NEW POSSIBILITIES OF COMPLEX TREATMENT FOR METASTATIC AND LOCALLY ADVANCED NEUROENDOCRINE TUMORS OF THE PANCREAS

2018 ◽  
Vol 64 (4) ◽  
pp. 493-498
Author(s):  
Sergey Popov ◽  
Aleksandr Pavlovskiy ◽  
Aleksey Polikarpov ◽  
Viktor Moiseenko ◽  
Andrey Moiseenko ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Cytoreductive Surgery ◽  
Combined Treatment ◽  
Locally Advanced ◽  
The Body ◽  
Pancreatic Tumors ◽  
Low Grade ◽  
Conformal Radiation Therapy ◽  
Local Methods ◽  
Neuroendocrine Pancreatic Tumors

During the period 2006 to 2017 years 86 patients with neuroendocrine pancreatic tumors were observed and treated. 25 (29,1%) patients underwent only chemotherapy due to generalized tumor process or severe concomitant somatic status. 61 (70,9%) patients with neuroendocrine pancreatic tumors underwent surgical treatment. In 34 patients tumors were localized in the body and tail, in 27 - in the head of the pancreas. Women predominated among patients (n = 41), the average age of the patients was 51 ± 3.1 years. Synchronous metastatic liver metastases were detected in 33 (54,1%) of 61 patients, with the size of the primary tumor from 10 to 73 mm. In 47 (77%) neuroendocrine pancreatic tumors were regarded as non-functioning. Radical surgery was performed in 24 patients of 61 (39,3%) with tumor sizes from 11 to 128 mm (average 56 ± 21 mm), cytoreductive surgery was performed in 37 (60.7%) patients. Patients with locally advanced neuroendocrine pancreatic tumors (n = 13) and neuroendocrine pancreatic tumors with synchronous liver metastases (n = 33) undergone combined treatment (n = 46). Combined treatment was performed by means of intra-arterial selective oil chemoembolization and chemoinfusion, supplemented with one or several local methods effects: cytoreductive surgery and radiofrequency ablation (n = 8). 6 (12.2%) of patients with high, moderately and low-grade tumors died after the operation in period from 7 to 63 months from progression of disease. 43 (87.8%) patients survived in period from 4 to 112 months, 32 patients still alive without signs of disease progression. Because of recurrence in five patients (11.9%) repeated operations were performed. One patient (2.4%) underwent conformal radiation therapy. Life expectancy after surgery in patients with low-grade neuroendocrine cancer of the pancreas ranged from 3 to 16 months, and the median survival was 8.3 ± 1.2 months.

scholarly journals Long lasting octreotide LAR therapy in non functioning pancreatic neuroendocrine carcinoma

2015 ◽  
Vol 4 (1S) ◽  
pp. 19-25
Author(s):  
Ivan Lolli ◽  
Antonio Logroscino ◽  
Simona Vallarelli ◽  
Maria A. Monteduro ◽  
Antonella Gentile ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Radical Surgery ◽  
Hormone Secretion ◽  
Locally Advanced ◽  
Specific Treatment ◽  
Pancreatic Tumors ◽  
Proliferation Index ◽  
Pancreatic Neuroendocrine Carcinoma ◽  
Well Differentiated ◽  
Unresectable Metastases

Non functioning endocrine pancreatic tumors (NF-PETs) have absent or low hormone secretion without symptoms and constitue ~60% of PETs. At diagnosis more than 50% of patients have liver metastases and almost 40% are not candidates for radical surgery because of either locally advanced disease or unresectable metastases. We described the case of a 47-year-old woman with a pancreatic carcinoma with secondarism in the liver not suitable for radical surgery. Histological test of liver metastases showed positivity for endocrine well-differentiated non functioning carcinoma expressing receptors for somatostatin with very low proliferation index (Ki67 < 2%). After this diagnosis she started a specific treatment with octreotide analogues which achieved durable stabilization of the disease.

scholarly journals Complete Responses after Hyperthermic Ablation by Ultrasound Guided High Intensity Focused Ultrasound Plus Systemic Chemotherapy for Locally Advanced Pancreatic Cancer

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Joan Vidal-Jove ◽  
Marta Garcia-Bernal ◽  
Eloi Perich ◽  
Manuel Alvarez del Castillo
Keyword(s):  
Pancreatic Cancer ◽  
Systemic Chemotherapy ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Stage Iv ◽  
High Intensity Focused Ultrasound ◽  
Stage Iii ◽  
Pancreatic Tumors ◽  
Clinical Responses

