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.

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.

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.

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 Prognostic factors and survival in endocrine tumor patients: comparison between gastrointestinal and pancreatic localization

2005 ◽  
Vol 12 (4) ◽  
pp. 1083-1092 ◽  
Author(s):  
Francesco Panzuto ◽  
Silvia Nasoni ◽  
Massimo Falconi ◽  
Vito Domenico Corleto ◽  
Gabriele Capurso ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Primary Tumor ◽  
Rate Ratio ◽  
Survival Rates ◽  
Hepatic Metastases ◽  
Distant Metastases ◽  
Endocrine Tumors ◽  
Term Survival ◽  
Pancreatic Endocrine Tumors ◽  
Degree Of Differentiation

Since gastro-entero-pancreatic endocrine tumors are rare and heterogeneous diseases, their prognosis and long-term survival are not well known. This study aimed at identifying prognostic factors and assessing long-term survival in gastro-entero-pancreatic endocrine tumors. A total of 156 patients enrolled. Prognostic factors were determined by univariate/multivariate analysis; survival rates were assessed by the Kaplan–Meier method. The tumors were non-functioning in 59.6% of patients, and originated from the pancreas in 42.9%. At diagnosis, 64.3% of patients had metastases. The tumors were well differentiated in 89.6% of patients. Ki67 was >2% in 39.6% of patients. Primary tumor size was >3 cm in 49.6% of cases studied. For the univariate analysis, the negative prognostic factors were: pancreatic origin (rate ratio 4.64, P = 0.0002), poorly differentiated tumor (rate ratio 7.70, P = 0.0001), primary tumor size >3 cm (rate ratio 4.26, P = 0.0009), presence of distant metastases (liver: rate ratio 5.88, P = 0.01; distant extra-hepatic: rate ratio 13.41, P = 0.0008). The pancreatic site, the poor degree of differentiation and the distant metastases were confirmed as negative prognostic factors at multivariate analysis. Overall 5-year survival rate was 77.5%. Survival rates differed according to: primary tumor site (62% for pancreatic vs 89.9% for gastrointestinal tract, P = 0.0001) and size (65.7% for >3 cm vs 88.8% for ≤ 3 cm, P = 0.0003), degree of differentiation (22% for poor vs 86.8% for good, P<0.0001), Ki67 (53.5% for > 2% vs 90.1% for ≤ 2%, P = 0.003), metastases (96.1, 77, 73.3 and 50.1% for absent, local, liver and distant extra-hepatic metastases respectively), age at diagnosis (85.3% for ≤ 50 years vs 70.3% for > 50 years, P = 0.03). Although 64.3% of gastro-entero-pancreatic endocrine tumors present metastases at diagnosis, the 5-year survival rate is 77.5%. Pancreatic site, a poor degree of tumor cell differentiation and distant extra-hepatic metastases are the major negative prognostic factors.

Effectiveness of FIr-B/FOx and liver metastasectomies in liver-only metastatic colorectal cancer (MCRC).

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 582-582
Author(s):  
G. Bruera ◽  
K. Cannita ◽  
P. Lanfiuti Baldi ◽  
A. Santomaggio ◽  
P. Marchetti ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Treatment Schedule ◽  
Resection Rate ◽  
Multiple Liver Metastasis ◽  
Unresectable Liver Metastases ◽  
Metastatic Sites ◽  
Multiple Liver Metastases ◽  
Single Versus

582 Background: Effectiveness of liver metastasectomies was evaluated in liver-MCRC patients treated with FIr-B/FOx association in a previous phase II study (Bruera et al, submitted 2010). Methods: Treatment schedule: 12h-timed-flat-infusion/5-Fluorouracil 900 mg/m2 days 1-2, 8-9, 15-16, 22-23; Irinotecan 160 mg/m2, Bevacizumab 5 mg/kg days 1, 15; Oxaliplatin 80 mg/m2 days 8, 22; every 4 weeks. Resection rate, activity, efficacy were analysed and compared in liver-only versus multiple metastatic sites and single versus multiple liver metastases. Results: Liver-MCRC were 33: liver-only 22 patients (67%); multiple metastatic sites 11 patients (33%). Liver metastasectomies were performed in 13 patients (11 R0, 84.6%): 26% of 50 MCRC patients enrolled in the FIr-B/FOx phase II study; 39% of liver-MCRC patients; 54% of liver-only, 6 of 9 (67%) single and 6 of 13 (46%) multiple liver metastases; one liver and lung metastasectomy. Pathologic complete responses (CRs) were 2 (15%); downsizing with modification of surgical resectability, 9 patients (41%); conversion rate of unresectable liver metastases, 83%. Overall activity, including 3 clinical CR, in liver-only patients, 68%. ORR, PFS, OS, respectively: in liver-MCRC patients, 84%, 11 and 23 months; in liver-only metastases, 86%, 17 and 44 months; in liver metastasectomies, 100%, 21 months (PFS from liver surgery 10 months) and 47 months. Significantly increased efficacy: PFS and OS in liver-only versus multiple metastatic sites (p 0.006 and 0.011, respectively) and single versus multiple liver metastasis (p 0.026 and 0.022, respectively). Conclusions: FIr-B/FOx chemotherapy increases resection rate of liver metastases, thus significantly improving efficacy of liver-only MCRC patients. No significant financial relationships to disclose.

