35 research outputs found
Antiproliferative effect of somatostatin analogs in advanced gastro-entero-pancreatic neuroendocrine tumors. a systematic review and meta-analysis
A meta-analysis has systematically investigated the antineoplastic efficacy and safety of somatostatin analogs (SSAs) in advanced gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Randomized controlled trials (RCTs) reporting the hazard ratio (HR) for disease progression (DP) were evaluated. Response rate and risk ratio (RR) for adverse events were also analyzed. A total of 289 patients (143 receiving SSAs vs. 146 placebo) were evaluated from two RCTs. A significant benefit from SSAs in terms of disease control was observed (HR 0.41, 95% CI: 0.29 to 0.58, P < 0.01; I20%), response rate being 58.0% vs. 32.2%, respectively.The occurrence of adverse events significantly differed from the placebo arm only in terms of biliary stones (RR 3.79, 95% CI: 1.28 to 11.17, P = 0.02; I20%). In conclusion, SSAs showed an antiproliferative effect in advanced GEP-NETs, with a good safety profile
Peritoneal Carcinomatosis in Gastro-Entero-Pancreatic Neuroendocrine Neoplasms: Clinical Impact and Effectiveness of the Available Therapeutic Options
Abstract
Background: Peritoneal carcinomatosis (PC) can affect the
quality of life of patients with gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs). Peritoneal disease control by medical therapies in these patients has been poorly
investigated Objectives: To describe, in a consecutive series
of GEP-NENs, the clinical impact of PC and to report the effectiveness of available treatments in PC control. Methods:
A retrospective, monocenter analysis was performed of 135
GEP-NENs (1993–2016) with at least a 12-month follow-up.
Peritoneal disease progression was defined as detection of a
significant increase in size or appearance of new implants by
imaging. Results: A total of 62.9% of cases had diffuse PC
(involving at least 2 abdominal quadrants). According to
WHO 2017 classification, cases were 42.3% neuroendocrine
tumors NET-G1, 45.5% NET-G2, 6.5% NET-G3, 4.9% neuroendocrine carcinomas NEC-G3, and 0.8% mixed neuroendocrine-nonneuroendocrine neoplasms. Bowel obstruction
occurred in 30 (22.2%) patients mainly depending on size of
peritoneal implants (HR: 1.10; 95% CI: 1.02–1.20; p = 0.01).
Patients with diffuse PC treated with peptide receptor radionuclide therapy (PRRT) showed peritoneal progression in
37.5% of cases, and bowel obstruction or ascites in 28.1%.
Better peritoneal disease control was observed in cases receiving somatostatin analogs at first-line therapy, probably
due to a less aggressive disease behavior for these patients.
Conclusions: Bowel obstruction is not uncommon in GEPNENs with PC. PRRT should be adopted with caution in GEPNENs with diffuse PC, but larger series are needed to confirm
these data
Appendiceal collision tumors: case reports, management and literature review
Appendiceal tumors are incidentally detected in 0.5% cases of appendectomy for acute appendicitis and occur in approximately 1% of all appendectomies. Here, we report two cases of appendiceal collision tumors in two asymptomatic women. In both cases, imaging revealed right-lower-quadrant abdominal masses, which were laparoscopically resected. In both cases, histological examinations revealed an appendiceal collision tumor comprising a low-grade appendiceal mucinous neoplasm and well-differentiated neuroendocrine neoplasm (NEN). For complete oncological control, right hemicolectomy was performed in one patient for the aggressive behavior of NEN; however, histology revealed no metastasis. The other patient only underwent appendectomy. No further treatment was recommended. According to the latest guidelines, exact pathology needs to be defined. Proper management indicated by a multidisciplinary team is fundamental
Acute leukaemia following low dose peptide receptor radionuclide therapy for an intestinal carcinoid.
in pres
Contrast Enhanced Ultrasonography (CEUS) and Quantitative Perfusion Analysis in the Assessment of Neuroendocrine Liver Metastases
Multicenter Analysis of Treatment Outcomes for Systemic Therapy in Well Differentiated Grade 3 Neuroendocrine Tumors (NET G3)
Well-differentiated grade 3 neuroendocrine tumors (NET G3) have been distinguished from poorly differentiated neuroendocrine carcinomas (NEC) in the most current WHO classifications. Commonly applied first-line chemotherapy protocols with cisplatin or carboplatin in combination with etoposide (PE) are less effective in NET G3 than NEC. Suggested alternative treatment protocols have not been studied in first-line therapy of NET G3 so far. We performed a retrospective analysis of patients with NET G3 in the databases of 3 German cancer centers. Out of 142 patients, 136 patients received palliative first-line therapy: overall response rate (ORR) was 35.1% for PE (n = 37), 56.4% for FOLFOX (n = 39), 27.3% for temozolomide/capecitabine (TEM/CAP) (n = 22), 45.0% for streptozotocin/5-fluorouracil (STZ/5-FU) (n = 20), and 16.7% for other (n = 18). Median progression-free survival (PFS) for PE was 6.9 months. Compared to PE, PFS in the other treatment groups was 6.9 months for FOLFOX (p = 0.333), 12.0 months for TEM/CAP (p = 0.093), 4.8 months for STZ/5-FU (p = 0.919), and 14.1 months for other (p = 0.014). In a univariate setting, all non-PE patients combined showed a significantly prolonged PFS vs. PE (9.0 months; p = 0.049) which could not be confirmed in a multivariate analysis. In conclusion, NET G3 with FOLFOX showed the highest ORR, and with TEM/CAP showed the longest PFS. Further prospective evaluation of the optimal therapeutic strategy for this tumor entity is needed