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1.
Anticancer Res ; 40(3): 1467-1473, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132045

RESUMO

BACKGROUND: BTH1677 is a beta-glucan pathogen-associated molecular pattern (PAMP) being evaluated as a novel immunotherapy of cancer. We previously described that the presence of antibodies against beta-glucan (ABA) in serum is necessary for BTH1677 antitumoral activity. We hypothesized that infusion of immunoglobulin can reinstate responses to BTH1677 in individuals with low ABA levels. PATIENTS AND METHODS: We report two single-patient studies: one in a patient with metastatic colorectal cancer who received BTH1677, combined with tumor targeting antibody cetuximab; and a second in a patient with metastatic neuroendocrine tumor who received BTH1677 combined with immune checkpoint inhibitor pembrolizumab. RESULTS: The patients had low serum titers of ABA and low innate immune effector functionality induced by BTH1677. Addition of intravenous immunoglobulins restored innate immune activity of BTH1677 and induced clinically meaningful anti-tumoral activity, with long-term disease control. CONCLUSION: Infusion of immunoglobulin can restore activity of BTH1677 in individuals with low serum ABA level.


Assuntos
Anticorpos/sangue , Neoplasias Colorretais/imunologia , Neoplasias Colorretais/terapia , Glucanos/administração & dosagem , Tumores Neuroendócrinos/imunologia , Tumores Neuroendócrinos/terapia , beta-Glucanas/imunologia , Idoso de 80 Anos ou mais , Anticorpos/imunologia , Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Cetuximab/administração & dosagem , Feminino , Humanos , Imunoglobulinas/administração & dosagem , Imunoterapia/métodos , Pessoa de Meia-Idade
2.
Eur J Endocrinol ; 182(4): 439-446, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32061159

RESUMO

Introduction: Management of malignant insulinomas is challenging due to the need to control both hypoglycaemic syndrome and tumor growth. Literature data is limited to small series. Aim of the study: To analyze clinico-pathological characteristics, treatments and prognosis of patients with malignant insulinoma. Materials and methods: Multicenter retrospective study on 31 patients (male: 61.3%) diagnosed between 1988 and 2017. Results: The mean age at diagnosis was 48 years. The mean NET diameter was 41 ± 31 mm, and 70.8% of NETs were G2. Metastases were widespread in 38.7%, hepatic in 41.9% and only lymph nodal in 19.4%. In 16.1% of the cases, the hypoglycaemic syndrome occurred after 46 ± 35 months from the diagnosis of originally non-functioning NET, whereas in 83.9% of the cases it led to the diagnosis of NET, of which 42.3% with a mean diagnostic delay of 32.7 ± 39.8 months. Surgical treatment was performed in 67.7% of the cases. The 5-year survival rate was 62%. Overall survival was significantly higher in patients with Ki-67 ≤10% (P = 0.03), insulin level <60 µU/mL (P = 0.015) and in patients who underwent surgery (P = 0.006). Peptide Receptor Radionuclide Therapy (PRRT) was performed in 45.1%, with syndrome control in 93% of patients. Conclusions: Our study includes the largest series of patients with malignant insulinoma reported to date. The hypoglycaemic syndrome may occur after years in initially non-functioning NETs or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 ≤10% are prognostic factors associated with better survival. PPRT proved to be effective in the control of hypoglycaemia in majority of cases.


Assuntos
Insulinoma/mortalidade , Tumores Neuroendócrinos/mortalidade , Neoplasias Pancreáticas/mortalidade , Feminino , Humanos , Hipoglicemia/etiologia , Hipoglicemia/mortalidade , Hipoglicemia/patologia , Insulinoma/patologia , Insulinoma/terapia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
3.
Eur J Endocrinol ; 182(4): R29-R58, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31999619

