47 months after diagnosis (mean: 29.7 months). CONCLUSIONS BMs are preferably located on axial skeleton, can be asymptomatic and are associated with hepatic metastases. Although the 111In-DTPAOC scintigraphy is able to detect some BM earlier than BS, the information provided by both studies is complementary. In patients with CaT, any invasive therapy on the hepatic metastases make it necessary to exclude extrahepatic metastases, including bone ones, and the somatostatin receptor scintigraphy is the diagnostic method of choice.
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Affiliation(s)
- J Banzo
- Servicio de Medicina Nuclear, Hospital Clínico Universitario Lozano Blesa. Zaragoza.
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Abstract
Carcinoid tumors are neuroendocrine tumors derived from enterochromaffin cells, which are widely distributed in the body. They can originate from any location in the body, but they are traditionally described as originating from the foregut, midgut, and hindgut. Although the overall incidence of carcinoid tumors appears to have increased in the past decades, the prognosis for patients with metastatic carcinoid tumors has improved during the last decade. Due to longer survival times, complications, such as carcinoid heart disease, and new metastatic patterns, like skin and bone metastases, may become more important features of carcinoid disease. Therapy focused on these complications should be part of the management. Combining new diagnostic and treatment modalities in metastatic carcinoid patients may result in better quality of life and longer survival times. The increasing number of therapeutic options and diagnostic procedures requires a multidisciplinary approach, with decisions made in multidisciplinary meetings focused on "tailor-made" therapy based on patients' specific conditions. Because carcinoid tumors are uncommon, effort should be made to treat these patients in specialized centers and for these centers to join together in multicenter studies.
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Affiliation(s)
- Johanna M Zuetenhorst
- Department of Gastroenterology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Abstract
Gastrointestinal (GI) carcinoids are ill-understood, enigmatic malignancies, which, although slow growing compared with adenocarcinomas, can behave aggressively. Carcinoids are classified based on organ site and cell of origin and occur most frequently in the GI (67%) where they are most common in small intestine (25%), appendix (12%), and rectum (14%). Local manifestations--mass, bleeding, obstruction, or perforation--reflect invasion or tumor-induced fibrosis and often result in incidental detection at emergency surgery. Symptoms are protean (flushing, sweating, diarrhea, bronchospasm), usually misdiagnosed, and reflect secretion of diverse amines and peptides. Biochemical diagnosis is established by elevation of plasma chromogranin A (CgA), serotonin, or urinary 5-hydroxyindoleacetic acid (5-HIAA), while topographic localization is by Octreoscan, computerized axial tomography (CAT) scan, or endoscopy/ultrasound. Histological identification is confirmed by CgA and synaptophysin immunohistochemistry. Primary therapy is surgical excision to avert local manifestations and decrease hormone secretion. Hepatic metastases may be amenable to cytoreduction, radiofrequency ablation, embolization alone, or with cytotoxics. Hepatic transplantation may rarely be beneficial. Chemotherapy and radiotherapy have minimal efficacy and substantially decrease quality of life. Intravenously administered receptor-targeted radiolabeled somatostatin analogs are of use in disseminated disease. Local endoscopic excision for gastric (type I and II) and rectal carcinoids may be adequate. Somatostatin analogues provide the most effective symptomatic therapy, although interferon has some utility. Overall 5-year survival for carcinoids of the appendix is 98%, gastric (types I/II) is 81%, rectum is 87%, small intestinal is 60%, colonic carcinoids is 62%, and gastric type III/IV is 33%.
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Affiliation(s)
- Irvin M Modlin
- Gastric Pathobiology Research Group, GI Surgical Division, Yale University School of Medicine, New Haven, Connecticut 06520-8062, USA.
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Pasieka JL, McEwan AJB, Rorstad O. The palliative role of 131I-MIBG and 111In-octreotide therapy in patients with metastatic progressive neuroendocrine neoplasms. Surgery 2005; 136:1218-26. [PMID: 15657579 DOI: 10.1016/j.surg.2004.06.050] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Radiolabeled octreotide and metaiodobenzylguanidine (MIBG) have demonstrated limited antitumor effect on neuroendocrine neoplasms (NENs). The purpose of this study was to assess the palliative benefit of radionuclide therapy (RNT) in NENs. METHODS Since April 2001, RNT for progressive, nonsurgically resectable NENs was utilized. NENs that were MIBG positive received 131 I-MIBG therapy, whereas octreotide-only-positive neoplasms received 111 In-octreotide therapy. Symptomatic, quality of life (QoL), biochemical, and radiographic responses to RNT were evaluated. RESULTS Twenty-four patients had either MIBG or octreotide avid NENs. A mean (range) of 4 (1-7) 131 I-MIBG treatments were given to 13 patients over a duration of 18 months (6-42). The group consisted of 2 medullary thyroid cancer (MTC), and 2 foregut and 9 small-bowel carcinoids; 12 patients (92%) had symptomatic improvement. Stability of tumor size was confirmed in 6, regression in 2, and progression in 5. Biochemical responses were demonstrated in 2. Five (2-16) treatments of 111 In-octreotide was given to 11 patients over 17 months (6-40). There were 1 MTC, 1 insulinoma, 2 gastrinomas, and 3 small-bowel and 4 foregut carcinoids. Symptomatic benefit was seen in 6 (55%), biochemical response in 3. Tumor regression was seen in 1, stability in 5, and progression in 5. CONCLUSIONS Radionuclide therapy appears to offer good palliation to patients with progressive NENs.