We describe results in unresectable pancreatic tumors treated with USgHIFU hyperthermia ablation plus adjuvant chemotherapy. Materials and Methods. Thirty two cases of nonresectable pancreatic tumors were treated from March 2010 to March 2012, and all of them underwent systemic chemotherapy. Clinical responses (thermal ablation achieved) were measured by image techniques. There were 23 stage III cases and 9 stage IV cases. Complications were also analyzed. Results. Clinical responses (ablation obtained) were 82% in all cases, sustained at 8 weeks of the procedure. We obtained 8 complete responses (25%) at the end of the combined treatment, 7 from stage III patients and 1 from stage IV. Major complications included (1) severe pancreatitis with GI bleeding and (2) skin burning grade III that required plastic surgery. No deaths were registered. Median survival was 12.5 month (6 months–2.5 year). Conclusion. HIFU plus SC is a potentially effective and safe modality for the treatment of unresectable pancreatic cancer.

scholarly journals Prognosis of the combination therapy results in patients with synchronous metastases of colorectal cancer

2019 ◽  
Vol 4 (3) ◽  
pp. 60-64
Author(s):  
S. V Kozlov ◽  
O. I Kaganov ◽  
A. A Moryatov ◽  
A. M Kozlov ◽  
A. P Borisov
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Cytoreductive Surgery ◽  
Thermal Ablation ◽  
Combined Treatment ◽  
Stage Iv ◽  
Radiofrequency Thermal Ablation ◽  
Mutational Status ◽  
Synchronous Metastases ◽  
Metastatic Liver

Objectives - to optimize the indications for radiofrequency thermal ablation in patients with synchronous multiple metastases of colorectal cancer to the liver on the basis of prognostic treatment results. Material and methods. The study group included 78 patients with colorectal cancer with synchronous multiple bilobar liver metastases, who have underwent combined treatment in the period of 2007- 2015, such as cytoreductive surgery removing the primary intestinal tumor in combination with RFA of metastases in the liver, followed by chemotherapy. Results. A computer program for preoperative risk assessment of disease progression was developed and introduced in clinical practice. It is based on the results of the analysis of the factors, predicting the risk of relapse during the first year after cytoreductive surgery with RFA of synchronous multiple CRC liver metastases. Conclusion. The index of metastatic liver damage (the product of the sum of the diameters of metastatic liver lesions by their number), the mutational status of the KRAS gene, CEA values are significant factors in predicting the progression of the disease, which can optimize indications for radiofrequency thermal ablation in the treatment of patients with stage IV CRC with synchronous metastases to the liver.

scholarly journals RADIATION-INDUCED TOXICITY IN BREAST CANCER PATIENTS TREATED WITH TRASTUZUMAB-BASED CHEMOTHERAPY

2021 ◽  
Vol 20 (4) ◽  
pp. 91-98
Author(s):  
R. Yu. Karabut ◽  
A. V. Vazhenin ◽  
E. Y. Mozerova ◽  
M. M. Sarycheva ◽  
A. A. Lozhkov ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Locally Advanced ◽  
Significant Risk ◽  
The Body ◽  
Radiotherapy Planning ◽  
Low Grade ◽  
Average Dose ◽  
Skin Damage ◽  
Radiation Induced