RESUMO

Ectopic ACTH syndrome (EAS) is rare but is frequently a severe condition because of the intensity of the hypercortisolism that may be dissociated from the tumoral condition. EAS should often be considered as an endocrine emergency requiring an emergency response both in terms of diagnostic procedures and therapeutic interventions. Patient management is complex and necessitates dual skills, in the diagnosis and treatment of CS and in the specific management of neuroendocrine tumors (NET). Therefore, initial management should be performed ideally by experienced endocrinology teams in collaboration with specialized hormonal laboratory, modern imaging platforms and intensive care units. Diagnostic procedures vary according to the endocrine and tumoral contexts but should be reduced to a minimum in intense hypercortisolism. Preventive and curative treatments of cortisol-induced comorbidities, non-specific management of hypercortisolism and etiological treatments should be considered simultaneously. Therapeutic strategies vary according to (1.) the intensity of hypercortisolism, the general condition of the patient and associated comorbidities and (2.) the tumoral status, ranging from resectable ACTH secreting tumors to non-resectable metastatic endocrine tumors or occult tumors. The ideal treatment is complete excision of the ACTH-secreting tumor that can be performed rapidly or after preoperative preparation using cortisol-lowering drugs. When this is not possible, the therapeutic strategy should be discussed by a multidisciplinary experienced team in a personalized perspective and include variable combinations of pharmacological agents, bilateral adrenalectomy and non-specific tumoral interventions. Here we discuss the diagnosis and therapeutic strategies including the modern, currently available tools and emphasize on the operational effectiveness of care.


Assuntos
Síndrome de ACTH Ectópico/diagnóstico , Síndrome de ACTH Ectópico/terapia , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/terapia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/terapia , Síndrome de ACTH Ectópico/complicações , Síndrome de Cushing/etiologia , Endocrinologia/métodos , Humanos , Tumores Neuroendócrinos/complicações , Resultado do Tratamento
4.
Int J Cancer ; 146(5): 1316-1323, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31509608

RESUMO

Due to the increasing incidence and prevalence of neuroendocrine tumors (NETs), there is a need to assess any gaps in awareness and care. A survey was undertaken in 2017 to identify perceived unmet needs from the perspectives of patients/families, patient advocates and health care professionals (HCPs). The survey consisted of 33-37 questions (depending on type of respondent) across four areas: information, care, treatments and research. In total, 443 participants from 26 countries responded: 338 patients/families, 35 advocates and 70 HCPs. Perceived unmet needs regarding provision of information at diagnosis differed between groups. While 59% of HCPs believed they provided sufficient information, informational needs were mostly/fully met for only 30% of patients and 18% of advocates. Additionally, 91% of patients and 97% of advocates felt that patients had to search for information themselves. Availability of Gallium-68-Dotatate PET/CT scan was limited for the majority of patients (patients: 73%; advocates: 85%; HCP: 86%), as was access to treatments, particularly peptide receptor radionuclide therapy (patients: 42%; advocates: 95%; HCPs: 77%). All groups felt that standards of care, including psychological needs and diagnosis of mental health, were not fully met. Although about two-thirds of patients were managed by a multidisciplinary team, 14% of patients reportedly did not have enough contact. All groups supported more patient involvement in research; patients and advocates prioritized improvement in diagnosis and HCPs focused on clinical trials. This survey revealed significant unmet needs but differing perceptions regarding these among the groups. There is a need for investigation and collaboration to improve standards of care for NET patients.


Assuntos
Saúde Global , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Tumores Neuroendócrinos/terapia , Participação do Paciente/estatística & dados numéricos , Lacunas da Prática Profissional/estatística & dados numéricos , Adolescente , Adulto , Carga Global da Doença , Comunicação em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Incidência , Comportamento de Busca de Informação , Oncologia/organização & administração , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/epidemiologia , Neuroendocrinologia/organização & administração , Neuroendocrinologia/estatística & dados numéricos , Defesa do Paciente/estatística & dados numéricos , Prevalência , Relações Profissional-Paciente , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
5.
J Surg Oncol ; 121(3): 480-485, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31853990

