Ablative therapies for liver metastases of digestive endocrine tumours.

2003 ◽  
pp. 463-468 ◽  
Author(s):  
D O'Toole ◽  
F Maire ◽  
P Ruszniewski
Keyword(s):  
Liver Metastases ◽  
Somatostatin Analogs ◽  
Hepatic Metastases ◽  
Vascular Occlusion ◽  
Treatment Method ◽  
Vascular Tumors ◽  
Endocrine Tumors ◽  
Hepatic Ischemia ◽  
Ablative Therapies

Hepatic metastases are frequently encountered in patients with digestive endocrine tumors and their presence plays an important role in quality of life and overall prognosis. Surgery is the treatment method of choice for hepatic metastases but this is frequently impossible due to the extent of disease. Systemic chemotherapy is offered to patients with diffuse and/or progressive liver metastases but results are disappointing especially in patients with metastases of midgut origin. In the latter patients with carcinoid syndrome, somatostatin analogs are frequently initially effective but their efficacy wanes due to disease progression and development of tachyphylaxis. Other therapeutic options in the treatment of hepatic metastases are locoregional strategies where vascular occlusion induces ischemia in these highly vascular tumors using either surgical or radiological techniques. Available methods include surgical ligation of the hepatic artery, transient hepatic ischemia or sequential hepatic arterialization. Trans-catheter arterial chemoembolization has proven effective in terms of long palliation and objective tumor responses. Other treatments aimed at regional destruction either alone or in combination with surgery include radiofrequency ablation and cryotherapy. The latter are usually important adjuncts to surgery and are usually reserved for limited disease.

scholarly journals Prospective Study of the Natural History of Gastrinoma in Patients with MEN1: Definition of an Aggressive and a Nonaggressive Form

2001 ◽  
Vol 86 (11) ◽  
pp. 5282-5293 ◽  
Author(s):  
Fathia Gibril ◽  
David J. Venzon ◽  
Jeremiah V. Ojeaburu ◽  
Showkat Bashir ◽  
Robert T. Jensen
Keyword(s):  
Natural History ◽  
Tumor Growth ◽  
Prospective Study ◽  
Liver Metastases ◽  
Hepatic Metastases ◽  
Endocrine Tumors ◽  
Zollinger Ellison Syndrome ◽  
Pancreatic Endocrine Tumors ◽  
History Of ◽  
Aggressive Tumor

The natural history of pancreatic endocrine tumors (PETs) in patients with MEN1 is largely unknown. Recent studies in patients with sporadic PETs show that in a subset, tumor growth is aggressive. To determine whether PETs in patients with MEN1 show similar growth behavior, we report results from a long-term prospective study of 57 patients with MEN1 and Zollinger-Ellison syndrome. All patients had tumor imaging studies yearly, and the mean follow-up was 8 yr. Only patients with PETs 2.5 cm or larger underwent abdominal surgical exploration. Hepatic metastases occurred in 23%, and in 14% tumors demonstrated aggressive growth. Three tumor-related deaths occurred, each due to liver metastases, and in each, aggressive tumor growth was present. Overall, 4% of the study group, 23% with liver metastases and 38% with aggressive disease, died. Aggressive growth was associated with higher gastrins and larger tumors. Patients with liver metastases with aggressive growth differed from those with liver metastases without aggressive growth in age at MEN1 onset or diagnosis and primary tumor size. Survival was decreased (P = 0.0012) in patients with aggressive tumor growth compared with those with liver metastases without aggressive growth or with no liver metastases without aggressive growth. Based on these results a number of factors were identified that may be clinically useful in determining in which patients aggressive tumor growth may occur. These results demonstrate in a significant subset of patients with MEN1 and Zollinger-Ellison syndrome, aggressive tumor growth occurs and can lead to decreased survival. The identification of prognostic factors that identify this group will be important clinically in allowing more aggressive treatment options to be instituted earlier.

scholarly journals Gastrointestinal neuroendocrine tumors: a role for targeted therapies?