scholarly journals Conversion to Resectability Using Hepatic Artery Infusion Plus Systemic Chemotherapy for the Treatment of Unresectable Liver Metastases From Colorectal Carcinoma

2009 ◽  
Vol 27 (21) ◽  
pp. 3465-3471 ◽  
Author(s):  
Nancy E. Kemeny ◽  
Fidel D. Huitzil Melendez ◽  
Marinela Capanu ◽  
Philip B. Paty ◽  
Yuman Fong ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Liver Metastases ◽  
Systemic Chemotherapy ◽  
Hepatic Metastases ◽  
Hepatic Arterial Infusion ◽  
Hepatic Artery Infusion ◽  
Baseline Variable ◽  
Unresectable Liver Metastases ◽  
Previously Treated ◽  
Additional Value

Purpose To determine the conversion to resectability in patients with unresectable liver metastases from colorectal cancer treated with hepatic arterial infusion (HAI) plus systemic oxaliplatin and irinotecan (CPT-11). Patients and Methods Forty-nine patients with unresectable liver metastases (53% previously treated with chemotherapy) were enrolled onto a phase I protocol with HAI floxuridine and dexamethasone plus systemic chemotherapy with oxaliplatin and irinotecan. Results Ninety-two percent of the 49 patients had complete (8%) or partial (84%) response, and 23 (47%) of the 49 patients were able to undergo resection in a group of patients with extensive disease (73% with > five liver lesions, 98% with bilobar disease, 86% with ≥ six segments involved). For chemotherapy-naïve and previously treated patients, the median survival from the start of HAI therapy was 50.8 and 35 months, respectively. The only baseline variable significantly associated with a higher resection rate was female sex. Variables reflecting extensive anatomic disease, such as number of lesions or number of vessels involved, were not significantly associated with the probability of resection. Conclusion The combination of regional HAI floxuridine/dexamethasone and systemic oxaliplatin and irinotecan is an effective regimen for the treatment of patients with unresectable liver metastases from colorectal cancer, demonstrating a 47% conversion to resection (57% in chemotherapy-naïve patients). Future randomized trials should compare HAI plus systemic chemotherapy with systemic therapy alone to assess the additional value of HAI therapy in converting patients with hepatic metastases to resectability.

scholarly journals Clinical and hormonal effects of a long-acting somatostatin analogue in pancreatic endocrine tumors and in carcinoid syndrome

Cancer ◽  
1987 ◽  
Vol 59 (9) ◽  
pp. 1654-1660 ◽  
Author(s):  
Jean-Christophe Souquet ◽  
Geneviève Sassolas ◽  
Jacques Forichon ◽  
Pascal Champetier ◽  
Christian Partensky ◽  
...  
Keyword(s):  
Carcinoid Syndrome ◽  
Somatostatin Analogue ◽  
Endocrine Tumors ◽  
Hormonal Effects ◽  
Pancreatic Endocrine Tumors ◽  
Long Acting

Metastasis-Associated Gene Products and Liver Metastases in Pancreatic Endocrine Tumors

Pancreas ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 276
Author(s):  
Aejaz Nasir ◽  
James Helm ◽  
Jonathan R. Strosberg ◽  
Leslie M. Turner ◽  
Evita B. Henderson-Jackson ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Endocrine Tumors ◽  
Gene Products ◽  
Pancreatic Endocrine Tumors ◽  
Metastasis Associated Gene

Hepatectomy for Liver Metastasis of Gastric Cancer: A Meta-Analysis

2019 ◽  
Vol 26 (6) ◽  
pp. 692-697 ◽  
Author(s):  
Jun-Kai Cui ◽  
Mei Liu ◽  
Xiao-Ke Shang
Keyword(s):  
Gastric Cancer ◽  
Liver Metastasis ◽  
Liver Metastases ◽  
Hepatic Resection ◽  
Meta Analysis ◽  
Hepatic Metastases ◽  
Outcome Analysis ◽  
Significant Difference ◽  
Promising Treatment ◽  
Multiple Liver Metastases

Background. Management of gastric cancer (GC) with liver metastases is debated. It is still controversial whether surgical resection provides a survival benefit or not. This systematic review was designed to evaluate the efficacy of hepatectomy for GC liver metastasis. Methods. We searched several electronic databases to identify eligible studies updated on September 2018. Studies assessing the efficacy and safety of hepatectomy versus no hepatectomy were included. Odds ratio (OR) along with 95% confidence interval (95% CI) were utilized for main outcome analysis. Results. In all, 10 studies were included. Patients who underwent hepatectomy had lower 1-year (OR = 0.15, 95% CI = 0.10-0.22, P < .00001), 3-year (OR = 0.16, 95% CI = 0.10-0.27, P < .00001), and 5-year mortality (OR = 0.13, 95% CI = 0.07-0.24, P < .00001) than those without hepatectomy. We also reported favorable survival outcome in patients with metachronous hepatic resection versus synchronous hepatic resection (OR = 2.09, 95% CI = 1.21-3.60, P = .008). However, there was no significant difference between solitary and multiple liver metastases (OR = 0.61, 95% CI = 0.35-1.07, P = .08). Conclusion. The present study demonstrates that hepatic resection in the management of liver metastases of GC can prolong the survival of patients and should be considered a promising treatment for such patients. Furthermore, there are more favorable outcomes in patients with metachronous metastases versus those with synchronous disease. Therefore, metachronous hepatic metastases from GC are not necessarily a contraindication for hepatectomy of the metastatic site.

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