RESUMO

BACKGROUND: Somatostatin analog functional imaging with gallium-68 (Ga-68) dotatate positron emission tomography/computed tomography (PET/CT) has demonstrated superiority in lesion detection in patients with neuroendocrine tumors (NETs). The clinical impact of this imaging modality on US surgical and medical oncology practices has not been established. METHODS: Consecutive patients with NET at our institution who received an initial Ga-68 dotatate PET/CT between July 2017 and September 2018 were included. Ga-68 dotatate PET/CT was compared with prior imaging. RESULTS: Among 101 eligible patients, 51 of 50 were female/male, site of origin was gastroenteropancreatic (75%), unknown primary (13%), lung (8%), thymus (2%), and other (2%). All NETs were histologically well/moderately differentiated. Ga-68 dotatate imaging findings altered management in 36 (35.6%) patients: documentation of progression led to the initiation of systemic therapy in 14 patients, obviated the need for biopsy in four patients, and altered surgical plans in 7 of 14 (50%) patients referred for surgery. In 11 patients, decisions regarding peptide receptor radionucleotide therapy and somatostatin analogs were altered. CONCLUSIONS: In this series, Ga-68 dotatate PET/CT altered diagnosis and management in one-third of patients and changed operative plans in half of the patients who were referred for surgical evaluation. These results support the routine use of this imaging in the care of patients with early-stage and advanced NETs.


Assuntos
Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/terapia , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/terapia , Compostos Organometálicos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/terapia , Feminino , Radioisótopos de Gálio , Humanos , Neoplasias Intestinais/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Primárias Desconhecidas/terapia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Neoplasias do Timo/terapia
6.
BMC Cancer ; 19(1): 1226, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842791

RESUMO

BACKGROUND: Neuroendocrine tumours (NETs) are rare malignancies characterised by its capacity to synthesise and secrete monoamines, due to its neuroendocrine origin. Its varied locations and symptoms have traditionally been responsible for extended delays in their diagnosis. The interest of this study was to characterise the patient population diagnosed with NETs in Spain and to revise how the disease is managed, together with the hospitalisation costs of these patients. METHODS: The database included records of all patients diagnosed with a NET between 2010 and 2015. Admission records were used to evaluate hospitalisation, disease management data and costs, and single-patient files were used to characterise the population. RESULTS: Nine Thousand One Hundred Twenty patients were diagnosed with a neuroendocrine tumour between 2010 and 2015, with a 2 fold increase in the diagnosis rate over the study period. 42.25% of the patients were females, while 57.75% were males, and mean diagnosis age was 62.58 years (SD = 14.65). Considering all the registered neuroendocrine neoplasms, 46.86% of the patients had malignant well-differentiated NETs, 32.02% had a malignant poorly differentiated neuroendocrine carcinoma and 42.93% of patients developed metastatic NETs. In addition, 18.59% of patients were diagnosed with benign well-differentiated NETs. The most common tumour sites were the bronchus, lung and other sites, including pancreatic tumours; metastasis was found in the liver and distant lymph nodes. Pancreatic resection was the most common surgical procedure utilised in these patients, summing 19% of total expenses, the injection of an unspecified therapeutic substance (including targeted therapies) was registered in 11.40% of admissions, while chemotherapy was registered in only 6.85% of admissions. The annual healthcare cost of NETs was €15,373,961, corresponding to €9092 per patient. CONCLUSIONS: The implementation of standard diagnosis procedures should be prioritised, with a focus on the pancreas and lung, and taking into account that 42.93% of the patients develop a metastatic tumour. The presence of comorbidities and multimorbidities should be considered in order to develop more efficient disease management protocols.