2007 ◽  
Vol 14 (2) ◽  
pp. 207-219 ◽  
Author(s):  
Matthew H Kulke
Keyword(s):  
Neuroendocrine Tumors ◽  
Tumor Regression ◽  
Somatostatin Analogs ◽  
Mammalian Target Of Rapamycin ◽  
Hepatic Metastases ◽  
Clinical Results ◽  
Interferon Α ◽  
Ablative Therapies ◽  
Surgical Debulking ◽  
Endothelial Growth Factor

Traditional therapies have offered patients with advanced gastrointestinal neuroendocrine tumors limited benefit. Selected patients with hepatic metastases may benefit from surgical debulking, embolization, or other ablative therapies. While somatostatin analogs are highly effective in controlling symptoms of hormonal secretion, they are only rarely associated with tumor regression. The clinical benefit associated with the administration of systemic agents such as interferon-α or cytotoxic chemotherapy is less clear, and the widespread use of such regimens has been limited by their relatively modest anti-tumor activity, as well as concerns regarding their potential toxicity. The mixed clinical results seen with these agents in neuroendocrine tumors have led to great interest in the development of novel treatment approaches for patients with advanced disease. Recent clinical studies of novel agents, particularly those targeting the vascular endothelial growth factor pathway and mammalian target of rapamycin, have demonstrated promising activity in patients with advanced neuroendocrine tumors. Ongoing randomized studies should help better define the role these and other targeted agents will play in the future treatment of patients with this disease.

Expression of metastasis-associated gene products and liver metastases in pancreatic endocrine tumors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 11089-11089
Author(s):  
J. Helm ◽  
J. Strosberg ◽  
E. Henderson-Jackson ◽  
N. Hafez ◽  
A. Hakam ◽  
...  
Keyword(s):  
Protein Expression ◽  
Liver Metastases ◽  
Sensitivity And Specificity ◽  
Predictive Accuracy ◽  
Hepatic Metastases ◽  
Endocrine Tumors ◽  
Metastatic Tumors ◽  
Allred Score ◽  
Parallel Testing ◽  
Pancreatic Endocrine Tumors

11089 Background: Outcomes in well-differentiated pancreatic endocrine tumors can be difficult to predict using pathologic criteria. We recently identified a novel set of 3 metastasis-associated genes by microarray: Palladin, p21, RUNX1T1. Our aim was to evaluate the potential for these markers, individually or in combination, to predict liver metastases as an indicator of adverse outcome. Methods: Palladin, p21, and RUNX1T1 immunostains were done on a tissue microarray of 39 resected primary pancreatic endocrine neoplasms, 14 of which had hepatic metastases. The Allred score was determined as the sum of stain intensity (scored 0–3) and % cells stained (scored 0–5). Receiver operating characteristic (ROC) analysis was used to choose the cutpoint in Allred score (high vs low protein expression) to optimize sensitivity and specificity for predicting liver metastases. Results: Nearly all tumors with liver metastases showed high Palladin and p21 levels (Allred score > 3 and > 4, respectively), while protein expression was lower in the majority of non-metastatic tumors. In contrast, RUNX1T1 expression was low (Allred score < 4) in most tumors with liver metastases, but higher in all except one of the non-metastatic tumors. Individual test sensitivities for predicting liver metastases were 100% for high Palladin, 93% for high p21 and 85% for low RUNX1T1, while corresponding specificities were 63%, 75%, and 96%. Tumors were correctly classified as being metastatic or not (predictive accuracy) by Palladin, p21, or RUNX1T1 expression in 76%, 76%, and 92% of cases, respectively. If abnormal expression of even one of 3 proteins is considered a positive test (parallel testing), then sensitivity of all 3 together for predicting liver metastases was 100%, specificity 48%, and predictive accuracy 68%. Conclusions: 1) High Palladin, high p21, or low RUNX1T1 expression have good sensitivity and specificity for predicting liver metastases in pancreatic endocrine tumors. 2) Parallel testing with all 3 markers achieved 100% sensitivity but at a cost of reduced specificity. 3) Differential expression of these biomarkers may predict aggressive tumor behavior that warrants more aggressive management. No significant financial relationships to disclose.

Patient-Reported Outcomes After Hepatic Resection of Colorectal Cancer Metastases

2012 ◽  
Vol 30 (12) ◽  
pp. 1364-1370 ◽  
Author(s):  
Jonathan R. Rees ◽  
Jane M. Blazeby ◽  
Peter Fayers ◽  
Elizabeth A. Friend ◽  
Fenella K.S. Welsh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Patient Reported Outcomes ◽  
Hepatic Metastases ◽  
Life Questionnaire ◽  
Quality Of Life Questionnaire ◽  
Patient Reported ◽  
The Impact

