Tumor Perfusion Changes During Everolimus (E) Treatment: Preliminary Results from Perfusion-CT (P-CT) Study

Introduction: Criteria other than RECIST are not validated for evaluation of response during treatment in pancreatic neuroendocrine tumors (pNETs). Preliminary evidence favors antiangiogenic proper- ties of E. Aim(s): To evaluate in a prospective study P-CT changes in pNET liver metastasis (LM) during E. Materials and Methods: We evaluated eight LM from three patients with G1-2 pNETs. P-CT was performed at baseline (T0), after two (T1) and four (T2) months of E on a 64-row multidetector CT scan. A single ROI was drawn within each LM on the main axial slice. Perfusion (PF), Time to Peak (TTP), Peak Enhancement Intensity (PEI) and Blood Volume (BV) were cal- culated. Results: All LM remained dimensionally stable, except for one LM with a reduction >30% at T1. At T0, all LM had high PF and PEI, consistent with hypervascularization of G1-2 pNETs. BV discriminated among two different patterns of perfusional changes in response to E: significant progressive increase (T2 v. T0 +58.2\ub15.5 ml/100 g; n = 3 LM) v. initial increase (T1 vs T0; +64.28\ub111.64 ml/100 g; n = 5 LM) and subsequent reduction (T2 v. T1; \u201373.58\ub13.3 ml/100 g). No clear patterns were identified for PF, TTP and PEI. Conclusion: BV changes seem to be the earliest, more significant modifications among P-CT values during E treatment in pNETs. BV could reflect early vascular changes in tumor circulation. Longer follow-up is needed to evaluate the role of BV as an early predictive parameter and further studies are claimed to understand physiopathol- ogy of vascular response to

Effects of Lanreotide Autogel on Growth Hormone, Insulinlike Growth Factor 1, and Tumor Size in Acromegaly : A 1-Year Prospective Multicenter Study

Objective: To evaluate the safety and effectiveness of lanreotide Autogel on growth hormone and insulinlike growth factor 1 (IGF-1) concentrations and tumor size in patients with acromegaly. Methods: Between September 2004 and March 2006, patients with active acromegaly who had not previously been treated with somatostatin analogues or received irradiation were enrolled in a 1-year, prospective, open, multicenter study. Lanreotide Autogel was injected subcutaneously starting with 90 mg every 4 weeks for 2 cycles and then individually titrated, aiming for safe growth hormone concentrations (<2.5 ng/mL) and normal age-matched IGF-1 concentrations. Tumor shrinkage, clinical score, pituitary function, and safety parameters were evaluated. Results: Twenty-seven patients (15 women, 12 men) were enrolled. One patient withdrew because of treatment intolerance, and 5 proceeded to neurosurgery 6 months into the study. Lanreotide Autogel was the primary treatment in 19 patients (4 with microadenoma, 15 with macroadenoma) and the adjuvant treatment in 8 patients in whom it followed a previous unsuccessful neurosurgery. In the 26 patients, safe growth hormone values were achieved in 11 (42%), normal IGF-1 values in 14 (54%), and both targets were achieved in 10 (38%). Tumors shrank in 16 of the 22 patients (73%) in whom tumor shrinkage could be evaluated. The maximal vertical diameter of the tumor decreased by a mean of 24% (range, 0% to 50%), from 14.4 \ub1 8.4 mm to 10.4 \ub1 7 mm, and tumor volume decreased by a mean of 44% (range, 0% to 76%), from 2536 mm3 (range, 115-7737 mm3) to 1461 mm3 (range, 63-6217 mm3) (both P<.015). Symptom scores and lipid levels significantly improved. In the 26 patients, glucose metabolism deteriorated in 3 (12%) and improved in 4 (15%). New biliary alterations appeared in 26%. Pituitary function and safety parameters did not change. Conclusions: Lanreotide Autogel treatment, titrated for optimal hormonal control, effectively controls IGF-1 and growth hormone levels, shrinks tumors, reduces acromegalic symptoms, and is well tolerated

The NET Management Study Group.

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Assessment of the awareness and management of sleep apnea syndrome in acromegaly. The COM.E.TA (Comorbidities Evaluation and Treatment in Acromegaly) Italian Study Group

In 2007 the Italian COM.E.T.A. (COMorbidities Evaluation and Treatment in Acromegaly) study group started to assess the application in a clinical setting of the Versailles criteria for management of acromegaly complications by a first questionnaire focusing on cardiovascular co-morbidities. A further questionnaire on sleep apnea syndrome (SAS) was delivered by the COM.E.T.A. study group to 107 endocrine centers in Italy. The results of our survey suggest that SAS is a well-known comorbidity even if its estimated prevalence is lower than in the literature. Polysomnography is the preferred tool for diagnosis. Control of SAS is considered relevant both for quality of life and co-morbidities. Continuous positive airway pressure is the cornerstone of therapy, but patients' acceptance may be critical. Control of GH/IGF-I secretion is important to improve SAS. Management of SAS requires cooperation between specialists. \ua92011, Editrice Kurtis

Gout, allopurinol intake and clinical outcomes in the hospitalized multimorbid elderly.

Increased serum uric acid has been considered a cardiovascular risk factor but no study has assessed its relation with hospital mortality or length of stay. On the basis of data obtained from a prospective registry, the prevalence of gout/hyperuricemia and its association with these and other clinical parameters was evaluated in an Italian cohort of elderly patients acutely admitted to internal medicine or geriatric wards