RESUMEN
PURPOSE OF REVIEW: To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland. RECENT FINDINGS: Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma. SUMMARY: Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Appropriate technological design, treatment planning and choice of imaging modality are necessary to overcome technical challenges associated with this emerging therapeutic approach.
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Técnicas de Ablación , Neoplasias de las Glándulas Suprarrenales , Técnicas de Ablación/efectos adversos , Técnicas de Ablación/métodos , Técnicas de Ablación/tendencias , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Enfermedades de las Glándulas Suprarrenales/cirugía , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Humanos , Hipertermia Inducida/métodos , Hipertermia Inducida/tendencias , Microondas/uso terapéutico , Ablación por Radiofrecuencia/métodos , Ablación por Radiofrecuencia/tendenciasRESUMEN
Targeted radionuclide therapies (TRT) using 131I-metaiodobenzylguanidine (131I-MIBG) and peptide receptor radionuclide therapy (177Lu or 90Y) represent several of the therapeutic options in the management of metastatic/inoperable pheochromocytoma/paraganglioma. Recently, high-specific-activity-131I-MIBG therapy was approved by the FDA and both 177Lu-DOTATATE and 131I-MIBG therapy were recommended by the National Comprehensive Cancer Network guidelines for the treatment of metastatic pheochromocytoma/paraganglioma. However, a clinical dilemma often arises in the selection of TRT, especially when a patient can be treated with either type of therapy based on eligibility by MIBG and somatostatin receptor imaging. To address this problem, we assembled a group of international experts, including oncologists, endocrinologists, and nuclear medicine physicians, with substantial experience in treating neuroendocrine tumors with TRTs to develop consensus and provide expert recommendations and perspectives on how to select between these two therapeutic options for metastatic/inoperable pheochromocytoma/paraganglioma. This article aims to summarize the survival outcomes of the available TRTs; discuss personalized treatment strategies based on functional imaging scans; address practical issues, including regulatory approvals; and compare toxicities and risk factors across treatments. Furthermore, it discusses the emerging TRTs.
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3-Yodobencilguanidina/uso terapéutico , Neoplasias de las Glándulas Suprarrenales/radioterapia , Neoplasias de las Glándulas Suprarrenales/secundario , Radioisótopos de Yodo/uso terapéutico , Lutecio/uso terapéutico , Octreótido/análogos & derivados , Compuestos Organometálicos/uso terapéutico , Paraganglioma/radioterapia , Paraganglioma/secundario , Feocromocitoma/radioterapia , Feocromocitoma/secundario , Radioisótopos/uso terapéutico , Radiofármacos/uso terapéutico , Radioterapia/métodos , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Humanos , Octreótido/uso terapéutico , Paraganglioma/diagnóstico por imagen , Feocromocitoma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de PositronesRESUMEN
BACKGROUND: Although guidelines recommend systemic therapy even in patients with limited extrahepatic metastases from hepatocellular carcinoma (HCC), a few recent studies suggested a potential benefit for resection of extrahepatic metastases. However, the benefit of adrenal resection (AR) for adrenal-only metastases (AOM) from HCC was not proved yet. This is the first study to compare long-term outcomes of AR to those of sorafenib in patients with AOM from HCC. METHODS: The patients with adrenal metastases (AM) from HCC were identified from the electronic records of the institution between January 2002 and December 2018. Those who presented AM and other sites of extrahepatic disease were excluded. Furthermore, the patients with AOM who received other therapies than AR or sorafenib were excluded. RESULTS: A total of 34 patients with AM from HCC were treated. Out of these, 22 patients had AOM, 6 receiving other treatment than AR or sorafenib. Eventually, 8 patients with AOM underwent AR (AR group), while 8 patients were treated with sorafenib (SOR group). The baseline characteristics of the two groups were not significantly different in terms of age, sex, number and size of the primary tumor, timing of AM diagnosis, Child-Pugh and ECOG status. After a median follow-up of 15.5 months, in the AR group, the 1-, 3-, and 5-year overall survival rates (85.7%, 42.9%, and 0%, respectively) were significantly higher than those achieved in the SOR group (62.5%, 0% and 0% at 1-, 3- and 5-year, respectively) (P = 0.009). The median progression-free survival after AR (14 months) was significantly longer than that after sorafenib therapy (6 months, P = 0.002). CONCLUSIONS: In patients with AOM from HCC, AR was associated with significantly higher overall and progression-free survival rates than systemic therapy with sorafenib. These results could represent a starting-point for future phase II/III clinical trials.