Assuntos
Gerenciamento Clínico , Tumores Neuroendócrinos/epidemiologia , Sistema de Registros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/economia , Tumores Neuroendócrinos/terapia , Espanha , Adulto Jovem
7.
Zhonghua Wai Ke Za Zhi ; 57(11): 866-871, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694137

RESUMO

Neuroendocrine tumor(NET) is a kind of highly heterogeneous and ubiquitous tumor, frequently localized in the gastrointestinal tract and pancreas. Surgery combined with regional ablation, endocrine therapy,chemotherapy and targeted therapy presents a favorable prognosis when treated with G1 or G2 gastroenteropancreatic neuroendocrine tumor(GEP-NET). However, there are only limited therapeutic strategies for metastatic unresectable tumors and poorly differentiated NEC,which are closely related to the special tumor microenvironment of neuroendocrine tumors.Targeting tumor microenvironment therapy is an important method in current systematic therapy, but till now the knowledge of neuroendocrine tumor microenvironment and its related treatment are limited. This article will specifically introduce the characteristics of tumor microenvironment in GEP-NET from the following aspects: the formation of enrichment vascular supply in TME,the role of tumor stroma,immune cells and cancer associacted fibroblast, and immune checkpoint and future trend of immunotherapy.


Assuntos
Neoplasias Intestinais/patologia , Neoplasias Intestinais/terapia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Microambiente Tumoral , Humanos
8.
World J Gastroenterol ; 25(39): 5991-6005, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31660035

RESUMO

BACKGROUND: Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) is a rare diagnosis, mainly encountered in the gastro-entero-pancreatic tract. There is limited knowledge of its epidemiology, prognosis and biology, and the best management for affected patients is still to be defined. AIM: To investigate clinical-pathological characteristics, treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of MiNEN. METHODS: Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European centres. Patient data were retrospectively collected from medical records. Pathological samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of MiNEN. Tumour responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours 1.1. Kaplan-Meier analysis was applied to estimate survival outcomes. Associations between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions (univariate) and Cox-regression analysis (multivariable). RESULTS: Sixty-nine consecutive patients identified; Median age at diagnosis: 64 years. Males: 63.8%. Localised disease (curable): 53.6%. Commonest sites of origin: colon-rectum (43.5%) and oesophagus/oesophagogastric junction (15.9%). The neuroendocrine component was; predominant in 58.6%, poorly differentiated in 86.3%, and large cell in 81.25%, of cases analysed. Most distant metastases analysed (73.4%) were occupied only by a poorly differentiated neuroendocrine component. Ninety-four percent of patients with localised disease underwent curative surgery; 53% also received perioperative treatment, most often in line with protocols for adenocarcinomas from the same sites of origin. Chemotherapy was offered to most patients (68.1%) with advanced disease, and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal proportion. In localised cases, median recurrence free survival (RFS); 14.0 mo (95%CI: 9.2-24.4), and median overall survival (OS): 28.6 mo (95%CI: 18.3-41.1). On univariate analysis, receipt of perioperative treatment (vs surgery alone) did not improve RFS (P = 0.375), or OS (P = 0.240). In advanced cases, median progression free survival (PFS); 5.6 mo (95%CI: 4.4-7.4), and median OS; 9.0 mo (95%CI: 5.2-13.4). On univariate analysis, receipt of palliative active treatment (vs best supportive care) prolonged PFS and OS (both, P < 0.001). CONCLUSION: MiNEN is most commonly driven by a poorly differentiated neuroendocrine component, and has poor prognosis. Advances in its biological understanding are needed to identify effective treatments and improve patient outcomes.


Assuntos
Diferenciação Celular , Neoplasias Intestinais/epidemiologia , Neoplasias Complexas Mistas/epidemiologia , Tumores Neuroendócrinos/epidemiologia , Neoplasias Pancreáticas/epidemiologia , Neoplasias Gástricas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante/métodos , Quimioterapia Adjuvante/métodos , Intervalo Livre de Doença , Europa (Continente)/epidemiologia , Feminino , Humanos , Neoplasias Intestinais/patologia , Neoplasias Intestinais/terapia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Neoplasias Complexas Mistas/patologia , Neoplasias Complexas Mistas/terapia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Cuidados Paliativos/métodos , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia
9.
J Zhejiang Univ Sci B ; 20(10): 861-864, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489805

