Impact of Tumor Location on Patient Outcomes in Small Bowel Cancers

2021 ◽  
Author(s):  
Irene S. Yu ◽  
Zamzam Al-Hashami ◽  
Parv Chapani ◽  
Caroline Speers ◽  
Janine M. Davies ◽  
...  
Keyword(s):  
Small Bowel ◽  
Patient Outcomes ◽  
Tumor Location

Methylguanine DNA methyl transferase (MGMT) expression to predict response to temozolomide (TMZ) in patients with digestive neuroendocrine tumors (NETs).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4133-4133 ◽  
Author(s):  
Pascal Hammel ◽  
Olivia Hentic ◽  
Jerome Cros ◽  
Vinciane Rebours ◽  
Magaly Zappa ◽  
...  
Keyword(s):  
Small Bowel ◽  
Stable Disease ◽  
Treatment Efficacy ◽  
Objective Response ◽  
Tumor Location ◽  
Methyl Transferase ◽  
Primary Tumors ◽  
Mgmt Expression ◽  
Who 2010 Classification ◽  
Well Differentiated

4133 Background: TMZ is an orally given drug used in patients (pts) with NETs, with encouraging results in pancreatic NETs in a recent study (Strosberg et al, 2011). Higher treatment efficacy seems to be correlated to MGMT tumor deficiency (Kulke et al, 2010). Aim-To assess MGMT expression in digestive NETs and to correlate with the efficacy of TMZ-based therapies. Methods: All pts with well differentiated, progressive, non resectable NETs treated with TMZ-based chemotherapy were included. Treatment efficacy was defined according to RECIST. Pts with progression or only stable disease were considered as “non-responders”. Nuclear expression of MGMT was assessed by immunohistochemistry on primary tumors or metastases and graded according the product of the intensity of staining (0 to 3) and the rate of positive cells (%), leading to a score comprised between 0 and 300. A score ≥ 80 was defined as “high” staining. Results: 22 pts (age 59 years (36-81)) with pancreatic (14 pts), small bowel (5 pts) or other (3 pts) NETs, grade 1 (5 pts) or 2 (17 pts) (WHO 2010 classification) were included. They received TMZ alone (19 pts) or combined with capecitabine (3 pts) as first line (3 pts) or 2+ line (19 pts).After a median of 6 cycles (3-16), objective response, stable disease and progression rates were seen in 32 % (7 pts, all with pancreatic NETs), 41% (9 pts, 5 pancreatic) and 27% (6 pts, 4 small bowel), respectively. Median (range) MGMT score was 10 (0-300). A “High” MGMT score was seen in 36% of pts (small bowel 4, pancreas 3 pts) ; it was correlated with primary tumor location (more frequent in small bowel NETs, p=0.02) and predictive of the absence of response (p=0.02). A “Low “MGMT score tended to be associated with objective response (p=0.06) whereas none of the pts with “high” score had tumor response. Response rate in pts with “low” MGMT score was 50%. Conclusions: MGMT deficiency is more frequent in pancreatic than small bowel NETs. Patients with pancreatic NET and low MGMT score are good candidates for TMZ, whereas those with high score should be treated with other drug in first intention. In patients with small bowel NET with most often high MGMT score, tumor stabilization using TMZ seems to be rare.

ERBB2 gene as a potential therapeutic target in small bowel adenocarcinoma.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 205-205
Author(s):  
Anais Laforest ◽  
Thomas Aparicio ◽  
Aziz Zaanan ◽  
Fabio pittella Silva ◽  
Audrey Didelot ◽  
...  
Keyword(s):  
Small Bowel ◽  
Somatic Mutations ◽  
Large Data ◽  
Standard Of Care ◽  
Tumor Location ◽  
Small Bowel Adenocarcinoma ◽  
Data Set ◽  
Mutational Hotspots ◽  
Low Incidence ◽  
Poor Outcomes