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Neoplasias de las Glándulas Suprarrenales/terapia , Adrenalectomía/métodos , Carcinoma Hepatocelular/terapia , Hepatectomía/métodos , Neoplasias Hepáticas/terapia , Estadificación de Neoplasias , Sorafenib/uso terapéutico , Neoplasias de las Glándulas Suprarrenales/mortalidad , Neoplasias de las Glándulas Suprarrenales/secundario , Anciano , Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/secundario , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Supervivencia sin Progresión , Estudios Retrospectivos , Rumanía/epidemiología , Tasa de Supervivencia/tendencias , Resultado del TratamientoRESUMEN
Background Dual-energy CT allows virtual noncontrast (VNC) attenuation and iodine density measurements from contrast material-enhanced examination, potentially enabling adrenal lesion characterization. However, data regarding diagnostic performance remain limited, and combined diagnostic values have never been investigated. Purpose To determine whether VNC attenuation, iodine density, and combination of the two allow reliable differentiation between adrenal adenomas and metastases. Materials and Methods This retrospective study included patients with adrenal lesions who underwent unenhanced and portal venous phase dual-energy CT between January 2017 and December 2018. Unenhanced, contrast-enhanced, and VNC attenuation, as well as iodine density, were measured for each lesion. Agreement between unenhanced and VNC attenuation was assessed by using Wilcoxon rank-sum test, Pearson correlation coefficient, and Bland-Altman plot. The ratio of iodine density to VNC attenuation was calculated for lesions with positive VNC attenuation. Each parameter was compared between adenomas and metastases; diagnostic performance was evaluated by using the area under the receiver operating characteristic curve (AUC) with sensitivity and specificity. Results A total of 149 patients (mean age, 65 years ± 13 [standard deviation]; 89 men; 98 patients with 104 adenomas; 51 patients with 56 metastases) were evaluated. VNC attenuation showed strong positive correlation with unenhanced attenuation (r = 0.92) but resulted in overestimates of adenoma attenuation (mean bias, +11 HU; P < .001) and was less sensitive (P = .03) in the diagnosis of adenomas compared with unenhanced attenuation (sensitivity of 79% [81 of 102] [95% confidence interval {CI}: 70%, 87%] and specificity of 95% [53 of 56] [95% CI: 85%, 99%] versus sensitivity of 85% [87 of 102] [95% CI: 77%, 92%] and specificity of 96% [54 of 56] [95% CI: 88%, 100%], with thresholds of ≤29 HU and ≤22 HU, respectively). Contrast-enhanced attenuation had no discriminatory ability (AUC, 0.54; 95% CI: 0.45, 0.62). Iodine density yielded moderate performance (sensitivity of 78% [80 of 102] [95% CI: 69%, 86%] and specificity of 71% [40 of 56] [95% CI: 58%, 83%], with a threshold of ≥1.82 mg/mL). The iodine-to-VNC ratio was higher in adenomas than in metastases (mean, 14.5 vs 4.6; P < .001), with sensitivity of 95% (97 of 102; 95% CI: 89%, 98%) and specificity of 95% (53 of 56; 95% CI: 85%, 99%), with a threshold of 6.7 or greater. Conclusion Contrast-enhanced dual-energy CT during the portal venous phase enabled accurate differentiation between adrenal adenomas and metastases by combining virtual noncontrast attenuation and iodine density. Virtual noncontrast imaging alone led to overestimates of adenoma attenuation, and iodine density alone had limited discriminatory utility. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Hindman and Megibow in this issue.
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Adenoma/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Imagen Radiográfica por Emisión de Doble Fotón/métodos , Tomografía Computarizada por Rayos X/métodos , Adenoma/patología , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/secundario , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Yodo , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
CONTEXT: Prognosis of metastatic pheochromocytoma/paraganglioma following 131-Iodine metaiodobenzylguanidine (MIBG) is incompletely characterized due to small samples and shorter follow-up in these rare, often indolent tumors. OBJECTIVE: To describe long-term survival, frequency, and prognostic impact of imaging, biochemical, and symptomatic response to 131-I MIBG. DESIGN: Retrospective chart and imaging review at a tertiary referral center. PATIENTS: Six hundred sixty-eight person-years of follow-up in 125 patients with metastatic pheochromocytoma/paraganglioma with progression through prior multimodal treatment. INTERVENTION: Median 18 800 MBq 131-I MIBG. MAIN OUTCOME MEASURES: Overall survival, Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST) imaging response, symptomatic response per chart review, and biochemical response (20% change over 2 consecutive assays of catecholamines, vanillylmandelic acid, metanephrines, or chromogranin A). RESULTS: Median survival standard deviation [SD] from diagnosis was 11.5 years [2.4]; following metastasis, 6.5 years [0.8]; post treatment, 4.3 years [0.7]. Among 88 participants with follow-up imaging, 1% experienced complete response, 33% partial response, 53% stability, and 13% progression. Fifty-one percent showed subsequent progression, median progression-free survival [SD] of 2.0 years [0.6]. Stability/response vs progression at first imaging follow-up (3-6 months) predicted improved survival, 6.3 vs 2.4 years (P = 0.021). Fifty-nine percent of 54 patients demonstrated biochemical response. Fifty percent of these relapsed, with median time to laboratory progression [SD] of 2.8 years [0.7]. Biochemical response did not predict extended survival. Seventy-five percent of 83 patients reported improvement in pretreatment symptoms, consisting primarily of pain (42%), fatigue (27%), and hypertension (14%). Sixty-one percent of these patients experienced subsequent symptomatic progression at median [SD] 1.8 years [0.4]. Symptomatic response did not predict extended survival. CONCLUSIONS: Imaging, symptomatic, and laboratory response to multimodal treatment including high-dose 131-I MIBG were achieved on long-term follow-up in metastatic pheochromocytoma or paraganglioma. Imaging response at 3 to 6 months was prognostic.