RESUMO

Rectal neuroendocrine neoplasms (NENs) are low-grade malignancies, which are slow-growing and usually become symptomatic late in the course of the disease (Basuroy et al., 2016). In recent years, rectal NENs are increasingly frequently detected, with the widespread availability and accessibility of endoscopy and cross-sectional imaging modalities (Kos-Kudla et al., 2017). Multiple studies have shown that endoscopic ultrasound (EUS) is an advanced endoscopic technique and is currently used in the diagnosis and preoperative assessment of NENs (Kim, 2012; Liu et al., 2013; Zhang et al., 2017). However, EUS imaging of rectal NEN and differential diagnosis with other submucosal tumors (SMTs) has not been adequately reported. In this study, we reviewed and summarized the EUS imaging and pathological features of rectal NENs of 38 cases to improve preoperative diagnosis rate and reduce unreasonable treatment.


Assuntos
Endossonografia/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Retais/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/terapia , Neoplasias Retais/terapia
10.
Gynecol Oncol ; 155(2): 254-261, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31519319

RESUMO

OBJECTIVE: Neuroendocrine carcinoma of the endometrium (NECE) is a rare malignancy. We examined the natural history and outcomes of women with NECE compared to patients with poorly differentiated endometrioid endometrial cancer (EC). METHODS: The National Cancer Database (NCDB) was used to identify women with NECE and women with poorly differentiated EC from 2004 to 2015. Clinical, demographic, and treatment characteristics were compared between groups. Kaplan-Meier survival curves and multivariable Cox proportional hazard regression models were used to identify associations between tumor histology and survival. RESULTS: A total of 28,291 women with EC and 364 women with NECE were identified. Patients with NECE were more often non-white and presented with later stage disease compared to patients with EC. Women with NECE were more likely to receive adjuvant chemotherapy (60.2% vs. 29.6%), but were less likely to receive radiation (28.0% vs. 47.6%) (P < 0.001 for both). Median survival was 17 months (95% CI, 12-23) for NECE and 144 months (95% CI, 140-148) for EC. 5-year survival was 38.3% (95% CI, 32.7-43.8%) for NECE vs. 68.8% (95% CI, 68.2-69.4%) for EC. In a multivariable model, the hazard ratio for death for women with NECE compared to EC was 2.32 (95% CI, 1.88-2.88). Similar findings were noted when the analysis was limited to women with stage I (HR = 1.62; 95% CI, 1.01-2.61), and stage III (HR = 2.57; 95% CI, 1.88-3.53) neoplasms. CONCLUSIONS: NECE is a rare and aggressive uterine carcinoma. Compared to patients with poorly differentiated EC, patients with NECE present with later stage disease and have decreased survival.


Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias do Endométrio/patologia , Tumores Neuroendócrinos/patologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma Neuroendócrino/mortalidade , Carcinoma Neuroendócrino/terapia , Quimioterapia Adjuvante , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/terapia , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/terapia , Radioterapia Adjuvante , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
12.
Future Oncol ; 15(26): 3015-3024, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31424273

RESUMO

Aim: Data from 69 well-differentiated gastroenteropancreatic neuroendocrine tumors treated with peptide receptor radionucleotide therapy + somatostatin analogs (SSAs) after SSA treatment failure were evaluated. Methods: We identified two groups: S1 - patients who kept the same SSA treatment beyond progression; S2 - patients who switched the SSA with another SSA after progression. Results: Median progression-free survival was 53 and 127 months in S1 and S2, respectively (p = 0.001; hazard ratio: 0.31; 95% CI: 0.15-0.63). Median overall survival was 69 versus 150 months in S1 and S2, respectively (p = 0.004; hazard ratio: 0.32; 95% CI: 0.14-0.71). Conclusion: In patients with advanced well-differentiated gastroenteropancreatic neuroendocrine tumors treated with peptide receptor radionucleotide therapy plus SSA after SSA failure, the 'switch' strategy of SSA after progression improve progression-free survival and overall survival.


