| 1. |
- Hellman, Per, et al.
(författare)
-
Effect of surgery on the outcome of midgut carcinoid disease with lymph node and liver metastases
- 2002
-
Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 26:8, s. 991-997
-
Tidskriftsartikel (refereegranskat)abstract
- We have evaluated survival and tumor-related symptoms in the presence of mesenteric lymph node and liver metastases in relation to surgical procedures in 314 patients (148 women, mean age at diagnosis 61 years; 249 with liver metastases) treated for midgut carcinoid tumors. Of the operated patients, 46% presented with severe abdominal pain and intestinal obstruction and were operated on before the diagnosis. Medical treatment (somatostatin analogs, interferon-a) was initiated in 67% and 86%, respectively. Surgical attempts included small intestine or ileocecal/right-sided colon resection with excision of mesenteric lymph node metastases. Most of the patients (n = 286) had mesenteric lymph node metastases; 33% of them had unresectable mesenteric lymph node metastases and underwent surgery without mesenteric dissection. Patients who underwent resection for the primary tumor had a longer survival than those with no resection (median survival 7.4 vs. 4.0 years; p <0.01). Patients who underwent successful excision of mesenteric metastases had a significantly longer survival than those with remaining lymph node metastases. Patients operated on for a primary tumor but with remaining lymph nodes but no liver metastases and who subsequently received interferon and somatostatin analog treatment had a median survival of 7.4 years. Resection of the primary tumor and the mesenteric lymph node metastases led to a significant reduction in tumor-related symptoms. Surgery to remove the primary intestinal tumor including mesenteric lymph node metastases is supported by the present results, even in the presence of liver metastases. Liver metastases and significant preoperative weight loss are identified as major negative prognostic factors for survival.
|
|
| 2. |
- Tiensuu Janson, Eva, et al.
(författare)
-
Treatment with high dose [(111)In-DTPA-D-PHE1]-octreotide in patients with neuroendocrine tumors : evaluation of therapeutic and toxic effects
- 1999
-
Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 38:3, s. 373-377
-
Tidskriftsartikel (refereegranskat)abstract
- Carcinoid tumors and endocrine pancreatic tumors often express somatostatin receptors (sst). Tumor spread may be visualized by sst scintigraphy using [(111)In-DTPA-D-Phe1]-octreotide. In this study, tumor targeting therapy with [(111)In-DTPA-D-Phe1]-octreotide at high doses (6 GBq every third week) was used to treat patients with sst-expressing tumors. Five patients entered the protocol and three were evaluable for response, while all could be evaluated for toxicity. Two patient responded with a significant reduction in tumor markers (> 50%). The third patient showed increasing levels of tumor markers. Side effects were expressed as depression of bone-marrow function. In one patient a grade 4 reduction in platelet count was observed requiring several thrombocyte transfusions. In another two patients platelet counts decreased significantly. We conclude that treatment with [(111)In-DTPA-D-Phe1]-octreotide can be used in patients with neuroendocrine tumors but blood parameters have to be carefully monitored to avoid severe side effects.
|
|
| 3. |
|
|
| 4. |
- Öhrvall, Ulf
(författare)
-
Intraoperative scintigraphic detection of abdominal endocrine tumors : Development and evaluation of hand held gamma sensitive probes for¹¹¹In
- 1998
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Surgery of endocrine tumors benefit from accurate pre and- intraoperative localization methods,and scintigraphy has become an important contribution in this respect. In the present thesis therequisites for scintigraphic localization of abdominal endocrine tumors and new detectors forintraoperative gammadetection are evaluated.Ac5 is a monoclonal murine antibody developed against human adrenocortical carcinoma. In a nude mouse experimental model, the radiolabeled antibody and its Fab´2 fragment were evaluated after grafting of two human adrenocortical carcinoma cell-lines (SW 13, T-CAR1). During scintigraphy of grafted animals, tumors were visualized especially with the fragmented antibody. The Ac5 antibody/Fab2 fragment may become a diagnostic tool for detection of adrenocortical carcinoma.The somatostatin analogue [111In]-DTPA-D-[Phe1]-octreotide (OctreoScan®) has been shown to visualize endocrine tumors with scintigraphy. The biodistribution of [111In]-DTPA-D-[phe1]-octreotide was studied by use of operative biopsies. Mid-gut carcinoids and endocrine pancreatic tumors of patients exposed to [111In]-DTPA-D-[Phe1]-octreotide, revealed high uptake in tumors with a tumor-to-blood ratio up to 2000. After preoperative single photon emission computerized tomography (SPECT), commercially available hand-held gammasensitive probes were used for intraoperative detection of tumors. These detectors were found to be insufficient in the abdomen mainly because of poor adaptation to the high background activity of 111In. A novel detector, H-probe2 was constructed. It was found to detect even tiny tumors, lesions inaccessible to surgical palpation upon ex vivo scanning of operative specimens. In vivo, H-probe2 detected smaller tumors than preoperative SPECT, but the scanning procedure was too time consuming for surgical applicability. Further development resulted in Matris 16, a computerized 16 channel detector for intraoperative use in combination with [111In]-DTPA-D-[Phe1]-octreotide. Matris 16 demonstratedsubstantial sensitivity and spatial resolution. It had the ability to detect abdominal endocrine tumorsmeasuring down to a few mm both in vivo and ex vivo. By allowing faster scanning with preserved sensitivity Matris 16 can improve the intraoperative tumor detection of endocrine neoplasms.
|
|
| 5. |
- Öhrvall, Ulf, et al.
(författare)
-
Method for dissection of mesenteric metastases in mid-gut carcinoid tumors
- 2000
-
Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 24:11, s. 1402-1408
-
Tidskriftsartikel (refereegranskat)abstract
- With adequate medical management the midgut carcinoid tumor generally is an indolent malignancy associated with substantial life expectancy and appreciable life quality, even in the presence of liver metastases and significant tumor burden. Abdominal complications may occur in this entity of carcinoids owing to entrapment of intestines and encasement of mesenteric vessels by mesenteric metastases and associated marked mesenteric fibrosis. This may be the cause of abdominal pain, disabling diarrhea, weight loss to the extent of malnutrition, and eventually the risk of death with acute or chronic intestinal obstruction or intestinal gangrene. Operative removal of the mesentericointestinal lesion is often indicated to prevent or treat these complications but may be technically difficult when mesenteric metastases extend in the vicinity of major vessels in the mesenteric root. At laparotomy 56 patients with advanced midgut carcinoids underwent removal of the mesenteric tumor with a method for preserving the mesenteric vessels. This was feasible by mobilizing and releasing the right colon and mesenteric root from posterior adhesions, identifying the mesenteric artery below the pancreas, and free-dissecting this artery on the tumor capsule in the mobilized mesentery. Dissection was successful even with tumors initially judged inoperable unless tumor growth completely surrounded the mesenteric vessels or extended retroperitoneally. One patient was subjected to distal intestinal artery bypass. Symptom relief was been substantial and often of long duration after mesenteric tumor removal in patients who prior to surgery often had threatening intestinal ischemia. Patients with advanced midgut carcinoids may benefit markedly from dissectional removal of mesenteric tumors, which (conceivably better than conventional wedge resection) preserves the length of the remaining intestine.
|
|
