Derivatives of nitrosoureas in treatment of patients with neuroendocrine tumors. Clinical case of successful treatment of patient with disseminated highly differentiated neuroendocrine pancreatic tumor with severe carcinoid syndrome in fourth line of therapy

We evaluated outcomes of treatment with 5-fluorouracil (5-FU), doxorubicin, and streptozocin (FAS) in well-differentiated pancreatic neuroendocrine tumors (PanNETs) and its impact on subsequent therapy (everolimus or temozolomide). Advanced PanNET patients treated at our center from 1992 to 2013 were retrospectively reviewed. Patients received bolus 5-FU (400 mg/m2), streptozocin (400 mg/m2) (both IV, days 1-5) and doxorubicin (40 mg/m2 IV, day 1) every 28 days. Overall response rate (ORR) was assessed using RECIST version 1.1. Of 243 eligible patients, 220 were evaluable for ORR, progression-free survival (PFS), and toxicity. Most (90%) had metastatic, nonfunctional PanNETs; 14% had prior therapy. ORR to FAS was 41% (95% confidence interval [CI]: 36-48%). Median follow-up was 61 months. Median PFS was 20 (95% CI: 15-23) months; median overall survival (OS) was 63 (95% CI: 60-71) months. Cox regression analyses suggested improvement with first-line vs subsequent lines of FAS therapy. Main adverse events ≥ grade 3 were neutropenia (10%) and nausea/vomiting (5.5%). Dose reductions were required in 32% of patients. Post-FAS everolimus (n=108; 68% second line) had a median PFS of 10 (95% CI: 8-14) months. Post-FAS temozolomide (n=60; 53% > fourth line) had an ORR of 13% and median PFS of 5.2 (95% CI: 4-12) months. In this largest reported cohort of PanNETs treated with chemotherapy, FAS demonstrated activity without significant safety concerns. FAS did not appear to affect subsequent PFS with everolimus; this sequence is being evaluated prospectively. Responses were noted with subsequent temozolomide-based regimens although PFS was possibly limited by line of therapy.

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Neuroendocrine Testicular Tumors: A Systematic Review and Meta-Analysis

Current Urology ◽

10.1159/000447146 ◽

2016 ◽

Vol 10 (1) ◽

pp. 15-25 ◽

Cited By ~ 7

Author(s):

Mseddi M. Amine ◽

Bouzguenda Mohamed ◽

Hadjslimane Mourad ◽

Hamza Majed ◽

Charfi Slim ◽

...

Keyword(s):

Survival Rate ◽

Neuroendocrine Tumors ◽

Carcinoid Syndrome ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Palpable Mass ◽

Pubmed Database ◽

Evolutionary Features ◽

Radical Orchiectomy

Purpose: The purpose of this study is to study the main epidemiological, clinical, para clinical, pathological, therapeutic, and evolutionary features of patients with testicular neuroendocrine tumors (TNET). Materials and Methods: Nine case series and sixteen case reports were identified by searching PubMed database and qualified for inclusion in this study. We added the data of one case treated in the department of urology in Habib Bourguiba Hospital in Sfax, to the published cases. Results: A total of 132 cases were collected. Median age at diagnosis was 39 years old (range 10- 83 years). The most common presenting symptom was either a testicular mass or a swelling in 38.46% of cases. Carcinoid syndrome was documented in 10.60% of patients. The clinical examination revealed a palpable mass in 44.70% of patients. This mass was painless and firm in most cases. Serum tumor markers (β-gonadotrophine chorionique humaine, α-feto protein, and lactate dehydrogenase) were within normal limits in all patients except in one case. Most testicular neuroendocrine tumors (76.52%) were primary and pure. The tumors were positive for chromogranin (100%), synaptophysin (100%) and cytokeratin (93.10%). Metastases were detected at time of diagnosis in eight cases (6.06%). The main treatment was radical orchiectomy performed in 127 patients (96.21%). The 5-year overall survival rate was 78.70% and the 5-year specific survival rate was 84.30%. Conclusion: The diagnosis of testicular carcinoids is based on the immunohistochemistry study. The treatment of choice for these tumors is radical orchiectomy. Somatostatin analogues were reported to be effective in patients with carcinoid syndrome.

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Application of the damage control principles and the use of a local negative pressure system for the prevention of infectious complications in a patient with traumatic separation of the upper limb and massive damage to soft tissues

Wounds and wound infections The prof B M Kostyuchenok journal ◽

10.25199/2408-9613-2019-6-4-22-25 ◽

2020 ◽

Vol 6 (4) ◽

pp. 22-25

Author(s):

I. M. Batyrshin ◽

M. I. Kizyavka ◽

D. S. Sklizkov ◽

Yu. S. Ostroumova ◽

E. P. Mikhelson ◽

...

