scholarly journals Insights of Outcome after Resection of Small Nonfunctioning Neuroendocrine Pancreatic Tumors

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Estela Regina Ramos Figueira ◽  
Julia Fray Ribeiro ◽  
Thiago Costa Ribeiro ◽  
Ricardo Jureidini ◽  
Guilherme Naccache Namur ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Tumor Size ◽  
Patient Survival ◽  
Survival Rates ◽  
Pancreatic Head ◽  
Tnm Staging ◽  
Pancreatic Tumors ◽  
Who Grade ◽  
Head Tumors ◽  
Neuroendocrine Pancreatic Tumors

Background. The incidence of small nonfunctioning neuroendocrine pancreatic tumors (NF-PNETs) has been increasing systematically in the last few decades. Surgical resection was once considered the treatment of choice but has been questioned in the direction of a more conservative approach for selected patients. Our aim was to analyze the outcome of surgical resection of small (≤3cm) NF-PNETs. Methods. We retrospectively evaluated 14 patients with sporadic NF-PNETs who underwent pancreatic resection. Data were collected from patients’ medical records. Results. Of the 14 patients included, 35.71% were men, and the average age was 52.36 ± 20.36 years. Comorbidities were present in 92.86% of the cases. The incidence of postoperative complications was 42.86%, the 30-day mortality was zero, and the length of follow-up was 3.31 ± 3.0 years. The results of pathological evaluations revealed WHO grade I in 42.86% of cases, II in 21.43%, and neuroendocrine carcinoma in 35.71%. The median tumor size was 1.85cm (range, 0.5–3cm), and 2 cases had synchronous metastasis. The median TNM stage was IIa (range, I–IV). The disease-free and patient survival rates were 87.5% and 100% at 3 years and 43.75% and 75% at 10 years, respectively. The tumor pathological grade was significantly higher in head tumors than body-tail tumors, but there were no differences with respect to tumor size and TNM staging. Conclusion. A surgical approach to treat small sporadic NF-PNETs is safe with low mortality and high patient survival. Based on these data, small pancreatic head tumors can be more aggressive, suggesting that surgical resection is still the best option to treat small nonfunctioning PNETS. Thus, conservative treatment should be indicated very cautiously for only cases with absolute contraindications for surgery.

Dose-dependent interleukin-3 stimulation of thrombopoiesis and neutropoiesis in patients with small-cell lung carcinoma before and following chemotherapy: a placebo-controlled randomized phase Ib study.

1993 ◽  
Vol 11 (11) ◽  
pp. 2063-2071 ◽  
Author(s):  
V D'Hondt ◽  
P Weynants ◽  
Y Humblet ◽  
T Guillaume ◽  
J L Canon ◽  
...  
Keyword(s):  
Patient Survival ◽  
Survival Rates ◽  
Small Cell ◽  
World Health ◽  
Small Cell Lung ◽  
Who Grade ◽  
Cell Lung Carcinoma ◽  
Interleukin 3 ◽  
Platelet Counts ◽  
Dose Dependent

PURPOSE To evaluate the safety, tolerance, and hematologic effects of recombinant human interleukin-3 (IL-3) in patients with small-cell lung cancer (SCLC) before and following multiagent antineoplastic therapy in a placebo-controlled, randomized, double-blind study. PATIENTS AND METHODS Twenty-eight patients (22 men and six women; median age, 60 years) with previously untreated SCLC entered the study. Patients were assigned to six groups of escalating-dose IL-3 ranging from 0.25 to 10 micrograms/kg/d administered by continuous infusion for 7 days, with one patient in each group receiving placebo. After a 1-week interval, the first of three cycles of carboplatin, etoposide (VP16), and epirubicin (CVE) given every 3 weeks was administered. The second cycle of CVE was followed by 7 days of IL-3 administered at the same daily dose as administered during the first infusion. RESULTS The maximum-tolerated dose was not encountered in this study. Fever was the most frequently observed side effect. Before any chemotherapy, World Health Organization (WHO) grade II fever only appeared at doses > or = 2.5 micrograms/kg/d. Other side effects included rash, headache, and myalgia. During the first infusion of IL-3, before administration of chemotherapy, dose-dependent increases in peripheral-platelet counts (r = .613; P < .001) and neutrophil counts (r = .505; P = .007) were observed. Following the second cycle of CVE, recovery of peripheral platelet counts was faster as compared with the first cycle of CVE for patients treated with 7.5 and 10 micrograms/kg of IL-3 (P = .021). Chemotherapy postponements due to myelotoxicity were also less frequent following the second cycle of CVE as compared with the first for patients treated with > or = 2.5 micrograms/kg of IL-3 (P = .036). Compared with an age-matched historical group receiving identical chemotherapy (n = 191), administration of IL-3 did not modify either disease-free survival or overall patient survival rates. CONCLUSION IL-3 is well tolerated at doses up to 10 micrograms/kg/d. In the absence of chemotherapy, biologic effects on both neutrophils and platelets were seen at doses > or = 2.5 micrograms/kg/d. IL-3 infusion following the second cycle of CVE appears to reduce chemotherapy-induced myelosuppression, but does not alter tumor response or patient survival rates.

