ΙΩΑΝΝΗΣ ΠΙΛΠΙΛΙΔΗΣ, MD, FEBGH
ΓΑΣΤΡΕΝΤΕΡΟΛΟΓΙΚΟ – ΟΓΚΟΛΟΓΙΚΟ ΤΜΗΜΑ
ΑΝΘ «ΘΕΑΓΕΝΕΙΟ»
ΝΕΤ MasterClass 2015
Dr ΧΑΡΑΛΑΜΠΟΣ ΑΝΔΡΕΑΔΗΣ
Γ’ ΤΜΗΜΑ ΚΛΙΝΙΚΗΣ ΟΓΚΟΛΟΓΙΑΣ
ΑΝΘ «ΘΕΑΓΕΝΕΙΟ»
Case Presentation
52 year-old man, good health
Dyspepsia (epigastric pain): 06/2012
Upper GI Endosccopy: Duodenal ulcer
Jaudice: 07/2012
Abdominal CT: tumor within the head of thepancreas (no mesenteric vessel involvement)
Question (1)
1.Biopsy
2.Surgery (pancreatectomy)
3.Stenting and biopsy
4.Stenting and surgery
5.Stenting and chemotherapy
7/11 G1 (64%) – 4 ασθενείς μεγαλύτερο G5/13 G2 (38%) – 8 ασθενείς μικρότερο G
Karoumpalis I, Salla Ch, Kontogeorgos G
Case Presentation
The patient underwent typical Whipple’s procedure(6-8-2012). R0 resection.
Pathology report: (well/poorly) differentiated NET, ki-67 about 20%. T3, N1, M1 (metastatic nodulesintraperitoneal?). CK, Chr A, synaptophysin (+), CD34 (+).
2nd consultation: (well/poorly) differentiated NEC(NET), ki-67 54%
Results• 31% of tumors were metastatic at diagnosis• Among GEP-NET: 57% were G1; 29% G2; and 14% G3
Conclusions• The relative distribution of NETs between GI and pulmonary
sites in French patients is comparable to that observed in other countries
Epidemiology of Neuroendocrine Tumors in France: The PRONET Study Scoazek J-Y , et al.
20% G3 WDNET
Case Presentation
RESTAGING on 2-10-2012:
Octreoscan: (-)
Abdominal MR imaging: (-)
Chromogranin A, NSE: (-)
Question (2)
1.Wait and watch – (PET-CT scan?)
2.Adjuvant chemotherapy (IA/ΙΒ)
3.“Adjuvant” somatostatin analogues (CLARINET)
4.“Adjuvant” everolimus (ΙΑ)
5.“Adjuvant” sunitinib (ΙΑ)
Case Presentation
The patient had received 4 cycleschemotherapy with the combination cisplatin+ etoposide, from 8/10/2012 – 13-12-2012.
Restaging on 10-1-2013: multiple secondaryliver lesions (>9)
Scintigraphy on 25-1-2013: Octreoscan: (-)
G1/G2
Question (3)
1.2nd line chemotherapy
2.Chemoembolization
3.RFAs (>9 lesions)
4.Surgery
5.PRRTs
6.Everolimus - Sunitinib
PET-CT scan?
PET-CT scan?
1.Liver only disease
2.Liver predominant disease
3.Liver predominantly progression of disease
Elias D, Goere D, Leroux G, et al. Eur J Surg Oncol 2009; 35: 1092–97.
10% infections, if enterobiliary anastomosisGillams A, Cassoni A, Conway G, Lees W, Abdom Imaging. 2005; 30: 435–41.
Question (4)
1.2nd line chemotherapy
2.PRRTs
3.Everolimus
71% disease-control
Case Presentation
Disease progression following 3 cycles ofchemotherapy with the combination(TEM + CAP + BEV).
Question (5)
1.3nd line chemotherapy
2.Everolimus
3.PRRTs (Octreoscan: -)
Case Presentation
131I-MIBG (on 11/4/2013): (+) uptake
On 26-4-2013: therapeutic dose (150 mCi 131IMIBG)
Addition of everolimus!!!
Clinical deterioration: 6/2013, CT scan +
7/2013: 68GA-Pet/CT scan: (-)
Case Presentation
5-8-2013: died because of liver failure.
Surgery: R0 resection
1st line chemo (cis-etoposide)
2nd line chemo (TEM – Cap – Bev)
PRRTs + Biologic (everolimus)
Case Presentation
1. Pathology report (preop biopsy)
2. Imaging (preoperatively)
3. MDT discussion (many options, many specialties)
4. Overtreatment!!!
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