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Gordon S, Chan DLH, Bernard EJ, Eslick ME, Willowson KP, Roach PJ, Engel AF, Maher R, Clarke SJ, Agarwal V, Yasmin L, De Silva M, Mascall S, Conner A, Nevell D, Pavlakis N, Bailey DL. Single-centre experience with peptide receptor radionuclide therapy for neuroendocrine tumours (NETs): results using a theranostic molecular imaging-guided approach. J Cancer Res Clin Oncol 2023; 149:7717-7728. [PMID: 37004598 PMCID: PMC10374703 DOI: 10.1007/s00432-023-04706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 04/04/2023]
Abstract
AIM To summarise our centre's experience managing patients with neuroendocrine tumours (NETs) in the first 5 years after the introduction of peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-DOTA-octreotate (LUTATE). The report emphasises aspects of the patient management related to functional imaging and use of radionuclide therapy. METHODS We describe the criteria for treatment with LUTATE at our centre, the methodology for patient selection, and the results of an audit of clinical measures, imaging results and patient-reported outcomes. Subjects are treated initially with four cycles of ~ 8 GBq of LUTATE administered as an outpatient every 8 weeks. RESULTS In the first 5 years offering LUTATE, we treated 143 individuals with a variety of NETs of which approx. 70% were gastroentero-pancreatic in origin (small bowel: 42%, pancreas: 28%). Males and females were equally represented. Mean age at first treatment with LUTATE was 61 ± 13 years with range 28-87 years. The radiation dose to the organs considered most at risk, the kidneys, averaged 10.6 ± 4.0 Gy in total. Median overall survival (OS) from first receiving LUTATE was 72.5 months with a median progression-free survival (PFS) of 32.3 months. No evidence of renal toxicity was seen. The major long-term complication seen was myelodysplastic syndrome (MDS) with a 5% incidence. CONCLUSIONS LUTATE treatment for NETs is a safe and effective treatment. Our approach relies heavily on functional and morphological imaging informing the multidisciplinary team of NET specialists to guide appropriate therapy, which we suggest has contributed to the favourable outcomes seen.
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Affiliation(s)
- S Gordon
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia
| | - D L H Chan
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - E J Bernard
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - M E Eslick
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - K P Willowson
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - P J Roach
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - A F Engel
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
- Department of Colorectal Surgery, Royal North Shore Hospital, Sydney, Australia
| | - R Maher
- Department of Medical Imaging, Royal North Shore Hospital, Sydney, Australia
| | - S J Clarke
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - V Agarwal
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia
| | - L Yasmin
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia
| | - M De Silva
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Bill Walsh Translational Cancer Research Laboratory, University of Sydney, Sydney, Australia
| | - S Mascall
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
| | - A Conner
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Bill Walsh Translational Cancer Research Laboratory, University of Sydney, Sydney, Australia
| | - D Nevell
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia
| | - N Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
- Bill Walsh Translational Cancer Research Laboratory, University of Sydney, Sydney, Australia
| | - D L Bailey
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia.
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia.
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.
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Lederer C, Buschulte K, Hellmich B, Heußel CP, Kriegsmann M, Polke M, Kreuter M. [Interstitial lung diseases : Classification, differential diagnosis and treatment approaches in a heterogeneous group of chronic lung disorders]. Inn Med (Heidelb) 2023; 64:247-259. [PMID: 36786822 PMCID: PMC9926427 DOI: 10.1007/s00108-023-01476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 02/15/2023]
Abstract
Interstitial lung diseases (ILD) comprise a heterogeneous group of chronic lung disorders of different etiologies that can not only affect the interstitium but also the alveolar space and the bronchial system. According to the "Global Burden of Disease Study" there has been an increase in incidence over the last decades and it is expected that the number of ILD-associated deaths will double over the next 20 years. ILD are grouped into those of unknown cause, e.g. idiopathic pulmonary fibrosis (IPF), and ILD of known cause, which include drug-induced and connective tissue disease-associated ILD as well as granulomatous ILD such as sarcoidosis and hypersensitivity pneumonitis. In addition, some ILD present a progressive fibrosing phenotype, which influences therapeutic decisions. Predominantly inflammatory entities are treated with immunosuppressives, whereas predominantly fibrosing ILD are treated with antifibrotic drugs; in some cases, a combination of both is necessary. The spectrum of differential diagnoses in ILD is broad, but definite diagnosis is essential for treatment selection; therefore, the multidisciplinary ILD board plays a pivotal role.