Assuntos
Neoplasias Intestinais/patologia , Neoplasias Intestinais/terapia , Marcação por Isótopo , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Nucleotídeos , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/terapia , Somatostatina/uso terapêutico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Intestinais/metabolismo , Neoplasias Intestinais/mortalidade , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Tumores Neuroendócrinos/metabolismo , Tumores Neuroendócrinos/mortalidade , Nucleotídeos/química , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/mortalidade , Prognóstico , Modelos de Riscos Proporcionais , Receptores de Peptídeos/metabolismo , Estudos Retrospectivos , Somatostatina/análogos & derivados , Somatostatina/química , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/mortalidade , Resultado do Tratamento
13.
Prostate ; 79(12): 1457-1461, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31294484

RESUMO

BACKGROUND: Small cell carcinoma (SCC) of the prostate is a rare, aggressive disease. Evidence is limited; however, the current standard of care is chemotherapy. The benefit of local treatment modalities is unknown. METHODS: We queried the National Cancer Database identifying all SCC/neuroendocrine cases of the prostate, excluding those with unknown nodal or metastatic status, unknown treatment, or those not receiving chemotherapy. Overall survival (OS) was calculated using Kaplan-Meier curves. Multivariable Cox proportional hazards model was used to identify factors associated with survival. A further subgroup analysis was performed on the utility of local therapy on survival in the nonmetastatic setting. RESULTS: Our final cohort included 657 patients with a median age of 68. Most patients had positive lymph nodes (60.1%) and metastatic disease (70.0%). Median survival was 12 months (95% confidence interval [95% CI], 11.1-13.3 months) with a median follow-up of 11.8 months. Metastatic disease, age greater than or equal to 70, omission of androgen deprivation therapy (ADT), and lower income (P < .05 for all) were all associated with reduced OS. Patients with prostate-specific antigen (PSA) greater than or equal to 33 ng/mL and those receiving ADT had better survival (P < .05). Those with nonmetastatic disease were more likely to undergo prostatectomy and/or prostatic/pelvic radiation (P < .0001). Prostatic/pelvic radiation in the nonmetastatic setting was associated with longer survival (P = .02). Though well powered, our study is limited by the selection bias inherent to all observational studies, despite the statistical methods utilized to reduce this effect. CONCLUSIONS: Although chemotherapy is the mainstay of treatment, radiation to the prostate/pelvis may be beneficial in the nonmetastatic setting. In addition to chemotherapy, ADT may benefit patients with an elevated PSA.


Assuntos
Carcinoma de Células Pequenas/epidemiologia , Carcinoma de Células Pequenas/terapia , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/terapia , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Pequenas/mortalidade , Bases de Dados Factuais , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/mortalidade , Neoplasias da Próstata/mortalidade , Resultado do Tratamento , Estados Unidos/epidemiologia
14.
Int J Gynecol Cancer ; 29(6): 986-995, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31263021

RESUMO

Neuroendocrine carcinomas of the cervix account for less than 2% of all invasive cervical cancers and are classified as low-grade (carcinoid, atypical carcinoid tumor) or high-grade (known as small- and large-cell) neuroendocrine carcinomas. There are increasing data showing that cervical neuroendocrine carcinomas may be associated with the human papillomavirus (HPV), especially HPV18, and most will stain positive for p16. Immunohistochemistry markers such as synaptophysin and CD56 are the most sensitive markers. Although there are no commonly associated mutations, PIK3CA, KRAS, and TP53 are the most frequently found mutations in neuroendocrine tumors. Neuroendocrine cervical carcinomas are exceedingly aggressive tumors with a high tendency for nodal involvement and distant metastases. Age, lymph node metastases, smoking, pure small-cell histology, and tumor size are independent prognostic factors. Overall, the 5-year survival rate is 36% and the median overall survival ranges between 22 and 25 months. Treatment options are often extrapolated from small-cell lung cancer and limited retrospective studies. The preferred treatment is a multimodal approach of surgery, chemoradiation, and systemic chemotherapy. The most common chemotherapy regimen used as initial therapy is a combination of cisplatin and etoposide. In the setting of recurrent disease, a combination of topotecan, paclitaxel, and bevacizumab has demonstrated favorable outcomes. Multicenter tumor registries, such as the Neuroendocrine Cervical Tumor Registry (NeCTuR), are an opportunity to evaluate patterns of disease treatment and oncologic outcomes.