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3-Yodobencilguanidina/uso terapéutico , Neoplasias de las Glándulas Suprarrenales/radioterapia , Radioisótopos de Yodo/uso terapéutico , Paraganglioma/radioterapia , Feocromocitoma/radioterapia , Radiofármacos/uso terapéutico , Neoplasias de las Glándulas Suprarrenales/secundario , Adulto , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Paraganglioma/patología , Feocromocitoma/patología , Pronóstico , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
AIM: This study was conducted to evaluate the efficacy of surgical treatment for metastases accompanied by modern targeted therapies and to evaluate the performance of the Leuven-Udine (L.U.) prognostic groups model. METHODS: This retrospective analysis included 97 consecutive patients with metastatic renal cell carcinoma (mR.C.C.) who underwent surgery for metastases at Helsinki University Hospital between 2006 and 2017. The endpoints were overall survival (O.S.), cancer-specific survival (C.S.S.), recurrence-free survival (R.F.S.) and interval from diagnosis to oncological treatment. RESULTS: The median follow-up time was 46 months (interquartile range, I.Q.R. = 24-74). The estimated median O.S. was 67 months (I.Q.R. = 30-130). A radical surgical result at metastasectomy was achieved in 46 of 97 patients (47%). Of those 46 patients, 28 (61%) experienced recurrence after complete metastasectomy. Median R.F.S. after complete metastasectomy was 10 months (I.Q.R. = 3-37). Five-year O.S. was 59% for patients with complete metastasectomy and 44% for patients with non-complete metastasectomy (p = .035). The median interval from diagnosis to the initiation of targeted oncological treatment was 19 months for patients with non-complete metastasectomy and has hitherto not been reached for patients with complete metastasectomy (p = .006). A statistically significant validation of the prognostic value of the L.U. prognostic groups for predicting C.S.S. was not obtained (p = .420). CONCLUSIONS: Metastasectomy is an option for selected patients with mR.C.C. Complete resection should be attempted when feasible. The data failed to support the prognostic significance of the L.U. model in patients with mR.C.C.
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Antineoplásicos/uso terapéutico , Carcinoma de Células Renales/terapia , Neoplasias Renales/terapia , Metastasectomía , Nefrectomía , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/terapia , Anciano , Neoplasias Óseas/secundario , Neoplasias Óseas/terapia , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/terapia , Carcinoma de Células Renales/secundario , Procedimientos Quirúrgicos de Citorreducción , Supervivencia sin Enfermedad , Everolimus/uso terapéutico , Femenino , Humanos , Indazoles , Ipilimumab/uso terapéutico , Neoplasias Renales/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Pirimidinas/uso terapéutico , Estudios Retrospectivos , Sorafenib/uso terapéutico , Sulfonamidas/uso terapéutico , Sunitinib/uso terapéutico , Tasa de Supervivencia , Tiempo de TratamientoRESUMEN
Unilateral adrenal metastases without disseminated disease has rarely been reported in differentiated thyroid carcinoma (DTC). A 72-year-old female presented with vague abdominal discomfort and loss of appetite of 2 months duration. She had undergone left hemithyroidectomy for a benign thyroid nodule 18 years ago. A contrast CT of the abdomen showed a large left adrenal mass measuring 11×9 cm, suspicious of adrenocortical carcinoma. Hormonal evaluation was in keeping with a non-functional tumour. The patient underwent left adrenalectomy, histopathology of which revealed metastatic well-differentiated thyroid carcinoma. Ultrasound of thyroid done postoperatively showed a subcentimetric hypoechoic lesion with increased vascularity and microcalcifications in the right thyroid bed. Histopathology from a completion thyroidectomy specimen was consistent with follicular variant of papillary thyroid carcinoma. She was treated with high-dose radioiodine ablation therapy and has remained disease-free on follow-up for more than a year.