205 Background: Small bowel adenocarcinoma (SBA) is an aggressive tumor responsible for poor outcomes with an expected median OS at 5 years inferior to 30%. Because of its low incidence, few prospective studies have been performed leading to insufficient knowledge and absence of standard of care. Aiming to better understand the small bowel carcinogenesis process we screened for somatic mutations a large data set of patients in more than 740 mutational hotspots among 46 genes. Methods: In total, 83 SBA cases were selected from 2 European databases. The sequencing was performed using the Ion 316 Chip. We additionally looked into MSI status and ERBB2 expression (immunochemistry and FISH). Results: Tumors were mostly located in the duodenum (47%) and stage ≥ 3 (63%). Among the 46 genes investigated, 8 were mutated in more than 5% of the cases: KRAS, TP53, APC, SMAD4, PIK3CA, ERBB2, BRAF, and FBXW7. Compelling mutations (7 cases) and amplifications (3 cases) 12% of the patients had an ERBB2 alteration. In this group, ERBB2 alterations were positively associated with dMMR status (p=0.006) and APC mutations (p=0.02) but negatively associated with p53 mutations (p=0.038). Interestingly, ERBB2 mutations were mainly detected within tumors derived from the foregut while ERBB2 amplifications were limited those derived from the midgut. Conclusions: This study describes the first large screening of somatic mutations in SBA using next generation sequencing. ERBB2 mutation was revealed to be one of the most frequent alterations in SBA with a distribution dependent on tumor location. In most cases patients harbored the same p.L755S-ERBB2 mutation. In clinical practice, this study may suggest that more than 10% of the patients with SBA could be treated using anti-ERBB2-targeted agents.[Table: see text]

scholarly journals Small bowel enterocutaneous fistulae: is waiting worth?

2017 ◽  
Vol 5 (7) ◽  
pp. 2956
Author(s):  
Mukesh Kumar ◽  
Abhinav Jauhari
Keyword(s):  
Small Bowel ◽  
Patient Outcomes ◽  
Enterocutaneous Fistula ◽  
General Surgeon ◽  
P Value ◽  
Male Population ◽  
Aggressive Approach ◽  
Medical College ◽  
Good Patient ◽  
Aggressive Surgical Approach

Background: Enterocutaneous fistula represents a group of complex intraperitoneal infectious processes. Even with recent advances in Para surgical management, critical care and nutritional support, enterocutaneous fistulas remain great challenges to the general surgeon. Mortality remains high largely due to frequent complications of sepsis and malnutrition. Most enterocutaneous fistulas occur following emergency abdominal surgeries and only 15-25% of spontaneous enterocutaneous fistulas are the result of underlying diseases such as Crohn’s diseases, radiation enteritis or diverticular disease. Expectant treatment consisting of octreotide, TPN, and antibiotics waiting for spontaneous closure is associated with high costs, high mortality and prolonged morbidity. In our country, there is need to abandon expectant lines of management for a more aggressive surgical approach once the fluid and electrolyte disturbance and sepsis have been corrected.Methods: The aim of the present study was to audit the result of an aggressive approach in patients with enterocutaneous fistulas and to identify the time of convalescence prior to restorative surgery thereby reducing the morbidity and mortality associated with them. The focus of this study was to determine whether, in patients with fistulae, early intervention resulted in low mortality and morbidity.Results: In the present study, 64 cases of small bowel enterocutaneous fistulas were taken, which were either operated in Patna medical college and hospital or outside in year 2011-13. Majority of patients were <60 years of age. Out of the total population (n=64), 50 patients were <60 years and 14 patients were ≥60 years, with mean age of 46 years (range 17-75 years). The percentage of male population was 56.2 and that of female was 43.8. Mortality was also higher in patients with sepsis, age>60 years and in patients with preoperative albumin below 3.0g/dl (p value>0.05). Early surgical intervention resulted in good patient outcomes as compared to conservative treatment (p value-0.0418). Mortality was higher in patients with foregut fistulae (p value-0.0178) and high output fistulae (p value-0.0309).Conclusions: This study shows that early surgery can result in good patient outcomes. Initial emphasis should be on the treatment of septic foci, aim to improve to patient’s condition. Rather than following a prolonged conservative line of management, surgical repair should be performed when the patient is stable.

scholarly journals Small Bowel Adenocarcinoma: Etiology, Presentation, and Molecular Alterations