Assuntos
Algoritmos , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/terapia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia , Feminino , Humanos
15.
Surg Clin North Am ; 99(4): 793-814, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31255207

RESUMO

Pancreatic neuroendocrine tumors are a diverse group of neoplasms with a generally favorable prognosis. Although they exhibit indolent growth, metastases are seen in roughly 60% of patients. Pancreatic neuroendocrine tumors may produce a wide variety of hormones, which are associated with dramatic symptoms, but the majority are nonfunctional. The diagnosis and treatment of these tumors is a multidisciplinary effort, and management guidelines continue to evolve. This review provides a concise summary of the presentation, diagnosis, surgical management, and systemic treatment of pancreatic neuroendocrine tumors.


Assuntos
Gerenciamento Clínico , Tumores Neuroendócrinos/diagnóstico , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico , Pancreaticoduodenectomia/métodos , Humanos , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/terapia , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
16.
Int J Surg Oncol ; 2019: 2912361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31186956

RESUMO

This study examines survival time in patients with small bowel tumors and determines its contributing factors. In this retrospective analytical study, the medical records of 106 patients with small bowel cancer (from 2006 to 2011) were investigated. The patients' data were extracted, including age, gender, clinical presentation, location of tumor, histological type, grade of tumor, site of metastasis, and type of treatment. The Kaplan-Meier test was used to estimate the overall survival time and the Log-rank test to compare the survival curves. The Cox regression was also used to evaluate the effect of the confounding variables on survival time. This study was conducted on 106 patients with a median age of 60 years (Min: 7, Max: 87). The tumor types included adenocarcinoma (n=78, 73.6%), MALToma (n=22, 20.8%), neuroendocrine tumors (n=4, 3.8%), and sarcoma (n=2. 1.8%). Grade 3 adenocarcinomas had a significantly lower survival time (HR: 1.48, 95% CI: 0.46-2.86; P=.001). Combined therapy (chemotherapy and surgery) vs. single-therapy (only surgery) had no significant effects on the survival of the patients with MALToma (5 vs. 3 months, 95% CI: 1.89-5.26; P=.06). There were no significant differences between the survival time in adenocarcinoma and MALToma (12 vs. 20 months, 95% CI: 6.24-24.76; P=.49). Tumor grade was the only independent prognostic factor that affected survival in adenocarcinoma. The patients diagnosed with MALToma in the study also had a poor prognosis, and the type of treatment had no significant effect on their survival.


Assuntos
Adenocarcinoma/mortalidade , Neoplasias Intestinais/mortalidade , Intestino Delgado , Linfoma de Zona Marginal Tipo Células B/mortalidade , Tumores Neuroendócrinos/mortalidade , Sarcoma/mortalidade , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Seguimentos , Humanos , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/patologia , Neoplasias Intestinais/terapia , Estimativa de Kaplan-Meier , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Linfoma de Zona Marginal Tipo Células B/patologia , Linfoma de Zona Marginal Tipo Células B/terapia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Prognóstico , Estudos Retrospectivos , Sarcoma/diagnóstico , Sarcoma/patologia , Sarcoma/terapia , Análise de Sobrevida , Adulto Jovem
17.
Br J Nurs ; 28(11): 715-720, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31188669