Purpose Hepatic resection of colorectal carcinoma (CRC) liver metastases is increasing, but evidence for the impact of surgery on patient-reported outcomes (PROs) is limited. This study aimed to describe comprehensively the impact of liver surgery for CRC hepatic metastases on PROs. Patients and Methods Consecutive patients selected for hepatic resection completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–C30 and Quality of Life Questionnaire–Liver Metastases C21 before and 3, 6, and 12 months after surgery. For functional scales, mean scores with 95% CIs were calculated at each time point, with differences in scores of at least 10 points considered clinically significant. Responses to symptom scales and items were categorized as minimal or severe. Proportions and 95% CIs for each symptom category were calculated. Results Hepatic surgery was planned in 241 patients but abandoned in nine because of unresectable disease. There were two postoperative deaths, 58 complications (25.2%), and 32 patients (14.9%) with disease recurrence. Questionnaire compliance was excellent (> 95% at all time points). After surgery, most functional aspects of health decreased, and the proportions of patients with severe symptoms increased; role function deteriorated significantly, and 30% of patients reported severe activity/vigor problems. Functional scales recovered by 6 months and were maintained at 1 year. Postoperative symptoms returned to baseline levels at 12 months, but 32.1% of patients reported severe problems with sexual dysfunction and 11.9% with abdominal pain. Conclusion These findings provide new evidence regarding outcomes of liver resection for CRC metastases. It is recommended that patients be reassured that surgery has a minimal and short-lived detrimental impact on health.

Ablative Therapies for Liver Metastases of Gastroenteropancreatic Endocrine Tumors

2004 ◽  
Vol 80 (1) ◽  
pp. 74-78 ◽  
Author(s):  
Philippe Ruszniewski ◽  
Dermot O’Toole
Keyword(s):  
Liver Metastases ◽  
Endocrine Tumors ◽  
Ablative Therapies

scholarly journals Multimodality Treatment of Unresectable Hepatic Metastases from Pancreatic Glucagonoma

Rare Tumors ◽  
2009 ◽  
Vol 1 (1) ◽  
pp. 13-15 ◽  
Author(s):  
Guido Poggi ◽  
Laura Villani ◽  
Giovanni Bernardo
Keyword(s):  
Liver Metastases ◽  
Hepatic Metastases ◽  
Multimodality Treatment ◽  
Endocrine Tumors ◽  
Pancreatic Islet Cell ◽  
Pancreatic Endocrine Tumors ◽  
Pancreatic Islet Cell Tumors ◽  
Unresectable Liver Metastases ◽  
Long Acting ◽  
Multiple Liver Metastases

Glucagonomas are pancreatic islet cell tumors arising from the alpha cells which belong to neuroendocrine tumors. They frequently metastasize to the liver. We report the case of a 52- year old man with a pancreatic glucagonoma with synchronous multiple liver metastases treated by surgery, transarterial chemoembolization, percutaneous radiofrequency thermal ablation and long-acting octreotide. Our report confirms that a multimodal approach is very effective in patients with unresectable liver metastases from pancreatic endocrine tumors providing long-lasting palliation and probably prolonging survival.

Psychotherapeutic components of commercially available virtual reality games (Preprint)

2020 ◽  
Author(s):  
Almira Osmanovic Thunström ◽  
Iris Sarajlic Vuković ◽  
Lilas Ali ◽  
Tomas Larson ◽  
Steinn Steingrimsson
Keyword(s):  
Mental Health ◽  
Virtual Reality ◽  
Mental Health Problems ◽  
Treatment Strategies ◽  
Treatment Method ◽  
Health Problems ◽  
E Learning ◽  
The Mean ◽  
Unique Games

BACKGROUND Immersive virtual reality (VR) games are increasingly becoming part of everyday life. Several studies support immersive VR technology as a treatment method for mental health problems. There is however minimal research into the feasibility, prevalence, and quality of commercially available VR games on commercial platforms as tools for treatment or add on to treatment of mental health problems. OBJECTIVE The aim of this study was to explore the prevalence, feasibility and quality of commercially available games related to psychotherapy on a commercially available platform. METHODS We performed a search for keywords related to diagnosis and treatment strategies of mental health problems. The search was performed during March 27th on STEAM (VR content and gaming platform). A usability scale was used as a tool to look at the interaction and usability of the games, the VR-UI-UX-8. The tool contains 8 statements about usability scored 0-10, 0 indicating “Not at all” and 10 indicating “very much so”. The score ranges from 0-80 with a higher score indicating worse usability. RESULTS In total, 516 hits were found, 371 unique games. After the games were reviewed, 83 games passed the inclusion criteria, were purchased and played. Majority of the games which were excluded were either not connected to mental health, contained violence, adult content or were in other ways irrelevant or inappropriate. The mean score for the games on the VR-UI-UX-8 was 16.5 (standard deviation 15.8) with a range from 0-68. Most relevant and feasible games were found in the search words meditation, mindfulness, and LSD. CONCLUSIONS Commercial platforms hold great potential for VR games with psychotherapeutic components. The platforms are only at the beginning of the development towards serious games, e-learning and psychotherapeutic treatments. Currently the quality and usability for clinical and at home applicability are scarce, but hold great potential.