2019 ◽  
Vol 17 (9) ◽  
pp. 1135-1141 ◽  
Author(s):  
Katrina S. Pedersen ◽  
Kanwal Raghav ◽  
Michael J. Overman
Keyword(s):  
Colorectal Cancer ◽  
Small Bowel ◽  
Patient Outcomes ◽  
Delayed Diagnosis ◽  
Small Bowel Adenocarcinoma ◽  
Rare Cancer ◽  
Molecular Alterations ◽  
Molecular Studies

Small bowel adenocarcinoma (SBA) is a rare cancer that has been treated similarly to colorectal cancer (CRC) in the advanced setting. Incidence has been increasing as detection efforts have been improving for these challenging-to-diagnose tumors, but patients frequently experience prolonged nonspecific symptoms due to delayed diagnosis. As a result of such delays and likely due to variant biology, patient outcomes for SBA are inferior to those for CRC at all stages of diagnosis. Recent molecular studies highlight the genomic differences underpinning these tumors and suggest new future pathways for treatment, distinct from CRC.

scholarly journals Clinical Features, Management, and Molecular Characteristics of Familial Small Bowel Neuroendocrine Tumors

2021 ◽  
Vol 12 ◽  
Author(s):  
James Y. Lim ◽  
Rodney F. Pommier
Keyword(s):  
Small Bowel ◽  
Patient Outcomes ◽  
Clinical Features ◽  
Neuroendocrine Tumors ◽  
Current Knowledge ◽  
Epidemiological Studies ◽  
Genetic Mutations ◽  
Molecular Characteristics ◽  
Increased Risk ◽  
Risk Of Disease

Small bowel neuroendocrine tumors are rare tumors with an increasing incidence over the last several decades. Early detection remains challenging because patients commonly develop symptoms late in the disease course, often after the tumors have metastasized. Although these tumors were thought to arise from sporadic genetic mutations, large epidemiological studies strongly support genetic predisposition and increased risk of disease in affected families. Recent studies of familial small bowel neuroendocrine tumors have identified several novel genetic mutations. Screening for familial small bowel neuroendocrine tumors can lead to earlier diagnosis and improved patient outcomes. This review aims to summarize the current knowledge of molecular changes seen in familial small bowel neuroendocrine tumors, identify clinical features specific to familial disease, and provide strategies for screening and treatment.

Small Bowel Adenocarcinoma Primary Tumor Location Determines Outcome: A Nationwide Analysis

2019 ◽  
Vol 229 (4) ◽  
pp. S274
Author(s):  
Denise Wong ◽  
Louis Magnotti ◽  
Ashley Dodd ◽  
Evan S. Glazer ◽  
Stephen W. Behrman ◽  
...  
Keyword(s):  
Small Bowel ◽  
Primary Tumor ◽  
Tumor Location ◽  
Small Bowel Adenocarcinoma ◽  
Primary Tumor Location

Laryngeal Manifestations of Autoimmune Diseases

2020 ◽  
Vol 5 (2) ◽  
pp. 439-456
Author(s):  
Jenny L. Pierce
Keyword(s):  
Autoimmune Disease ◽  
Autoimmune Diseases ◽  
Patient Outcomes ◽  
Correct Diagnosis ◽  
Upper Airway ◽  
Clinical Implications ◽  
Laryngeal Function ◽  
The Past ◽  
Referral Practices ◽  
Timely Referral

Purpose This review article provides an overview of autoimmune diseases and their effects on voice and laryngeal function. Method A literature review was conducted in PubMed. Combinations of the following keywords were used: “autoimmune disease and upper airway,” “larynx,” “cough,” “voice,” “dysphonia,” and “dyspnea.” Precedence was given to articles published in the past 10 years due to recent advances in this area and to review articles. Ultimately, 115 articles were included for review. Results Approximately 81 autoimmune diseases exist, with 18 of those highlighted in the literature as having laryngeal involvement. The general and laryngeal manifestations of these 18 are discussed in detail, in addition to the clinical implications for a laryngeal expert. Conclusions Voice, breathing, and cough symptoms may be an indication of underlying autoimmune disease. However, these symptoms are often similar to those in the general population. Appropriate differential diagnosis and timely referral practices maximize patient outcomes. Guidelines are provided to facilitate correct diagnosis when an autoimmune disease is suspected.

Sign in / Sign up

Export Citation Format

Share Document