Elettra Merola1,2, Vikas Prasad3,4, Andreas Pascher5,6, Ulrich-Frank Pape7, Ruza Arsenic8, Timm Denecke9,10, Uli Fehrenbach10, Bertram Wiedenmann7, Marianne Ellen Pavel11,7. 1. Department of Gastroenterology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy, elettra.merola@gmail.com. 2. Department of Medicine, Division of Endocrinology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany, elettra.merola@gmail.com. 3. Department of Nuclear Medicine, University Hospital of Ulm, Ulm, Germany. 4. Department of Nuclear Medicine, Charité Universitätsmedizin, Berlin, Germany. 5. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Germany. 6. Department of General, Visceral and Transplantation Surgery, Charité Universitätsmedizin, Berlin, Germany. 7. Department of Hepatology and Gastroenterology, Charité Universitätsmedizin, Berlin, Germany. 8. Institute of Pathology, Charité University Hospital, Berlin, Germany. 9. Department of Diagnostic and Interventional Radiology, University of Leipzig Medical Center, Leipzig, Germany. 10. Department of Diagnostic and Interventional Radiology, Charité Universitätsmedizin, Berlin, Germany. 11. Department of Medicine, Division of Endocrinology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Abstract
BACKGROUND: Peritoneal carcinomatosis (PC) can affect the quality of life of patients with gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs). Peritoneal disease control by medical therapies in these patients has been poorly investigated Objectives: To describe, in a consecutive series of GEP-NENs, the clinical impact of PC and to report the effectiveness of available treatments in PC control. METHODS: A retrospective, monocenter analysis was performed of 135 GEP-NENs (1993-2016) with at least a 12-month follow-up. Peritoneal disease progression was defined as detection of a significant increase in size or appearance of new implants by imaging. RESULTS: A total of 62.9% of cases had diffuse PC (involving at least 2 abdominal quadrants). According to WHO 2017 classification, cases were 42.3% neuroendocrine tumors NET-G1, 45.5% NET-G2, 6.5% NET-G3, 4.9% neuroendocrine carcinomas NEC-G3, and 0.8% mixed neuroendocrine-nonneuroendocrine neoplasms. Bowel obstruction occurred in 30 (22.2%) patients mainly depending on size of peritoneal implants (HR: 1.10; 95% CI: 1.02-1.20; p = 0.01). Patients with diffuse PC treated with peptide receptor radionuclide therapy (PRRT) showed peritoneal progression in 37.5% of cases, and bowel obstruction or ascites in 28.1%. Better peritoneal disease control was observed in cases receiving somatostatin analogs at first-line therapy, probably due to a less aggressive disease behavior for these patients. CONCLUSIONS: Bowel obstruction is not uncommon in GEP-NENs with PC. PRRT should be adopted with caution in GEP-NENs with diffuse PC, but larger series are needed to confirm these data.
BACKGROUND:Peritoneal carcinomatosis (PC) can affect the quality of life of patients with gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs). Peritoneal disease control by medical therapies in these patients has been poorly investigated Objectives: To describe, in a consecutive series of GEP-NENs, the clinical impact of PC and to report the effectiveness of available treatments in PC control. METHODS: A retrospective, monocenter analysis was performed of 135 GEP-NENs (1993-2016) with at least a 12-month follow-up. Peritoneal disease progression was defined as detection of a significant increase in size or appearance of new implants by imaging. RESULTS: A total of 62.9% of cases had diffuse PC (involving at least 2 abdominal quadrants). According to WHO 2017 classification, cases were 42.3% neuroendocrine tumors NET-G1, 45.5% NET-G2, 6.5% NET-G3, 4.9% neuroendocrine carcinomas NEC-G3, and 0.8% mixed neuroendocrine-nonneuroendocrine neoplasms. Bowel obstruction occurred in 30 (22.2%) patients mainly depending on size of peritoneal implants (HR: 1.10; 95% CI: 1.02-1.20; p = 0.01). Patients with diffuse PC treated with peptide receptor radionuclide therapy (PRRT) showed peritoneal progression in 37.5% of cases, and bowel obstruction or ascites in 28.1%. Better peritoneal disease control was observed in cases receiving somatostatin analogs at first-line therapy, probably due to a less aggressive disease behavior for these patients. CONCLUSIONS:Bowel obstruction is not uncommon in GEP-NENs with PC. PRRT should be adopted with caution in GEP-NENs with diffuse PC, but larger series are needed to confirm these data.
Authors: Satya Das; Liping Du; Aimee Schad; Shikha Jain; Aaron Jessop; Chirayu Shah; David Eisner; Dana Cardin; Kristen Ciombor; Laura Goff; Marques Bradshaw; Dominique Delbeke; Martin Sandler; Jordan Berlin Journal: Endocr Relat Cancer Date: 2021-03 Impact factor: 5.678
Authors: Satya Das; Aman Chauhan; Liping Du; Katharine E Thomas; Aasems Jacob; Aimee Schad; Shikha Jain; Aaron Jessop; Chirayu Shah; David Eisner; Dana B Cardin; Kristen K Ciombor; Laura W Goff; Marques Bradshaw; Dominique Delbeke; Martin Sandler; Robert A Ramirez; Jordan Berlin Journal: JAMA Netw Open Date: 2022-01-04