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Neoplasias de las Glándulas Suprarrenales/diagnóstico , Carcinoma Papilar/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Anciano , Carcinoma Papilar/diagnóstico por imagen , Carcinoma Papilar/secundario , Carcinoma Papilar/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Radioisótopos de Yodo/uso terapéutico , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Surgical resection of all sites of disease, in combination with effective systemic chemotherapy, offers the only potential chance for cure for patients with stage IV colorectal cancer (CRC). Coordinated multistage resection using a minimally invasive approach may provide optimal oncologic outcome while potentially offering the benefit of decreased morbidity. PATIENT: A 66-year-old women presented with transverse colon cancer and synchronous metastasis (CRLM) in segment IV involving the middle hepatic vein and main left portal pedicle, as well as the left adrenal gland. Due to favorable response to neoadjuvant chemotherapy (FOLFOX/bevacizumab), the patient was considered for resection but developed some obstructive symptoms from the primary tumor, necessitating re-coordination of treatment sequencing from the 'liver-first' approach. METHODS: The first procedure combined laparoscopic subtotal colectomy (extracorporeal anastomosis) with left adrenalectomy. After restaging, CRLM was removed separately 2 months later via laparoscopic left hepatectomy extending beyond the middle hepatic vein. Successful completion of the two procedures depended on optimal patient/port positioning for the combined colon/adrenal surgery and the second-stage liver resection. Postoperative lengths of stay were 4 and 3 days, respectively, and were without complication. Adjuvant FOLFOX was initiated 21 days following liver surgery, and the patient has been disease-free for 36 months. CONCLUSION: This case illustrates the feasibility of the total laparoscopic approach to multivisceral resection for synchronous stage IV CRC in the context of a preplanned, staged multidisciplinary strategy. This approach may offer optimal cancer management, including early return to systemic therapy, shortened time intervals between stages, and minimal postoperative morbidity.1 - 3.
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Neoplasias de las Glándulas Suprarrenales/cirugía , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Laparoscopía/métodos , Neoplasias Hepáticas/cirugía , Neoplasias de las Glándulas Suprarrenales/tratamiento farmacológico , Neoplasias de las Glándulas Suprarrenales/secundario , Adrenalectomía , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab/administración & dosificación , Colectomía , Neoplasias del Colon/tratamiento farmacológico , Femenino , Fluorouracilo/uso terapéutico , Hepatectomía , Humanos , Leucovorina/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Estadificación de Neoplasias , Compuestos Organoplatinos/uso terapéuticoRESUMEN
Recurrent disease after esophagectomy bears an infaust prognosis, especially when multiple recurrences are present. But little is known about survival in patients with limited recurrence (solitary locoregional recurrence or solid organ metastasis). Herein, we report our experience with these subgroups. We analyzed 1754 consecutive patients surgically treated with curative resection for esophageal cancer and cancer of the gastroesophageal junction between 1990 and 2012. Seven subgroups were defined according to the recurrence type (locoregional vs. organ metastasis), the site of recurrence (abdominal, thoracic, cervical for lymph nodes and lung, liver, adrenals and others for organ metastasis) and also the number of lesions (one vs. multiple lymph node stations or organ metastasis) Of these groups; clinical isolated locoregional recurrence (ciLR) was defined as solitary lymph-node recurrence confined to one compartment (cervical, thoracic or abdominal, within or outside surgical dissection-field) at clinical staging. Clinical solitary solid organ metastasis (csSOM) was defined as metastasis in a resectable solid organ, i.e. liver, lung, brain or adrenal. Salvage therapies were grouped in five categories. Kaplan-Meier curves were used to calculate survival. Recurrent disease was observed in 766 patients (43.7%) with overall 5-year survival of 4.5% after diagnosis of recurrence. Fifty-seven patients (7.4%) showed ciLR and 110 (14.4%) csSOM. Median time-to-recurrence was 16.8 months in ciLR and 9.9 months in csSOM (P = 0.0074). Survival is significantly improved compared to supportive therapy when local therapy is possible (P < 0.0001). In 25 (15%) of ciLR or csSOM patients, surgical therapy with or without systemic therapy, yielded a 5-year survival of 49.9% (median 54.8 months) after diagnosis of recurrence. When surgery was impossible or contraindicated, the combination of chemoradiotherapy appeared to be superior to chemotherapy alone (respectively 27.0% vs. 4.6% 5-year survival) or radiotherapy alone (no 5-year survival). Recurrent disease after esophagectomy is a common problem with poor overall survival. However prolonged survival could be obtained in selected patients if the recurrent disease is limited to ciLR or csSOM, if surgery (+/- systemic therapy) can be performed. If not a combination of chemoradiotherapy seems to offer the second best option. Patients presenting with a ciLR or csSOM should be discussed in a dedicated multidisciplinary team meeting as to evaluate and define the place of salvage treatment which in well selected cases could offer a perspective of prolonged survival.
