Solid-pseudopapillary tumor (SPT) is a rare neoplasm of the pancreas that usually occurs in young females. It is generally considered a low-grade malignant tumor that can remain asymptomatic for several years. The occ...Solid-pseudopapillary tumor (SPT) is a rare neoplasm of the pancreas that usually occurs in young females. It is generally considered a low-grade malignant tumor that can remain asymptomatic for several years. The occurrence of infiltrating varieties of SPT is around 10%-15%. Between 1986 and 2006, 282 cystic tumors of the pancreas were observed. Among them a SPT was diagnosed in 8 patients (2.8%) with only one infiltrating variety. This was diagnosed in a 49-year-old female 13 years after the sonographic evidence of a small pancreatic cystic lesion interpreted as a pseudocyst. The tumor invaded a long segment of the portal- mesenteric vein confluence, and was removed with a total pancreatectomy, resection of the portal vein and reconstruction with the internal jugular vein. Histological examination confirmed the R-0 resection of the primary SPT, although a vascular invasion was demonstrated. The postoperative course was uneventful, but 32 mo after surgery the patient experienced diffuse liver metastases. Chemotherapy with different drugs was started. The patient is alive and symptom-free, with stable disease, 75 mo after surgery. Twenty-five patients with invasion of the portal vein and/or of mesenteric vessels were retrieved from the literature, 16 recent patients with tumor relapse after potentially curative resection were also retrieved. The best treatment remains a radical resection whenever possible, even in locally advanced or metastatic disease. The role of chemotherapy, and/or radiotherapy, is still to be defined.展开更多
Tumor biopsies may help to reliably distinguish hepatocellular carcinoma(HCC) from other tumors, mostly cholangiocarcinoma as well as to identify the patient populations who most benefit from target-driven HCC treatme...Tumor biopsies may help to reliably distinguish hepatocellular carcinoma(HCC) from other tumors, mostly cholangiocarcinoma as well as to identify the patient populations who most benefit from target-driven HCC treatments, in order to improve the success rate of experimental therapies. Clarifying tumor biology may also lead to identify biomarkers with prognostic role and/or enabling to predict response or resistance to therapies. Recently, clinical trials have more efficiently included biomarker endpoints and increasingly collected tumor tissue from enrolled patients. Due to their frail status and sometimes fast-progressing disease, the performance status of patients with HCC progressing on first-line therapy can deteriorate quickly, preventing their enrollment in clinical trials. However, the challenge of identifying the proper patient at the proper time can be overcome by periodic inter-department meetings involving the key specialists taking care of HCC patients, and solid networks between research centers and referring institutions. An early planned biopsy would also facilitate timely inclusion of patients in biology-driven clinical trials. Ultimately, institution of multidisciplinary teams can optimize treatment choice, biopsy timing, and quick enrollment of patients in clinical trials, before their performance status deteriorates.展开更多
Chemotherapy induced cardio-toxicity is a well known side effect of anticancer treatments, moreover the 70% of all tumors involve patients over 65 years-old, frequently with cardiac co- morbidity. We evaluated the fea...Chemotherapy induced cardio-toxicity is a well known side effect of anticancer treatments, moreover the 70% of all tumors involve patients over 65 years-old, frequently with cardiac co- morbidity. We evaluated the feasibility of the application during chemotherapy administration of some of the most recent diagnostic techniques as 12-diagnostic leads telemetry, 7 days EKG monitoring device (R-Test Evolution 3R), blood level dosage of Brain Natriuretic Peptide (BNP) and Ischemia Modified Albumin (IMA). Some sub-clinical changes in the investigated parameters were found in patients undergoing chemotherapy, mostly containing fluorouracil, as shown in the following paper. Far from suggesting a widespread use of these methods during chemotherapy administration, we think that some more tools are needed to prevent cardiac toxicity in high-risk patients and some of what we studied may deserve further valuation in chemotherapy clinical trials.展开更多
After decades of frustrating nihilism due to lack of innovative therapeutic solutions, the onco-hepatological community is facing up to important novelties for the treatment of intermediate and advanced stages of live...After decades of frustrating nihilism due to lack of innovative therapeutic solutions, the onco-hepatological community is facing up to important novelties for the treatment of intermediate and advanced stages of liver cancer. Four new drugs have been investigated and resulted in positive data: lenvatinib resulted not inferior to the standard of care sorafenib in first line, regorafenib and cabozantinib demonstrated prolonging survival in patients progressed to sorafenib and nivolumab approved by FDA as option after first-line. Contemporary, the knowledge acquired after ten years' experience of sorafenib in patient selection and adverse events management revealed an increase of the outcomes. Physicians dedicated to treat advanced and intermediated liver cancer are close to live a new era where systemic treatments could have a huge impact on the disease. The aim of this review is to anticipate this new approach at the disease, summarizing data currently available for these therapies to identify therapeutic strategies of sequences and choosing drugs according to the patient profile.展开更多
