Radiofrequency Ablation of Pancreatic Neuroendocrine Tumors

Rossi, Sandro; Viera, F. Torello; Ghittoni, Giorgia; Cobianchi, Lorenzo; Rosa, Laura; Siciliani, L.; Bortolotto, Chandra; Veronese, Letizia; Vercelli, Alessandro; Gallotti, Anna; Ravetta, Valentina

doi:10.1097/mpa.0000000000000133

Cited by 99 publications

(35 citation statements)

References 30 publications

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“…Included in the recent literature are reports of the control of the symptoms of the insulinoma hormone-excess state by using: everolimus[•39, 40–46, 170, 171]; tyrosine kinase inhibitor sunitinib[•50]; PRRT[44, 55, 58–60, •61, •76, 170, 172]; liver directed therapies including TACE/TAE[44, 70, 72, •73, 74 75, •76, 172–17444, 70, 172]; RFA and use of ablative treatment(ethanol, microwave of primary/metastases[81, 83–87, •89, 90, 92, •93, 175, •176, 177, 178]; by increasing the dosage of octreotide/Lanreotide in refractory cases[153, 155]; use of cytoreductive surgery[157, 158, 160, 172, 174]; use of 131 I-MIBG[•111] and with pasireotide in octreotide resistant cases[125]. …”

Section: Summary Of Recent Advances In Management Of Specific Hormmentioning

confidence: 99%

“…Both studies and case reports have reported the successful use in patients with ZES of the control of the symptoms of the hormone-excess state by using: PRRT[65]; liver directed therapies including TACE/TAE[70, 173, 174, 181]; radioembolization[70], RFA[81, 83, •176, 182]; by increasing the dosage of octreotide/Lanreotide in refractory cases[155, 183]; use of cytoreductive surgery[156, 160, 174]; use of 131 I-MIBG[110, 164] and with pasireotide in octreotide resistant cases[•122]. …”

Section: Summary Of Recent Advances In Management Of Specific Hormmentioning

confidence: 99%

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Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

Ito¹,

Lee²,

Jensen³

2016

Expert Opinion on Pharmacotherapy

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Introduction Neuroendocrine tumors(NETs), once thought rare, are increasing in frequency in most countries and receiving increasing-attention. NETs present two-treatment problems. A proportion is functional, hormone-excess-state(F-NET), each of which must be treated. Recently, there are many advances, well-covered in reviews/consensus papers on imaging-NETs;new, novel anti-tumor treatments and understanding their pathogenesis. However, little attention has been paid to advances in the treatment of the hormone-excess-state. These advances are usually reported in case-series, and case-reports with few large studies. In this paper these advances are reviewed. Areas covered Advances in the last 5-years are concentrated on, but a review up to 10-years was performed. PubMed and other databases(Cochrane, etc) were searched for F-NET-syndromes including carcinoid-syndrome, as well as meeting-abstracts on NETs. All advances that controlled hormone-excess-states or facilitated-control were covered. These include new medical-therapies[serotonin-synthesis inhibitors(telotristat), Pasireotide, new agents for treating ACTHomas], increased dosing with conventional therapies(octreotide-LAR, Lanreotide-Autogel), mTor inhibitors(everolimus), Tyrosine-kinase inhibitors(sunitinib), cytoreductive surgery, liver-directed therapies(embolization, chemoembolization, radioembolization, RFA), peptide radio-receptor-therapy(PRRT) and 131I-MIBG, ablation of primary F-NETs. Expert Opinion Although many of the newer therapies controlling the hormone-excess-states in F-NETs are reported in relatively few patients, all the approaches show promise. Their description also generates some controversies/unresolved areas, such as the order of these new treatments, their longterm-efficacy, and effectiveness of combinations which may require large, controlled studies.