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Affiliation(s)
- Christoph Lederer
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland.,Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - Katharina Buschulte
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland.,Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, medius Klinik Kirchheim und Vaskulitiszentrum Süd, Kirchheim, Deutschland
| | - Claus Peter Heußel
- Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik Heidelberg, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,Sektion Thoraxpathologie, Abteilung für Allgemeine Pathologie, Institut für Pathologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | | | - Markus Polke
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland.,Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland
| | - Michael Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland. .,Deutsches Zentrum für Lungenforschung (DZL), Heidelberg, Deutschland. .,Lungenzentrum Mainz, 55131, Mainz, Deutschland.
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Osborne LA, Emery S, Vij M, Purwar B, Reed P. Acceptability and effectiveness of a multidisciplinary team approach involving counselling for mesh-removal patients. J OBSTET GYNAECOL 2021; 42:1431-1436. [PMID: 34939523 DOI: 10.1080/01443615.2021.1990230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients with complications following mesh removal risk a variety of symptoms, and can view medical intervention negatively. This study explored the patient-acceptability of a Multidisciplinary Team (MDT), and whether the presence of a Counsellor would be accepted and effective. Twenty consecutively referred women, who had undergone mesh-removal but experienced complications were interviewed about their experiences, and completed the Queensland scale for pelvic floor symptoms, McGill Pain Questionnaire, and Hospital Anxiety and Depression Scales, before and after treatment. Patients had high levels of pelvic-floor symptoms, sensory and affective pain, anxiety, and depression. 70% reported a positive MDT experience; predicted by higher anxiety, and lower depression. 60% elected to receive Counselling, which commenced within one week of referral, typically lasted 1-4 sessions, and reduced pelvic-floor symptoms, affective pain, anxiety, and depression. Results suggest that the MDT approach is generally acceptable for this patient group, and that mesh-removal patients accept and benefit from input by a Counsellor.Impact statementWhat is already known on this subject? Concerns have been raised regarding the safety of mesh insertion. Multidisciplinary Teams (MDTs) are suggested to offer a strong approach to managing many women's health conditions, but no studies have examined mesh-removal patients, making generalisation difficult to the current patient group. Furthermore, it is unknown whether an MDT approach, including a Counsellor, would be acceptable to mesh-removal patients.What do the results of this study add? Patients had high levels of pelvic-floor symptoms, pain, anxiety, and depression. 70% reported the MDT experience as positive, predicted by higher anxiety, and lower depression. 60% elected to receive Counselling, which reduced pelvic-floor symptoms, affective pain, anxiety, and depression.What are the implications of these findings for clinical practice and/or further research? The Counselling provided as part of the MDT approach was able to commence quickly, did not require many sessions, and reduced reported pelvic-floor symptoms, affective pain, anxiety, and depression. These findings suggest that an MDT approach involving Counselling is generally acceptable, and that mesh-removal patients accept and benefit from the input of a Counsellor, as part of their treatment.
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Affiliation(s)
- Lisa A Osborne
- School of Psychology and Counselling, The Open University, UK.,Department of Women's Health, Swansea Bay University Health Board, UK
| | - Simon Emery
- Department of Women's Health, Swansea Bay University Health Board, UK
| | - Monika Vij
- Department of Women's Health, Swansea Bay University Health Board, UK
| | - Bhawana Purwar
- Department of Women's Health, Swansea Bay University Health Board, UK
| | - Phil Reed
- Department of Psychology, Swansea University, UK
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