scholarly journals RADT-40. TRENDS IN THE USE OF RADIATION FOR MENINGIOMA ACROSS THE UNITED STATES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii190-ii190
Author(s):  
Hirsch Matani ◽  
Stephen Abel ◽  
Linda Xu ◽  
Alexander Yu ◽  
Tulika Ranjan ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Tumor Size ◽  
Survival Benefit ◽  
Survival Curve ◽  
Survival Rates ◽  
The United States ◽  
External Beam Radiation ◽  
Treatment Facility ◽  
Beam Radiation ◽  
Who Grade

Abstract BACKGROUND Meningiomas are tumors originating from arachnoid cap cells on the surface of the brain or spinal cord. Treatment differs by grade but can consist of surgery, radiation therapy or both. We utilized the national cancer database (NCDB) to compare trends in the use stereotactic radiosurgery (SRS) and external beam radiation therapy (EBRT) in the management of meningioma. METHODS We queried the NCDB from 2004-15 for meningioma patients (Grade 1-3) treated with radiation therapy, either SRS or EBRT. Multivariable logistic regression was used to identify predictors of each treatment and to generate a propensity score. Propensity adjusted Kaplan-Meier survival curve analysis and multivariable cox hazards ratios were used to identify predictors of survival. RESULTS We identified 5406 patients with meningioma meeting above criteria. Median follow up was 43 months. 45%, 44%, and 11% were Grade 1, 2, and 3, respectively. Predictors for SRS were distance from treatment facility and histology. Predictors of EBRT were tumor size and WHO grade 2 or 3 disease. Tumor size, treatment year, and receipt of chemotherapy were associated with improved survival. Five and ten year survival rates were 89.2% vs. 72.6% (p &lt; 0.0001) and 80.3% vs. 61.4% (p = 0.29) for SRS and EBRT respectively. After propensity matching 226 pairs were generated. For SRS, 5 year survival was not significantly improved at 88.2% (p = 0.056) CONCLUSIONS In the present analysis, predictors of SRS utilization in management of meningioma include distance from treatment facility and histology whereas conventional EBRT utilization was associated with tumor size and grade 2 or 3 disease. Despite a possible survival benefit with SRS, inherent selection bias may confound interpretation of the apparent survival benefit reflected in our study.

Duodenum preserving pancreatic head resection for treatment of neuroendocrine pancreatic tumors of the head of the pancreas

Pancreatology ◽  
2016 ◽  
Vol 16 (3) ◽  
pp. S65-S66
Author(s):  
Anna Caterina Milanetto ◽  
Valbona Liço ◽  
Rita Alaggio ◽  
Sergio Pedrazzoli ◽  
Claudio Pasquali
Keyword(s):  
Pancreatic Head ◽  
Pancreatic Tumors ◽  
Pancreatic Head Resection ◽  
Head Of The Pancreas ◽  
Neuroendocrine Pancreatic Tumors

scholarly journals INTRAOPERATIVE ULTRASONOGRAPHY IN PANCREATIC SURGERY: STAGING AND RESECTION GUIDANCE

2015 ◽  
Vol 37 (4) ◽  
pp. 285-291 ◽  
Author(s):  
O Kolesnik ◽  
A Lukashenko ◽  
A Shudrak ◽  
T Golovko ◽  
G Lavryk ◽  
...  
Keyword(s):  
Blood Supply ◽  
Intraoperative Ultrasound ◽  
Pancreatic Head ◽  
Pancreatic Tumors ◽  
Surgical Interventions ◽  
Head Tumors ◽  
Arterial Blood ◽  
Mesenteric Vessels ◽  
Additional Tumor ◽  
Variant Anatomy