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Section: Summary Of Recent Advances In Management Of Specific Hormmentioning

confidence: 99%

Section: Summary Of Recent Advances In Management Of Specific Hormmentioning

confidence: 99%

Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

Ito¹,

Lee²,

Jensen³

2016

Expert Opinion on Pharmacotherapy

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“…11 In cases of tumour radio-frequency ablation, tumour grade cannot be assessed by histological examination. 12 As the risk of the presence of high-grade tumours cannot be completely excluded, there is a need for other strategies to enable pNETs to be graded preoperatively.…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced MDCT in patients with pancreatic neuroendocrine tumours: correlation with histological findings and diagnostic performance in differentiation between tumour grades

Belousova

Kаrmаzаnovsky

Kriger³

et al. 2017

Clinical Radiology

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AIM To identify the multidetector computed tomography (MDCT) features of pancreatic neuroendocrine tumours (pNETs), which correlate with tumour histology and enable preoperative grading. MATERIALS AND METHODS Thirty-nine patients with histologically confirmed pNET who underwent preoperative contrast-enhanced MDCT were included in this study. Nineteen tumours were classified as Grade 1 (G1) and 20 as Grade 2 (G2). Histopathology slides were reviewed to assess the intratumoural microvascular density (MVD) and the amount of tumour stroma. Computed tomography (CT) image analysis included tumour size, margin delineation, calcifications, homogeneity, contrast enhancement (CE) pattern, tumour absolute and relative enhancement, presence of cystic changes, pancreatic duct dilatation, regional and distant metastases. The diagnostic ability to predict tumour grade was measured for each MDCT finding and their combinations. RESULTS The mean arterial enhancement ratio had a mean±standard deviation of 1.53±0.45 in G1 and 1.01±0.33 in G2 pNETs (p=0.0003) and correlated with intratumoural microvascular density (MVD; r=0.55, p=0.0002). Tissue stroma percentage did not correlate with imaging findings. Late CE of the tumour (the peak attenuation observed in the venous phase) was significantly associated with G2. Tumour size ≥20 mm, arterial enhancement ratio <1.1, and late CE showed 74.4%, 79.5%, and 74.4% accuracy, respectively, in diagnosing G2 tumours, while the accuracy of at least two of these criteria used in combination was 82%. Based on these results, a diagnostic algorithm was proposed, which showed high interobserver agreement (k=0.82) in the prediction of tumour grade. CONCLUSION Contrast-enhanced MDCT features correlate with histological findings and enable the differentiation between G1 and G2 pNETs during preoperative examination.

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“…Several severe adverse events (e.g., thermal-induced pancreatitis, and duodenal or biliary injury) have been previously reported after intraoperative and percutaneous pancreatic RFA [6,17]. However, after an adjustment of both temperature and length of the dispensed energy, better outcomes with fewer complications were achieved [6,12,14].…”

Section: Discussionmentioning

confidence: 97%

EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success

Crinò¹,

D’Onofrio

Bernardoni³

et al. 2018

JGLD

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Background & Aims: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a promising technique for the treatment of pancreatic neoplasm. We evaluated the feasibility, safety, and technical success of pancreatic EUS-RFA performed in a single center.Methods: 9 consecutive patients (8 with pancreatic adenocarcinoma and 1 with renal cancer metastasis) were referred for EUS-RFA between November 2016 and July 2017. EUS-RFA was performed using 18-gauge internally cooled electrode with a 5 or 10 mm exposed tip. Feasibility, technical success or early and late adverse events were assessed.Results: One patient was excluded because of a large necrotic portion. EUS-RFA was feasible in all the other 8 (100%) cases. An ablated area inside the tumor was achieved in all treated patients. No early or late major adverse event was observed after a mean follow-up of 6 months. Three patients experienced mild postprocedural abdominal pain.Conclusions: EUS-RFA seems a feasible, safe, and effective procedure for pancreatic neoplasms. Its role in the treatment and management of pancreatic masses must be further investigated.

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Radiofrequency Ablation of Pancreatic Neuroendocrine Tumors

Abstract: Radiofrequency ablation is a feasible, safe, and effective option for patients with small PNETs who cannot or do not want to undergo surgical resection.

Cited by 99 publications

References 30 publications

Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

Contrast-enhanced MDCT in patients with pancreatic neuroendocrine tumours: correlation with histological findings and diagnostic performance in differentiation between tumour grades

EUS-guided Radiofrequency Ablation (EUS-RFA) of Solid Pancreatic Neoplasm Using an 18-gauge Needle Electrode: Feasibility, Safety, and Technical Success

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