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Adenocarcinoma/terapia , Neoplasias de las Glándulas Suprarrenales/terapia , Neoplasias Encefálicas/terapia , Carcinoma de Células Escamosas/terapia , Neoplasias Esofágicas/cirugía , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/terapia , Recurrencia Local de Neoplasia/terapia , Adenocarcinoma/patología , Adenocarcinoma/secundario , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias Encefálicas/secundario , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Quimioradioterapia , Medicamentos Herbarios Chinos , Neoplasias Esofágicas/patología , Esofagectomía , Unión Esofagogástrica/patología , Unión Esofagogástrica/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Masculino , Metastasectomía , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Radioterapia , Estudios Retrospectivos , Terapia Recuperativa , Tasa de SupervivenciaRESUMEN
Solitary adrenal metastasis of rectal cancer is comparatively rare condition and it is difficult to be diagnosed because it doesn't have any characteristic symptoms. We report a case of this type of adrenal tumor that could be figured out by tumor markers and the analysis of CT scan image. A 67-year-old man visited our department with the right adrenal tumor. He has a past medical history of rectal cancer and a low anterior resection was performed in 2011. After the surgery, he received adjuvant chemotherapy for 6 months. There has been no finding of recurrence or metastasis after chemotherapy. However, his follow-up abdominal CT in 2013 showed the right adrenal tumor which was 23 mm in diameter. Serum CEA level has also increased to 4.1 ng/ml, but there was no abnormal finding with hormonal study. The tumor size and CEA level gradually increased up to 46 mm in size and 10.4 ng/ml during 6 months. Enhanced CT also showed 39% at rate of absolute percentage wash out, which was not the finding of typical functional adrenal tumor. Based on these findings, we diagnosed that the origin of this adrenal tumor should be solitary metastasis of the rectal cancer. For the treatment of surgical procedure, we performed laparoscopic right adrenalectomy. The pathological finding showed adenocarcinoma, the origin of which was the previous rectal cancer. Six months have passed since the surgery, but CEA level still has remained normal range and neither finding of recurrence nor metastasis has been found.
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Adenocarcinoma/secundario , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias del Recto/patología , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Colectomía , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Masculino , Compuestos Organoplatinos/uso terapéutico , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugía , Recurrencia , Tomografía Computarizada por Rayos XRESUMEN
Computed tomography and magnetic resonance imaging detected an isolated adrenal lesion in an elderly man with high-risk prostate cancer who was undergoing radiotherapy (RT) and hormonal therapy (HT). When prostate-specific antigen (PSA) was 31.66 ng/mL, the lesion was not identified as a metastasis by 18F-choline positron emission tomography/computed tomography (18F-choline-PET/CT). When PSA was over 100 ng/mL, 18F-choline-PET/CT diagnosed the malignancy. After adrenalectomy, PSA returned to normal, and stable disease remission was obtained. This case suggests that atypical metastasis may be underdiagnosed.
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Adenocarcinoma/diagnóstico , Adenocarcinoma/secundario , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/secundario , Adrenalectomía , Biomarcadores de Tumor/sangre , Colina/análogos & derivados , Radioisótopos de Flúor , Tomografía de Emisión de Positrones , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/patología , Adenocarcinoma/cirugía , Neoplasias de las Glándulas Suprarrenales/cirugía , Anciano , Antineoplásicos Hormonales/uso terapéutico , Quimioterapia Adyuvante , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Imagen Multimodal/métodos , Neoplasias Primarias Secundarias/diagnóstico , Tomografía de Emisión de Positrones/métodos , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/terapia , Radioterapia Adyuvante , Tomografía Computarizada por Rayos XRESUMEN
A 58-year-old woman underwent sigmoidectomy and partial cystectomy for sigmoid colon cancer following colostomy. The final staging of the tumor was T3, N1, tub2, M0, fStage IIIa. She received 6 courses of CapeOX (oxaliplatin 130mg/m², capecitabine 200mg/m²) as adjuvant chemotherapy, which was discontinued because of severe general fatigue. At the same time, an increase in the levels of serum carcinoembryonic antigen (CEA) was detected and abdominal computed tomography (CT) revealed an expanded adrenal mass. Since whole-body ¹8F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) showed no evidence of multiple organ metastases except for the right adrenal tumor, a solitary adrenal metastasis from sigmoid colon cancer was strongly suspected. Hence, colostomy closure and laparoscopic adrenalectomy were concurrently performed. Histological examination revealed non-functional adrenal adenoma. Therefore, laparoscopic surgery was a reasonable choice even in this complex case.
