Will clinical heterogeneity of neuroendocrine tumors impact their management in the future? Lessons from recent trials
Purpose of review: Neuroendocrine tumors (NETs) are a group of biologically and clinically heterogeneous neoplasms arising from the diffuse neuroendocrine system. In the last few years, advances in our understanding of the biology of these tumors have translated into an expansion of treatment options for patients with NETs. Current treatment modalities include somatostatin analogs (SSAs), radiolabeled SSAs, targeted agents, cytotoxic drugs and liver-directed therapies for the management of metastatic disease. Recent findings: Recent studies have expanded the role of SSAs in gastroenteropancreatic (GEP)-NETs, and everolimus has shown robust antitumor activity across a broad range of NETs of the lung and GEP tract. The radiolobeled SSA 177Lu-DOTATATE has been investigated in a randomized phase III trial, and has demonstrated exceptional efficacy and tolerability in patients with progressive midgut NETs. The new serotonin inhibitor telotristat etiprate has shown significant activity in the palliation of symptoms of carcinoid syndrome, and its approval by regulatory authorities is expected soon. Summary: The field of NETs has been transformed from one dominated by limited treatment options to one characterized by an increasing number of therapeutic agents and active clinical trials. Navigating the current therapeutic algorithm may be challenging, and requires an understanding both of the heterogeneity of NETs and of characteristics that are shared by NETs across tumor subtypes.
CONCLUSIONSGrade was the dominant driver of prognosis in patients with neuroendocrine tumors of the lung. Incorporation of grade with traditional TNM parameters better discriminates between stage categories compared to current AJCC staging. Future NETL staging systems should include histologic grade.
CONCLUSIONS: Grade was the dominant driver of prognosis in patients with neuroendocrine tumors of the lung. Incorporation of grade with traditional TNM parameters better discriminates between stage categories compared to current AJCC staging. Future NETL staging systems should include histologic grade. PMID: 31706866 [PubMed - as supplied by publisher]
ConclusionsAs a result, high neoplasm in ADD patients can be shown with incidence of perforation and plastron, and in order to avoid possible neoplasm or major complications, it is necessary to carry out new studies for the right diagnosis of ADD whether the diagnosis is done preoperatively or ıntraoperatively. We recommend surgical resection of the ADD, which may even be incidentally detected during any surgical procedure, due to its high risk of neoplasm and rapid perforation.
CONCLUSION: Traditional imaging techniques and fusion imaging techniques are essential for diagnosing and treating orbital metastases. PMID: 31685587 [PubMed - in process]
ConclusionThe treatment plan of patient with PCI depends on underlying cause and clinical condition severity. When conservative treatment is adopted the clinical evolution of pneumatosis cystoides intestinalis is unpredictable and can even disappear in an indeterminate number of patients.ResumoA pneumatose cistoide intestinal é uma doença incomum, de etiologia desconhecida, caracterizada pela presença de múltiplos cistos preenchidos com gás na submucosa ou subserosa da parede intestinal. O pneumoperitônio e/ou a perfuração intestinal são complicaçõ...
This case highlights the important role ultrasound can play in the diagnosis of lung typical carcinoid tumors.BMC Pulmonary Medicine
This report describes a carcinoid in the proximal mainstem bronchus which was successfully resected without lobectomy or pneumonectomy and concludes that sleeve resection under extracorpor eal membrane oxygenation should be considered in the surgical treatment of mainstem bronchial carcinoid.
Dr Carr highlights an important feature of our study1: it does not provide information on patients' lymph node status. Could undetected lymph node metastases explain the survival difference between patients with small ( ≤2 cm) and large (>2 cm) carcinoid tumors, given that nearly one-third of patients with large tumors underwent appendectomy instead of right hemicolectomy?
We appreciate Dr Sugarbaker's thoughtful commentary on our article,1 in which he proposes an innovative solution to the dilemma of how to manage biologically non-aggressive appendiceal malignancies. Systematically performing radical appendectomies in cases suspicious for appendiceal carcinoid enables up-front removal of lymph nodes most likely to contain tumor metastases, while sparing the colon. In addition to avoiding a second operation for patients, this strategy seems particularly appealing to surgeons, who understandably hesitate to abandon lymph node sampling despite evidence suggesting that nodal positivity might no...
I thoroughly enjoyed reading the article “Practice Patterns and Guideline Non-Adherence in Surgical Management of Appendiceal Carcinoid Tumors,” by Heller and colleagues.1 The article provided a lot of good information on the somewhat controversial topic of appendectomy vs colectomy for appendiceal carcinoid tumors. The authors reviewe d 3,198 cases of appendiceal carcinoid tumors treated surgically, and did not find any statistically significant difference in recurrence or survival based on the type of operation performed.