The aim of the study was to determine and analyze the most significant risk factors for developing cardiac, pulmonary and skin toxicities among patients who received concurrent radiation therapy and chemotherapy with trastuzumab.Material and methods. The study included 66 patients with histologically verified invasive intermediate or low-grade breast carcinoma, who received radiation therapy and chemotherapy with trastuzumab from 2018 to 2019. The average age of the patients was 53.1 ± 4.2 years. Locally advanced stage iii a and iii b breast cancer was the most common (52 %) followed by stage ii a and ii b cancer (36 %). The lvef of all patients was ≥50 %. All patients received neoadjuvant chemotherapy with anthracyclines and/or taxanes. Radiation-induced side effects were assessed using the rtog/eortc scoring criteria. Dose-volume histogram (dvh) of radiotherapy planning was matched to the quantec criteria.Results. Radiation-induced pulmonitis was observed in 2 patients within 2 to 6 months after the completion of radiation therapy. A 10 % reduction in lvef was observed in 3 patients, while a 20 % decrease in ef was not found. Long qt syndrome was observed in 3 patients, and it was accompanied by clinical manifestations in 2 patients. When evaluating the echo-cg protocols after treatment, normal lv diastolic function was recorded in 39 patients, moderate diastolic dysfunction (lv dd) in 27, and 1 patient had severe lv dd. When assessing the dose received by the lv myocardium, the excess of the average dose to the myocardium was present both on the left and on the right. Only in 16 % of cases, left myocardial irradiation met criterion v 25. Clinically, arrhythmias, unstable angina pectoris, and other manifestations of coronary artery disease were mostly observed among patients with left-sided breast cancer. Significant factors for the development of cardiotoxicity were left-sided breast cancer, previous chemotherapy with anthracyclines and/or taxanes, as well as myocardial doses. The occurrence of radiation pulmonitis did not show an obvious relationship with any factor, while the body mass index (bmi) of >30 was a significant factor for the occurrence of radiation-induced skin damage.Conclusion. The combination of radiation therapy and trastuzumab was associated with an acceptable risk of cardiotoxicity. Monitoring of the cardiovascular system parameters during treatment and detection of early signs of cardiotoxicity were shown to be of great importance.

scholarly journals The laparoscopic enucleation for branch duct type intraductal papillary mucinous neoplasms located at the body of pancreas: A case report

2015 ◽  
Vol 143 (5-6) ◽  
pp. 332-336 ◽  
Author(s):  
Dejan Stevanovic ◽  
Dragos Stojanovic ◽  
Nebojsa Mitrovic ◽  
Damir Jasarovic ◽  
Sanja Milenkovic ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
The Body ◽  
Pancreatic Tumors ◽  
Low Grade ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Mucinous Neoplasms ◽  
Gastric Type ◽  
Branch Duct Type ◽  
Laparoscopic Enucleation

Introduction. Intraductal papillary mucinous neoplasms (IPMN) are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8?5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN) with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2), which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.

EXPERIENCE OF THE APPLICATION OF THERMOCHEMIORRADIOTHERAPY IN COMBINED TREATMENT OF DYSTAL CANCER OF DIRECT INTESTINE

2019 ◽  
Vol 65 (1) ◽  
pp. 131-134
Author(s):  
Zhanna Startseva ◽  
Sergey Afanasev ◽  
Dina Plaskeeva
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Primary Tumor ◽  
Advanced Colorectal Cancer ◽  
Combined Treatment ◽  
Locally Advanced ◽  
Chemoradiation Therapy ◽  
Locally Advanced Colorectal Cancer

The article describes the experience of using ther-mochioradiotherapy in the combined treatment of distal locally advanced colorectal cancer, as well as comparing the effectiveness of treatment with chemoradiation therapy. The use of the proposed method as a component of the combined treatment of patients with rectal cancer allowed to increase the percentage of organ-preserving operations. As a result of thermochemotherapy, the prevalence of the primary tumor was significantly reduced, as a result of which the number of sphincter-bearing operations was reduced by almost 2 times (p

Immunotherapy and potential predictive biomarkers in the treatment of neuroendocrine neoplasia

2020 ◽  
Author(s):  
Guanghui Xu ◽  
Yuhao Wang ◽  
Hushan Zhang ◽  
Xueke She ◽  
Jianjun Yang
Keyword(s):  
Current Knowledge ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Predictive Biomarkers ◽  
The Body ◽  
Low Grade ◽  
Ablative Therapies ◽  
Cancer Types ◽  
New Treatment ◽  
Well Differentiated

Neuroendocrine neoplasias (NENs) are a heterogeneous group of rare tumors scattered throughout the body. Surgery, locoregional or ablative therapies as well as maintenance treatments are applied in well-differentiated, low-grade NENs, whereas cytotoxic chemotherapy is usually applied in high-grade neuroendocrine carcinomas. However, treatment options for patients with advanced or metastatic NENs are limited. Immunotherapy has provided new treatment approaches for many cancer types, including neuroendocrine tumors, but predictive biomarkers of immune checkpoint inhibitors (ICIs) in the treatment of NENs have not been fully reported. By reviewing the literature and international congress abstracts, we summarize the current knowledge of ICIs, potential predicative biomarkers in the treatment of NENs, implications and efficacy of ICIs as well as biomarkers for NENs of gastroenteropancreatic system, lung NENs and Merkel cell carcinoma in clinical practice.

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