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Neoplasias de las Glándulas Suprarrenales/cirugía , Laparoscopía , Neoplasias del Colon Sigmoide/patología , Neoplasias de las Glándulas Suprarrenales/secundario , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Capecitabina , Quimioterapia Adyuvante , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/análogos & derivados , Humanos , Persona de Mediana Edad , Imagen Multimodal , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Tomografía de Emisión de Positrones , Recurrencia , Neoplasias del Colon Sigmoide/cirugía , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: External beam radiotherapy (EBRT) is recommended as a therapeutic strategy for stage III hepatocellular carcinoma (HCC) in national guidelines of the Chinese Society of Liver Disease and in Korea Liver Cancer Study Group practice guidelines, but has not been considered a therapeutic option for HCC in Western countries. In this study, we review evidence supporting EBRT as an option for HCC treatment. METHODS: Retrospective investigation was made of 775 patient records of intermediate/advanced HCC treated in our hospital during the last 10 years, including 98 patients with confined intrahepatic tumor, 181 with portal vein (PV) or inferior vena cava (IVC) tumor thrombi, 191 with lymph node metastases, 55 with adrenal gland metastases, 205 with bone metastases, 13 with lung metastases and 32 with brain metastases. RESULTS: Transcatheter arterial chemoembolization combined with radiotherapy was found to constitute an improved therapeutic strategy for unresectable but confined intrahepatic HCC with poor lipid accumulation. Survival of HCC patients with PV/IVC tumor thrombi was prolonged to 10.7 months by radiotherapy, and it was 8.0 months in patients with abdominal lymph node metastasis. Radiotherapy also shrinks adrenal and lung metastatic HCC lesions, resulting in median survival times of 13.6 and progression-free survival of 13.4 months, respectively. In bone metastatic HCC, radiotherapy significantly relieved symptoms, although median survival time was only 7.4 months. Radiotherapy is effective for treatment of intermediate/advanced stages of HCC. Although our finding is based only on retrospective analysis, no therapeutic option that provides better treatment than EBRT in this indication has thus far been identified. Because sorafenib has been recommended as a treatment strategy by the National Comprehensive Cancer Network (NCCN) for HCC, we compared the survival after EBRT with sorafenib treatment on the basis of published clinical data. From this comparison, we found that EBRT treatment was more effective than sorafenib for improving patient survival when tested on tumors of comparable metastatic size. CONCLUSION: Based on the evidence reviewed, we propose that EBRT be included in the NCCN guideline as a treatment strategy for intermediate/advanced HCC.
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Neoplasias de las Glándulas Suprarrenales/radioterapia , Neoplasias Óseas/radioterapia , Carcinoma Hepatocelular/radioterapia , Quimioembolización Terapéutica , Neoplasias Hepáticas/radioterapia , Neoplasias Pulmonares/radioterapia , Guías de Práctica Clínica como Asunto , Neoplasias de las Glándulas Suprarrenales/secundario , Antineoplásicos/uso terapéutico , Neoplasias Óseas/secundario , Carcinoma Hepatocelular/secundario , Carcinoma Hepatocelular/terapia , Terapia Combinada , Supervivencia sin Enfermedad , Aceite Etiodizado/administración & dosificación , Humanos , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundario , Metástasis Linfática , Niacinamida/análogos & derivados , Niacinamida/uso terapéutico , Compuestos de Fenilurea/uso terapéutico , Estudios Retrospectivos , Sorafenib , Tasa de SupervivenciaRESUMEN
A 63-year-old man underwent a colectomy for sigmoid colon cancer in 1997. The upper lobe of his left lung and his left adrenal gland were resected because of metachronous metastases, 7 and 10 years after the initial surgery, respectively. Recurrence of metastases to the middle lobe of the right lung and left adrenal gland were sequentially detected in 2007, and a multimodal therapy, consisting of the combination of radiotherapy and chemotherapy, was conducted since 2007. The chemotherapy included drugs such as FOLFOX, FOLFIRI, bevacizumab, capecitabine, and cetuximab. In 2011, the complete response of all metastatic lesions could be achieved, and no recurrence was detected for more than 1 year. In spite of repeated recurrences, by the combination of surgical resection, chemotherapy, and radiotherapy, the complete response could be achieved 14 years after the initial surgical resection, which can be attributed to the development of new treatment modalities and new agents for colorectal cancer.
Asunto(s)