Background: Intraoperative ultrasound examination (IOUS) is indispensable part of modern surgical interventions in tumors of hepatopancreatobiliary zone. In this study retrospective analysis of IOUS efficiency in surgical treatment of pancreatic tumors was provided. Materials and Methods: In the period from January 2013 till November 2015 in the National Cancer Institute IOUS was applied during 76 surgical interventions: for pancreatic head tumors — in 46 (60.5%) patients, for body/tail pancreatic tumors — in 20 (26.3%) patients, in 10 (13.2%) patients — for periampullary zone neoplasms. In IOUS we performed primary tumor assessment (localization, degree of tumor spreading to superior mesenteric vessels, hepatoduodenal ligament vessels, additional foci occurrence in pancreas), and liver metastases detection. Surgical interventions were performed: pancreatoduodenectomy in 52 (68.4%) patients, radical antegrade modal pancreatosplenectomy — in 14 (18.4%) patients. Results: IOUS allowed determining additional tumor foci in pancreas in 2 (2.6%) patients, in 8 (10.5%) observations tumor invasion into portal or superior mesenteric vein was determined. In 21 (27.6%) patient additional hepatic neoplasms were detected (in half of cases — 11.8%, metastases). These findings resulted in change of surgical intervention extent in 23 (30.3%) patients: expansion to combined resections in 14 (18.4%) patients, reduction to symptomatic operations in 5 (6.6%) cases, organ-preserving operations were performed in 4 (5.3%) patients. Variant anatomy of hepatic arterial blood supply was determined in 41 (53.9%) patients that necessitated performance correction of resection stages for preservation of adequate hepatic blood supply. Conclusions: IOUS is a highly-precise diagnostic method substantively influencing operation course in pancreatic tumors, enabling surgeon to provide adequate staging and permanent correction of operation course.

scholarly journals Complete Surgical Resection and Aggressive Treatment for Liver Metastasis May Be Beneficial to Adult Patients With Pancreatoblastoma: A Case Report and Review of Literature

2020 ◽  
Vol 104 (3-4) ◽  
pp. 149-154
Author(s):  
Shih-Min Yin ◽  
Yueh-Wei Liu ◽  
Fong-Fu Chou ◽  
Fang-Ying Kuo ◽  
Leung-Chit Tsang
Keyword(s):  
Liver Metastasis ◽  
Surgical Resection ◽  
Tumor Size ◽  
Case Reports ◽  
Abdominal Mass ◽  
Pancreatic Neoplasm ◽  
Pancreatic Head ◽  
Curative Treatment ◽  
Postprandial Fullness ◽  
Complete Surgical Resection

Introduction: Pancreatoblastoma (PB) is a rare pancreatic neoplasm that occurs most in pediatric patients. Here, we report a rare case of adult PB with liver metastasis and review the literature in order to assist clinicians in the management of the disease. Case Presentation: A 27-year-old female patient suffered from postprandial fullness, anorexia, and weight loss in the past 3 months. An abdominal ultrasound and contrast-enhanced computed tomography scans confirmed right abdominal mass with compression of major liver vessels, as well as the P-duct and biliary ducts and causing mild dilatation. Pancreatoduodenectomy was performed and pathologic findings showed typical squamoid corpuscles, which confirmed the diagnosis of PB. The patient was alive and disease-free for 1 year and 10 months until a new metastatic lesion was found. Radiofrequency ablation was arranged as a curative treatment, and no viable tumor or sign of recurrence was found until this paper was submitted. Based on a review of previous case reports, we found adult PB patients with only liver metastasis presented with a smaller tumor size (P = 0.031), more frequent pancreatic head origin (P = 0.043), and decreased 1-year mortality (P = 0.009) compared with patients with other distal metastases. Therefore, we assumed that PB with liver metastasis might present favorable outcome by complete surgical resection or other curative treatment. Conclusion: PB patients with liver metastasis are more likely to show a pancreatic head origin, smaller tumor size, and more favorable outcomes compared with other sites of metastasis. PB should be treated aggressively with surgical resection or other curative treatment as opposed to chemotherapy alone.