Keyword(s):

Upper Limb ◽

Successful Treatment ◽

Negative Pressure ◽

Clinical Case ◽

Soft Tissues ◽

Damage Control ◽

Infectious Complications ◽

Pressure System

The article presents a clinical case of the successful treatment of a patient with traumatic separation of the upper limb and massive damage to the soft tissues of the upper shoulder and chest. The effectiveness of applying the damage control principles and the method of local negative pressure for the prevention of local and systemic infectious complications is emphasized.

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А сlinical case report of mediastinal teratoma in an adolescent patient with Klinefelter syndrome

Pediatric Hematology/Oncology and Immunopathology ◽

10.24287/1726-1708-2020-19-4-143-149 ◽

2020 ◽

Vol 19 (4) ◽

pp. 143-149

Author(s):

S. S. Saliyeva ◽

R. Z. Boranbayeva ◽

B. M. Zhumadullayev ◽

K. E. Khairov ◽

E. V. Krivenko ◽

...

Keyword(s):

Clinical Case ◽

Multidisciplinary Approach ◽

Klinefelter Syndrome ◽

Malignant Tumors ◽

Complete Removal ◽

Cell Tumor ◽

Growing Teratoma Syndrome ◽

Mediastinal Teratoma ◽

Mature Type ◽

Derivatives Of

Teratoma is a germ cell tumor, which consists of derivatives of three germ layers and has various malignant potentials – from benign mature forms to immature embryonic forms with a somatic type of malignancy. Even the mature type of teratoma is biologically unpredictable providing for an ability to grow locally with invasion. Necessity for complete removal of tumors, wherever they are located, is explained by the fact that there is a risk of a possible development of growing teratoma syndrome or transformation into malignant tumors. This article describes the clinical case of growing teratoma syndrome of mediastinal localization in a teenager with Klinefelter syndrome, also as an example of the multidisciplinary approach of pediatric oncologists, surgeons, radiotherapists and pathomorphologists in decision-making for optimal treatment. The patients' parents gave their consent to the use of their child's data, including photographs, for research purposes and in publications.

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Chromogranin A: From Laboratory to Clinical Aspects of Patients with Neuroendocrine Tumors

International Journal of Endocrinology ◽

10.1155/2018/8126087 ◽

2018 ◽

Vol 2018 ◽

pp. 1-12 ◽

Cited By ~ 15

Author(s):

Paola Di Giacinto ◽

Francesca Rota ◽

Laura Rizza ◽

Davide Campana ◽

Andrea Isidori ◽

...

Keyword(s):

Neuroendocrine Tumors ◽

Phase Ii ◽

Chromogranin A ◽

Carcinoid Syndrome ◽

Phase Ii Trial ◽

Randomized Study ◽

Clinical Aspects ◽

Clinical Activity ◽

Octreotide Lar ◽

Well Differentiated

Background. Neuroendocrine tumors (NETs) are characterized by having behavior and prognosis that depend upon tumor histology, primary site, staging, and proliferative index. The symptoms associated with carcinoid syndrome and vasoactive intestinal peptide tumors are treated with octreotide acetate. The PROMID trial assesses the effect of octreotide LAR on the tumor growth in patients with well-differentiated metastatic midgut NETs. The CLARINET trial evaluates the effects of lanreotide in patients with nonfunctional, well-, or moderately differentiated metastatic enteropancreatic NETs. Everolimus has been approved for the treatment of advanced pancreatic NETs (pNETs) based on positive PFS effects, obtained in the treated group. Sunitinib is approved for the treatment of patients with progressive gastrointestinal stromal tumor or intolerance to imatinib, because a randomized study demonstrated that it improves PFS and overall survival in patients with advanced well-differentiated pNETs. In a phase II trial, pasireotide shows efficacy and tolerability in the treatment of patients with advanced NETs, whose symptoms of carcinoid syndrome were resistant to octreotide LAR. An open-label, phase II trial assesses the clinical activity of long-acting repeatable pasireotide in treatment-naive patients with metastatic grade 1 or 2 NETs. Even if the growth of the neoplasm was significantly inhibited, it is still unclear whether its antiproliferative action is greater than that of octreotide and lanreotide. Because new therapeutic options are needed to counter the natural behavior of neuroendocrine tumors, it would also be useful to have a biochemical marker that can be addressed better in the management of these patients. Chromogranin A is currently the most useful biomarker to establish diagnosis and has some utility in predicting disease recurrence, outcome, and efficacy of therapy.

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