Adenocarcinoma/secundario , Adenocarcinoma/terapia , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/terapia , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/terapia , Neoplasias del Colon Sigmoide/patología , Adenocarcinoma/cirugía , Neoplasias de las Glándulas Suprarrenales/cirugía , Anticuerpos Monoclonales Humanizados/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bevacizumab , Camptotecina/análogos & derivados , Camptotecina/uso terapéutico , Capecitabina , Cetuximab , Quimioradioterapia Adyuvante , Colectomía , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Fluorouracilo/administración & dosificación , Fluorouracilo/análogos & derivados , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Compuestos Organoplatinos/uso terapéutico , Inducción de Remisión , Neoplasias del Colon Sigmoide/cirugíaAsunto(s)
Neoplasias de las Glándulas Suprarrenales/secundario , Glándulas Suprarrenales/patología , Carcinoma Hepatocelular/tratamiento farmacológico , Neoplasias Hepáticas/tratamiento farmacológico , Niacinamida/análogos & derivados , Compuestos de Fenilurea/uso terapéutico , Enfermedades de las Glándulas Suprarrenales/inducido químicamente , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/patología , Glándulas Suprarrenales/efectos de los fármacos , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/patología , Hemorragia/inducido químicamente , Hemorragia/diagnóstico , Humanos , Neoplasias Hepáticas/patología , Masculino , Persona de Mediana Edad , Necrosis/inducido químicamente , Necrosis/diagnóstico , Niacinamida/efectos adversos , Niacinamida/uso terapéutico , Compuestos de Fenilurea/efectos adversos , SorafenibRESUMEN
Receptor tyrosine kinase (RTK) inhibitors have revolutionized the treatment of metastatic renal cell carcinoma (mRCC) and significantly extended survival in these patients. Sunitinib is an oral multitargeted inhibitor of vascular endothelial growth factor receptors (VEGFRs-1, -2, and -3), platelet-derived growth factor receptors (PDGFRs-α and -ß), stem-cell factor receptor (KIT), FMS-like tyrosine kinase 3 (FLT3), colony-stimulating factor 1 receptor (CSF-1R), and glial cell line-derived neurotrophic factor receptor (REarranged during Transfection; RET). Sunitinib is approved multinationally for the treatment of advanced RCC, and is considered the reference standard of care for first-line treatment. In clinical trials, sunitinib has been associated with a consistent, distinct profile of adverse events. Here we describe three cases that show that it is possible to manage adverse events occurring during sunitinib therapy, and thus allow patients with mRCC to receive an effective dose of sunitinib in order to achieve long-term disease control. These cases also show that surgical resection, performed whenever possible, can help to improve control of metastatic disease and so avoid the unnecessary toxicity and high costs of prolonged antiangiogenic therapy.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/terapia , Adrenalectomía , Inhibidores de la Angiogénesis/administración & dosificación , Neoplasias Óseas/terapia , Carcinoma de Células Renales/terapia , Indoles/administración & dosificación , Neoplasias Renales/patología , Neoplasias Pulmonares/terapia , Osteotomía , Neumonectomía , Inhibidores de Proteínas Quinasas/administración & dosificación , Pirroles/administración & dosificación , Administración Oral , Neoplasias de las Glándulas Suprarrenales/tratamiento farmacológico , Neoplasias de las Glándulas Suprarrenales/enzimología , Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Anciano , Inhibidores de la Angiogénesis/efectos adversos , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/enzimología , Neoplasias Óseas/secundario , Neoplasias Óseas/cirugía , Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/enzimología , Carcinoma de Células Renales/secundario , Carcinoma de Células Renales/cirugía , Quimioterapia Adyuvante , Femenino , Humanos , Indoles/efectos adversos , Neoplasias Renales/enzimología , Neoplasias Renales/cirugía , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/enzimología , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Terapia Molecular Dirigida , Estadificación de Neoplasias , Nefrectomía , Inhibidores de Proteínas Quinasas/efectos adversos , Pirroles/efectos adversos , Sunitinib , Factores de Tiempo , Resultado del TratamientoRESUMEN
Sorafenib is a multikinase inhibitor that is used for the treatment of metastatic renal-cell carcinoma. We report the case of a patient with painless acute pancreatitis associated with sorafenib treatment. The patient was a 71-year-old man who had undergone surgery for left renal carcinoma and tumor thrombus in the inferior vena cava and right atrium (IVC-RA). After a follow-up period of 3 years, he developed right adrenal metastasis and received interferon (IFN)-alpha treatment. One year later, progression of the adrenal metastasis was observed, and he was admitted to a hospital for treatment with sorafenib, which was administered at a dose of 800 mg/day. Two weeks later, he developed painless acute pancreatitis associated with sorafenib treatment. Thereafter, sorafenib treatment was discontinued, and he was treated with conservative therapy. Three weeks later, he was discharged. Even though painless acute pancreatitis associated with sorafenib treatment is rare, the possible development of painless acute pancreatitis in patients undergoing sorafenib treatment must be kept in mind.