scholarly journals SURG-29. CLINICAL FACTORS ASSOCIATED WITH RECURRENCE IN ATYPICAL MENINGIOMA: RETROSPECTIVE ANALYSIS OF 99 PATIENTS IN TWO INSTITUTES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii209-ii209
Author(s):  
Kyung Soo Sung ◽  
Young Jin Song ◽  
Young Zoon Kim
Keyword(s):  
Mitotic Index ◽  
Malignant Transformation ◽  
Surgical Resection ◽  
Tumor Size ◽  
Extent Of Resection ◽  
Atypical Meningioma ◽  
Proliferative Index ◽  
Who Grade ◽  
The Mean ◽  
Atypical Meningiomas

Abstract OBJECTIVE The objectives of this study were to examine the local control (LC) rate of atypical meningioma after surgical resection with or without adjuvant treatment, to identify risk factors for the recurrence of atypical meningioma, and to compare our results to known factors from the literature. METHODS Clinical and radiological records of patients with atypical meningiomas diagnosed at two institutes from January 2000 to December 2018 were reviewed retrospectively. Histopathological features were also reviewed using formalin-fixed paraffin embedded samples from pathological archives. RESULTS Of the 99 atypical meningiomas eligible for analysis, 36 (36.4%) recurred during the follow-up period (mean 83.3 months, range 12–232 months). The rate of 3-year LC and 5-year LC was 80.8% and 74.7% respectively. The mean time-to-recurrence was 49.4 months (range 12–150 months). Multivariate analysis using Cox proportional-hazard regression model showed that the extent of resection (Hazard ratio [HR] 4.761, p=0.013), Ki67 index (HR 8.541, p=0.004), mitotic index (HR 3.275, p=0.044), tumor size (HR 3.228, p=0.041), and radiotherapy (HR 3.816, p=0.029) were independently associated with 3-year LC. These factors was also statistically associated with recurrence-free survival. In terms of radiotherapy after surgical resection, the recurrence was not prevented by immediate radiotherapy because of the strong effect of proliferative index on recurrence. Three cases of malignant transformation to WHO grade III meningioma were histopathologically confirmed after repeated surgery. Two out of these three patients succumbed to malignant transformation. The mean Ki67 proliferative index increased for recurrent cases in 18 patients (58.1%) from 7.55% (range 4-16) to 11.81% (range 5-24). CONCLUSION The present study suggests that the extent of resection, proliferative index (according to Ki67 expression) and mitotic index, tumor size, and radiotherapy are associated with recurrence of atypical meningiomas. However, our results should be further validated through prospective and randomized clinical trials.

scholarly journals Osteosarcoma of the Pelvis: Clinical Presentation and Overall Survival

Sarcoma ◽  
2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Jeffrey Mark Brown ◽  
David Matichak ◽  
Kyla Rakoczy ◽  
John Groundland
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Metastatic Disease ◽  
Tumor Size ◽  
Surgical Intervention ◽  
Survival Rates ◽  
High Grade ◽  
Histologic Subtype ◽  
Primary Osteosarcoma ◽  
Anatomic Locations