文摘Solid-pseudopapillary tumor (SPT) is a rare neoplasm of the pancreas that usually occurs in young females. It is generally considered a low-grade malignant tumor that can remain asymptomatic for several years. The occurrence of infiltrating varieties of SPT is around 10%-15%. Between 1986 and 2006, 282 cystic tumors of the pancreas were observed. Among them a SPT was diagnosed in 8 patients (2.8%) with only one infiltrating variety. This was diagnosed in a 49-year-old female 13 years after the sonographic evidence of a small pancreatic cystic lesion interpreted as a pseudocyst. The tumor invaded a long segment of the portal- mesenteric vein confluence, and was removed with a total pancreatectomy, resection of the portal vein and reconstruction with the internal jugular vein. Histological examination confirmed the R-0 resection of the primary SPT, although a vascular invasion was demonstrated. The postoperative course was uneventful, but 32 mo after surgery the patient experienced diffuse liver metastases. Chemotherapy with different drugs was started. The patient is alive and symptom-free, with stable disease, 75 mo after surgery. Twenty-five patients with invasion of the portal vein and/or of mesenteric vessels were retrieved from the literature, 16 recent patients with tumor relapse after potentially curative resection were also retrieved. The best treatment remains a radical resection whenever possible, even in locally advanced or metastatic disease. The role of chemotherapy, and/or radiotherapy, is still to be defined.
文摘Tumor biopsies may help to reliably distinguish hepatocellular carcinoma(HCC) from other tumors, mostly cholangiocarcinoma as well as to identify the patient populations who most benefit from target-driven HCC treatments, in order to improve the success rate of experimental therapies. Clarifying tumor biology may also lead to identify biomarkers with prognostic role and/or enabling to predict response or resistance to therapies. Recently, clinical trials have more efficiently included biomarker endpoints and increasingly collected tumor tissue from enrolled patients. Due to their frail status and sometimes fast-progressing disease, the performance status of patients with HCC progressing on first-line therapy can deteriorate quickly, preventing their enrollment in clinical trials. However, the challenge of identifying the proper patient at the proper time can be overcome by periodic inter-department meetings involving the key specialists taking care of HCC patients, and solid networks between research centers and referring institutions. An early planned biopsy would also facilitate timely inclusion of patients in biology-driven clinical trials. Ultimately, institution of multidisciplinary teams can optimize treatment choice, biopsy timing, and quick enrollment of patients in clinical trials, before their performance status deteriorates.
文摘Chemotherapy induced cardio-toxicity is a well known side effect of anticancer treatments, moreover the 70% of all tumors involve patients over 65 years-old, frequently with cardiac co- morbidity. We evaluated the feasibility of the application during chemotherapy administration of some of the most recent diagnostic techniques as 12-diagnostic leads telemetry, 7 days EKG monitoring device (R-Test Evolution 3R), blood level dosage of Brain Natriuretic Peptide (BNP) and Ischemia Modified Albumin (IMA). Some sub-clinical changes in the investigated parameters were found in patients undergoing chemotherapy, mostly containing fluorouracil, as shown in the following paper. Far from suggesting a widespread use of these methods during chemotherapy administration, we think that some more tools are needed to prevent cardiac toxicity in high-risk patients and some of what we studied may deserve further valuation in chemotherapy clinical trials.
文摘After decades of frustrating nihilism due to lack of innovative therapeutic solutions, the onco-hepatological community is facing up to important novelties for the treatment of intermediate and advanced stages of liver cancer. Four new drugs have been investigated and resulted in positive data: lenvatinib resulted not inferior to the standard of care sorafenib in first line, regorafenib and cabozantinib demonstrated prolonging survival in patients progressed to sorafenib and nivolumab approved by FDA as option after first-line. Contemporary, the knowledge acquired after ten years' experience of sorafenib in patient selection and adverse events management revealed an increase of the outcomes. Physicians dedicated to treat advanced and intermediated liver cancer are close to live a new era where systemic treatments could have a huge impact on the disease. The aim of this review is to anticipate this new approach at the disease, summarizing data currently available for these therapies to identify therapeutic strategies of sequences and choosing drugs according to the patient profile.