RESUMO

The number of people diagnosed and living with cancer in the UK continues to rise, placing increasing demands on specialist cancer care services. The incidence and prevalence of neuroendocrine tumours (NETs) has increased. An NET remains a rare cancer requiring specialist care and the clinical nurse specialist (CNS) team is ideally placed to support these patients. Oncology clinics are becoming increasingly pressured and the need to think of innovative ways of reducing pressure while maintaining and enhancing the patient's experience is important. A new multidisciplinary team (MDT) systemic anti-cancer therapy (SACT) clinic for NET patients was developed that incorporated a CNS SACT non-medical prescriber (NMP) to improve patient experience and reduce the number of oncologist clinic reviews. Methods and analysis: the clinic was designed and a protocol developed to help ensure safe practice and support for the CNS NMP. The patient experience was prioritised and the medical team was involved in the design. All NMP SACT prescriptions were reviewed and questionnaires were given to patients after 3 months. A questionnaire was also given to all oncologists within the clinic and to the oncology pharmacist for analysis. Findings: 29 SACT NMP prescriptions for 15 patients were written. Patient and medical colleague feedback was positive. Discussion: this experience has helped to highlight the positive impact of innovative clinics that combine the expertise of both independent nurse practitioners and the medical team. This has paved the way for further clinics of this kind within the author's trust and the NET service.


Assuntos
Institutos de Câncer/organização & administração , Tumores Neuroendócrinos/terapia , Enfermeiras Clínicas , Equipe de Assistência ao Paciente/organização & administração , Pesquisas sobre Serviços de Saúde , Humanos , Tumores Neuroendócrinos/epidemiologia , Papel do Profissional de Enfermagem , Pesquisa em Avaliação de Enfermagem , Reino Unido/epidemiologia
20.
Ann Surg Oncol ; 26(9): 2711-2721, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147993

RESUMO

BACKGROUND: Given a slow course of disease, end-of-life issues are understudied in neuroendocrine tumors (NETs). To date, there are no data regarding symptoms at the end of life. This study examined symptom trajectories and factors associated with high symptom burden in NETs at the end of life. METHODS: We conducted a retrospective cohort study of NET patients diagnosed from 2004 to 2015 and who died between 2007 and 2016, in Ontario, Canada. Prospectively collected patient-reported Edmonton Symptom Assessment System scores were linked to administrative healthcare datasets. Moderate-to-severe symptom scores (≥ 4 out of 10) in the 6 months before death were analyzed, with multivariable modified Poisson regression identifying factors associated with moderate-to-severe symptoms scores. RESULTS: Among 677 NET decedents, 2579 symptom assessments were recorded. Overall, moderate-to-severe scores were most common for tiredness (86%), wellbeing (81%), lack of appetite (75%), and drowsiness (68%), with these proportions increasing as death approached. For symptoms of lack of appetite, drowsiness, and shortness of breath, the increase was steepest in the 8 weeks before death. On multivariable analyses, the risk of moderate-to-severe symptoms was significantly higher in the last 2 months before death and for patients with shorter survival (< 6 months). Women had higher risks of anxiety, nausea, and pain. CONCLUSION: A high prevalence of moderate-to-severe symptoms was observed for NETs at the end of life, not previously described. The proportion of moderate-to-severe symptoms increases steeply as death nears, highlighting an opportunity for improved management. Combined with identified factors associated with moderate-to-severe symptoms, this information is important to improve patient-centred and personalized supportive care for NETs at the end of life.


Assuntos
Tumores Neuroendócrinos/complicações , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Índice de Gravidade de Doença , Avaliação de Sintomas/mortalidade , Assistência Terminal/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/diagnóstico , Ansiedade/etiologia , Fadiga/diagnóstico , Fadiga/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/diagnóstico , Náusea/etiologia , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/terapia , Ontário/epidemiologia , Dor/diagnóstico , Dor/etiologia , Cuidados Paliativos , Prevalência , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
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