Asunto(s)
Antineoplásicos/efectos adversos , Bencenosulfonatos/efectos adversos , Pancreatitis/inducido químicamente , Piridinas/efectos adversos , Neoplasias de las Glándulas Suprarrenales/tratamiento farmacológico , Neoplasias de las Glándulas Suprarrenales/secundario , Anciano , Antineoplásicos/uso terapéutico , Bencenosulfonatos/uso terapéutico , Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/secundario , Humanos , Factores Inmunológicos/uso terapéutico , Interferón-alfa/uso terapéutico , Neoplasias Renales/tratamiento farmacológico , Neoplasias Renales/patología , Masculino , Niacinamida/análogos & derivados , Compuestos de Fenilurea , Piridinas/uso terapéutico , SorafenibRESUMEN
We report a rare case of adrenal and renal metastases from papillary thyroid carcinoma (PTC). A 30-year-old man underwent total thyroidectomy with left neck dissection for cytology proven nodal metastases from PTC. This was followed by high-dose radioiodine therapy with a dose of 265 mCi (9.805 GBq). Thereafter, patient was lost to follow-up. He presented 2 decades later with low backache radiating to both the lower limbs. Magnetic resonance imaging examination of spine detected left SI joint, dorsal and lumbar vertebral metastases. A whole-body radioiodine scan showed extensive iodine avid foci in thyroid bed, mediastinum, bilateral lungs, liver, bones, and in bilateral lumbar regions. An abdominal single photon emission computed tomography-computed tomography (CT) revealed the lumbar lesions to be within bilateral adrenal glands. Contrast-enhanced CT of abdomen revealed lesions in bilateral adrenals and renal regions suggestive of metastases. A CT-guided biopsy of left adrenal focus confirmed metastasis from the carcinoma of thyroid. A high degree of suspicion with further radiologic and cytologic correlation clinched the diagnosis of both adrenal and renal metastases from PTC, which has been rarely reported. Fortunately, radioiodine concentration in adrenal metastases made them amenable to high-dose radioiodine therapy. Therefore, 225 mCi (8.325 GBq) of radioiodine was administered to this patient. This case is a strong reminder of the fact that regular and long-term follow-up is imperative in the management of thyroid cancer patients.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/secundario , Carcinoma Papilar/patología , Neoplasias Renales/secundario , Neoplasias de la Tiroides/patología , Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/patología , Adulto , Medios de Contraste , Fluorodesoxiglucosa F18 , Humanos , Radioisótopos de Yodo , Neoplasias Renales/diagnóstico por imagen , Masculino , Tomografía de Emisión de Positrones , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos X , Imagen de Cuerpo EnteroRESUMEN
We report a case of 57-year-old woman suffering from advanced sigmoid colon cancer with adrenal and para-aortic lymph node recurrence. Sigmoidectomy was performed for sigmoid colon cancer in January 2002. Pathological staging was Stage II (pT3, pN0, pM0, Cur A). She received a UFT + CPT-11 regimen as preoperative chemotherapy for liver metastasis (S2, S7) from December 2002. A partial liver resection (S2, S7) was performed for liver metastasis in July 2003, and the UFT + CPT-11 was introduced as adjuvant chemotherapy. However, adrenal and para-aortic lymph node recurrence was detected in February 2007, and mFOLFOX6 was performed as preoperative chemotherapy. Right adrenalectomy and para-aortic lymph node dissection was performed in July 2007. mFOLFOX6 as postoperative chemotherapy was done, mFOLFOX6 + bevacizumab was started because of CEA increase. The chemotherapy was performed for 23 courses and temporarily stopped due to adverse reactions, such as peripheral neuropathy (grade 2), general fatigue (grade 1), and nausea (grade 1). She had no recurrence for almost 3 years after a resection of adrenal and para-aortic lymph node metastasis.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/terapia , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Metástasis Linfática , Neoplasias del Colon Sigmoide/patología , Neoplasias del Colon Sigmoide/terapia , Adrenalectomía , Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Antineoplásicos Fitogénicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Aorta , Bevacizumab , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Terapia Combinada , Femenino , Fluorouracilo/uso terapéutico , Hepatectomía , Humanos , Irinotecán , Leucovorina/uso terapéutico , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Compuestos Organoplatinos/uso terapéutico , Tegafur/administración & dosificación , Uracilo/administración & dosificaciónRESUMEN
PURPOSE: To evaluate the safety and efficacy of high-dose [(131)I]metaiodobenzylguanidine ([(131)I]MIBG) in the treatment of malignant pheochromocytoma (PHEO) and paraganglioma (PGL). METHODS: Fifty patients with metastatic PHEO or PGL, age 10 to 64 years, were treated with [(131)I]MIBG doses ranging from 492 to 1,160 mCi (median, 12 mCi/kg). Cumulative [(131)I]MIBG administered ranged from 492 to 3,191 mCi. Autologous hematopoietic stem cells were collected and cryopreserved before treatment with [(131)I]MIBG greater than 12 mCi/kg or with a total dose greater than 500 mCi. Sixty-nine [(131)I]MIBG infusions were given, which included infusions to 35 patients treated once and infusions to 15 patients who received two or three treatments. Response was evaluated by [(123)I]MIBG scans, computed tomography/magnetic resonance imaging, urinary catecholamines/metanephrines, and chromogranin A. RESULTS: The overall complete response (CR) plus partial response (PR) rate in 49 evaluable patients was 22%. Additionally, 35% of patients achieved a CR or PR in at least one measure of response without progressive disease, and 8% of patients maintained stable disease for greater than 12 months. Thirty-five percent of patients experienced progressive disease within 1 year after therapy. The estimated 5-year overall survival rate was 64%. Toxicities included grades 3 to 4 neutropenia (87%) and thrombocytopenia (83%). Grades 3 to 4 nonhematologic toxicity included acute respiratory distress syndrome (n = 2), bronchiolitis obliterans organizing pneumonia (n = 2), pulmonary embolism (n = 1), fever with neutropenia (n = 7), acute hypertension (n = 10), infection (n = 2), myelodysplastic syndrome (n = 2), and hypogonadism (n = 4). CONCLUSION: Although serious toxicity may occur, the survival and response rates achieved with high-dose [(131)I]MIBG suggest its utility in the management of selected patients with metastatic PHEO and PGL.