scholarly journals Long-Term Survival of Two Patients with Liver Metastases from Advanced Gastric Cancer Treated with Radiofrequency Ablation and Chemotherapy

2021 ◽  
pp. 67-72
Author(s):  
Sung Jin Oh
Keyword(s):  
Gastric Cancer ◽  
Radiofrequency Ablation ◽  
Liver Metastases ◽  
Advanced Gastric Cancer ◽  
Systemic Chemotherapy ◽  
Subtotal Gastrectomy ◽  
Hepatic Metastases ◽  
Term Survival ◽  
Long Term Survival

Liver metastasis from gastric cancer has a very poor prognosis. Herein, we present two cases of liver metastases (synchronous and metachronous) from advanced gastric cancer. In the first case, the patient underwent radical subtotal gastrectomy. Liver metastases occurred 6 months after surgery while the patient was receiving adjuvant chemotherapy, but two hepatic tumors were successfully removed by radiofrequency ablation (RFA). In the second case, liver metastases occurred 15 months after surgery for gastric cancer. The patient also received RFA for one hepatic tumor, and other suspicious metastatic tumors were treated with systemic chemotherapy. Although these case presentations are limited for the efficacy of RFA treatment with systemic chemotherapy for hepatic metastases from gastric cancer, our findings showed long-term survival (overall survival for 108 and 67 months, respectively) of the affected patients, without recurrence. Therefore, we suggest that RFA treatment with systemic chemotherapy could be an effective alternative treatment modality for hepatic metastases from gastric cancer.

scholarly journals Obvious Reduction of the Tumor Size in Dedifferentiated Liposarcoma in a Lung Metastasis Patient Receiving Individualized Treatment

2021 ◽  
pp. 1080-1084
Author(s):  
Xin-Li Wang ◽  
Jia-Yao Gong ◽  
Yan Xue
Keyword(s):  
Quality Of Life ◽  
Therapeutic Effect ◽  
Tumor Size ◽  
Systemic Treatment ◽  
Treatment Method ◽  
Palliative Surgery ◽  
Dedifferentiated Liposarcoma ◽  
Comprehensive Treatment ◽  
Back Surgery

Abdominal metastasis is relatively rare in dedifferentiated liposarcoma of the shoulder and back. Surgery is the best treatment option, whether it is radical or palliative surgery. Chemotherapy is the standard systemic treatment for advanced unresectable/metastatic patients, but the therapeutic effect is limited. Here, we treat advanced abdominal dedifferentiated liposarcoma through a comprehensive treatment method of targeting, surgery, and chemotherapy, which improves the quality of life of the patient, and shrinks the tumor significantly.

scholarly journals Effect of Heat Treatment by the Sous-Vide Method on the Quality of Poultry Meat

Foods ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 1610
Author(s):  
Wiesław Przybylski ◽  
Danuta Jaworska ◽  
Katarzyna Kajak-Siemaszko ◽  
Piotr Sałek ◽  
Kacper Pakuła
Keyword(s):  
Heat Treatment ◽  
Sensory Quality ◽  
Treatment Method ◽  
Poultry Meat ◽  
Chicken Breast ◽  
Breast Meat ◽  
Sous Vide ◽  
The Impact ◽  
Cooked Meat

An increase in the consumption of poultry meat has been observed due to its availability, nutritional value, and delicate flavor. These characteristics make it possible to prepare, with the use of spices and other additives, many different dishes and products for increasingly demanding consumers. The sous-vide technique is increasingly being used to give new sensory attributes to dishes in gastronomy. The study aimed to assess the impact of the heat treatment method, i.e., the sous-vide method, as compared to traditional cooking, on the sensory quality of poultry meat, as well as the efficiency of the process with regard to technological quality. The cooking yield with the sous-vide method of processing poultry meat was higher than with the traditional method of cooking in water (88.5% vs. 71.0%, respectively). The meat was also found to be redder (a* = 254 vs. 074) and less yellow (b* = 1512 vs. 1649), as well as more tender. The sensory quality of chicken breast meat obtained by the sous-vide method was higher in terms of attributes such as color tone, tenderness, juiciness, and overall quality. At the same time, it was lower in terms of the odor of cooked meat and the flavor of cooked meat as compared to meat subjected to traditional cooking.

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