Introduction. Osteosarcoma is the most common sarcoma of bone. Pelvic osteosarcoma presents a significant therapeutic challenge due to potential late symptom onset, metastatic dissemination at diagnosis, and inherent difficulties of wide surgical resection secondary to the complex and critical anatomy of the pelvis. The rates of survival are well reported for osteosarcoma of the appendicular skeleton, but specific details regarding presentation and survival are less known for osteosarcoma of the pelvis. Methods. The Surveillance, Epidemiology, and End Results (SEER) program was queried for primary osteosarcoma of the bony pelvis from 2004 to 2015. Cases with Collaborative Staging variables (available after 2004) were analyzed by grade, histologic subtype, surgical intervention, tumor size, tumor extension, and presence of metastasis at diagnosis. The 2-, 5-, and 10-year survival rates were assessed with respect to these variables. The SEER database was then queried for age, tumor size, surgical intervention, metastasis at time of presentation, and survivorship data for patients with primary osteosarcoma of the upper extremity, lower extremity, vertebrae, thorax, and face/skull, and rates for all anatomic locations were then compared to patients with primary pelvic osteosarcoma. Results. A total of 292 cases of pelvic osteosarcoma were identified from 2004 to 2015 within the database, representing 9.8% of cases among all surveyed primary sites. The most common histologic subtype was osteoblastic osteosarcoma (69.9%), followed by chondroblastic osteosarcoma (22.3%). The majority of cases were high-grade tumors (94.3%), of size >8 cm (72.0%), and with extension beyond the originating bone (74.0%). For the entire pelvic osteosarcoma group, the 2-, 5-, 10-year survival rates were 45.6%, 26.5%, and 21.4%, respectively, which were the poorest among surveyed anatomic sites. The 5-year overall survival was an abysmal 5.3% for patients with metastatic disease at diagnosis, and 37.0% for non-metastatic pelvic osteosarcoma treated with surgery and chemotherapy. When compared to other locations, pelvic osteosarcoma had higher rates of metastatic disease at presentation (33.5%), larger median tumor size (11.0 cm), and older median age at diagnosis (47.5 years). While over 85% of patients with tumors at the extremities received surgery, only 47.4% of pelvic osteosarcomas in this cohort received surgical resection—likely influenced by larger tumor size, sacral involvement, frequency of metastasis, older age, or delayed referral to a sarcoma center. Conclusion. This study clarifies presenting features and clinical outcomes of pelvic osteosarcomas, which often present with large, high-grade tumors with extracompartmental extension, high likelihood of metastatic disease at diagnosis, and a potential limited ability to be addressed surgically. The survival rates of primary osteosarcoma of the pelvis are poor and are lower than osteosarcomas from other anatomic locations. While acknowledging the influence of metastasis, tumor characteristics, and advanced age on the decision to undergo surgical excision of a pelvic osteosarcoma, the rates of surgical resection are low and highlight the importance of understanding appropriate conditions for oncologic resection of pelvic sarcomas.

scholarly journals Prognostic factors for the outcome of nonfunctioning pancreatic neuroendocrine tumors in MEN1: a systematic review of literature

2020 ◽  
Vol 27 (6) ◽  
pp. R145-R161 ◽  
Author(s):  
S M Sadowski ◽  
C R C Pieterman ◽  
N D Perrier ◽  
F Triponez ◽  
G D Valk
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Surgical Resection ◽  
Tumor Size ◽  
Clinical Decision Making ◽  
Data Extraction ◽  
Distant Metastases ◽  
Clinical Decision ◽  
Endocrine Tumors ◽  
Who Grade

Metastatic duodenopancreatic neuro-endocrine tumors (dpNETs) are the most important disease-related cause of death in patients with multiple endocrine neoplasia type 1 (MEN1). Nonfunctioning pNETs (NF-pNETs) are highly prevalent in MEN1 and clinically heterogeneous. Therefore, management is controversial. Data on prognostic factors for risk stratification are limited. This systematic review aims to establish the current state of evidence regarding prognostic factors in MEN1-related NF-pNETs. We systematically searched four databases for studies assessing prognostic value of any factor on NF-pNET progression, development of distant metastases, and/or overall survival. In- and exclusion, critical appraisal and data-extraction were performed independently by two authors according to pre-defined criteria. Thirteen studies (370 unique patients) were included. Prognostic factors investigated were tumor size, timing of surgical resection, WHO grade, methylation, p27/p18 expression by immunohistochemistry (IHC), ARX/PDX1 IHC and alternative lengthening of telomeres. Results were complemented with evidence from studies in MEN1-related pNET for which data could not be separately extracted for NF-pNET and data from sporadic NF-pNET. We found that the most important prognostic factors used in clinical decision making in MEN1-related NF-pNETs are tumor size and grade. NF-pNETs <2 cm may be managed with watchful waiting, while surgical resection is advised for NF-pNETs ≥2 cm. Grade 2 NF-pNETs should be considered high risk. The most promising and MEN1-relevant avenues of prognostic research are multi-analyte circulating biomarkers, tissue-based molecular factors and imaging-based prognostication. Multi-institutional collaboration between clinical, translation and basic scientists with uniform data and biospecimen collection in prospective cohorts should advance the field.

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