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Affiliation(s)
- Janice L Pasieka
- Division of General Surgery, Department of Surgery, North Tower, University of Calgary and Tom Baker Cancer Center, 1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9
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Leondi A, Koutsikos J, Zerva C. Interpretation of the post-surgical Somatostatin Receptor Scintigram of a Primary Neuroendocrine Tumor of the Thymus: a case report and literature review. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2005; 2:7. [PMID: 15788105 PMCID: PMC1079925 DOI: 10.1186/1477-7800-2-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 03/23/2005] [Indexed: 11/17/2022]
Abstract
A case of a thymic neuroendocrine tumor and the interpretation problems in a post-surgical Somatostatin Receptor Scintigraphy are presented. In a 53-year-old man with superior vena cava obstruction syndrome an atypical carcinoid of the thymus (neuroendocrine carcinoma of intermediate grade 2), was found at surgery. During his first year of follow-up a Somatostatin Receptor Scintigraphy was recommended. An area of abnormal concentration of the radiopharmaceutical was revealed in the mediastinum at this time. A thorough understanding of the mechanisms of the radiopharmaceutical uptake and of the various clinical settings in which uptake can occur are essential for a proper evaluation of the scintigraphic findings and result in the optimal use of this valuable modality. The literature review provides an overview of this rare type of tumor and insight into the clinical significance of Somatostatin Receptor Scintigraphy.
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Affiliation(s)
- Anastasia Leondi
- Department of Nuclear Medicine, Alexandra University Hospital, Athens, Greece
| | - John Koutsikos
- Department of Nuclear Medicine, Alexandra University Hospital, Athens, Greece
| | - Cherry Zerva
- Department of Nuclear Medicine, Alexandra University Hospital, Athens, Greece
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Quigley AM, Buscombe JR, Shah T, Gnanasegaran G, Roberts D, Caplin ME, Hilson AJW. Intertumoural variability in functional imaging within patients suffering from neuroendocrine tumours. An observational, cross-sectional study. Neuroendocrinology 2005; 82:215-20. [PMID: 16601361 DOI: 10.1159/000092522] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 02/13/2006] [Indexed: 11/19/2022]
Abstract
(123)I mIBG (meta-iodobenzylguanidine) and (111)In pentetreotide scintigraphy imaging modalities are useful in demonstrating neuroendocrine tumours. Although (111)In pentetreotide is generally held to be a more superior imaging agent than (123)I mIBG for neuroendocrine tumours, we noted a differential uptake of the two agents by different tumour sites within individual patients. In some cases, the two tracers appeared to demonstrate different lesions within the same patient. The aim of this study wasto determine the positivity of the two imaging modalities, the degree of correlation between them and to highlight any clinically useful differences between the two modalities. (123)I mIBG and (111)In pentetreotide images of 149 consecutive, biopsy-proven or biochemically confirmed, neuroendocrine tumour patients were compared. All the patients underwent whole-body imaging and upper abdominal single-photon emission computed tomography (SPECT). The results of both types of imaging were compared, lesion by lesion, for each individual patient. The overall positivity rate for (111)In pentetreotide was 79%, and that for (123)I mIBG was 63%. When both agents were positive, the (111)In pentetreotide highlighted more lesions within the same patient in 33%, whilst the (123)I mIBG highlighted more lesions in 13%. In 12% of patients both agents were positive, but different lesions were seen with the two agents. (111)In pentetreotide has greater positivity than (123)I mIBG for imaging neuroendocrine tumours. However, the two modalities can highlight different tumour lesions, suggesting the presence of phenotypically diverse tumour populations within individual patients. These findings are likely to influence clinical management in the future.
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Bombardieri E, Aktolun C, Baum RP, Bishof-Delaloye A, Buscombe J, Chatal JF, Maffioli L, Moncayo R, Mortelmans L, Reske SN. 131I/123I-metaiodobenzylguanidine (MIBG) scintigraphy: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging 2004; 30:BP132-9. [PMID: 14989227 DOI: 10.1007/s00259-003-1357-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bombardieri E, Aktolun C, Baum RP, Bishof-Delaloye A, Buscombe J, Chatal JF, Maffioli L, Moncayo R, Mortelmans L, Reske SN. 111In-pentetreotide scintigraphy: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging 2004; 30:BP140-7. [PMID: 14989228 DOI: 10.1007/s00259-003-1358-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Oberg K, Kvols L, Caplin M, Delle Fave G, de Herder W, Rindi G, Ruszniewski P, Woltering EA, Wiedenmann B. Consensus report on the use of somatostatin analogs for the management of neuroendocrine tumors of the gastroenteropancreatic system. Ann Oncol 2004; 15:966-73. [PMID: 15151956 DOI: 10.1093/annonc/mdh216] [Citation(s) in RCA: 351] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This consensus report gives a detailed description of the use of somatostatin analogs in the management of neuroendocrine tumors of the gastroenteropancreatic system. As background information we have outlined critical aspects of the pathology, the use of tumor markers, a definition of functional and non-functional digestive neuroendocrine tumors, different imaging modalities, surgical considerations, liver embolization and the use of cytotoxic drugs as well as interferon. Included in the report is an overview of somatostatin, somatostatin analogs and its receptor expression in different neuroendocrine tumors. It will also define the binding affinities of different somatostatin analogs to the five different subtypes of somatostatin receptor. We compare the efficacy of octreotide and lanreotide in reducing diarrhea and flushing. Side-effects are described and we provide practical information on somatostatin analog treatment.
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Affiliation(s)
- K Oberg
- Department of Endocrine Oncology, University Hospital, Uppsala, Sweden.
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