ECE2018 Poster Presentations: Adrenal and Neuroendocrine Tumours Endocrine tumours and neoplasia (34 abstracts)
Patients with metastatic bone disease and neuroendocrine neoplasms: the experience of a multi-center study
Krystallenia Alexandraki 1 , Marina Tsoli 1 , Inbal Uri 2 , Tristan Page 3 , Michail Pizanias 4 , Dimitrios Thomas 1 , Chen Sheng Low 3 , Vasiliki Mavroeidi 1 , Olu Adesanya 3 , Denise Kolomodi 1 , Srirajaskanthan Rajaventhan 4 , Simona Grozinsky-Glasberg 2 , Martin Weickert 3 & Gregory Kaltsas 1,
1Endocrine Unit, 1st Department of Propaedeutic Medicine, Laiko University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; 2Neuroendocrine Tumor Unit, Endocrinology and Metabolism Department, Division of Medicine, Hadassah-Hebrew University Medical Center, P.O.B. 12000, 91120, Jerusalem, Israel; 3The ARDEN NET Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; 4Institute of Liver Studies, King’s College Hospital, London, UK.
Introduction: Neuroendocrine neoplasms (NENs) have variable biological behavior but the majority exhibits a slow progression. Metastatic bone disease (mBD) in NENs is relatively uncommon and not well described albeit associated with an increased mortality.
Methods: Seventy-four [37 males (50%), aged(±S.D.) 60.2±19.3] patients with NENs and bone metastases were recruited from 4 centers.
Results: Seventy-three (98.6%) patients had sporadic disease while 1(1.4%) had MEN-1. The primary disease sites were: pancreas: 22(29.2%); small bowel: 18(24.3%); unknown origin: 12(16.2%); lung: 11(14.9%); sigmoid: 4(9.5%), thymus: 2(2.7%), breast: 1(1.4%) and caecum 1(1.4%). Four (5.4%) had functional syndrome, 2 ACTH-ectopic syndrome and 2 carcinoid syndrome. Thirty-four (46%) patients had synchronous diagnosis of NEN and mBD, while in the remaining the time to mBD since first diagnosis was 27.9±56.7(0-383) months. Metastatic deposits were found as following: liver 48(64.9%), lymph nodes 24(32.4%), adrenal gland 4(5.4%), lymph nodes 11(14.9%), retroperitoneal and pelvic implantation 2(2.7%), mediastinum 2(2.7%), orbital brain 2(2.7%), brain 1(1.4%), parotid gland 1(1.4%), ovaries and uterus 1(1.4%), pancreas 1(1.4%). Sixteen (28.1%) patients had Ki-67≤2% (grade 1), 27(47.4%) 3-20% (grade 2), 25(15.8%) >20% (grade 3) for gastro-intestinal NENs and for lung and thymus all 9(15.8%) had atypical NENs. The treatment for mBD included bisphosphonates in 40 (74%), peptide receptor radionuclide therapy (PRRT) 29(39.2%), denosumab 13(17.6%), and RT 13(17.6%). The imaging studies dentified mBD as following: 45/54(83.3%) bone scan, 21/35(60%) MRI, 36/67(53.7%) CT, 35/54(64.8%) octreoscan, 11/21(52.4%) PET-FDG and 28/30(93.3%) gallium-68 positron emission tomography (Ga-PET). The mBD therapy resulted in improvement in 6.3%, stable disease in 45.3%, and deterioration in 37.5% while 10.9% of patients passed away before the evaluation of treatment response. No difference was seen after treatment with an intensified bishphosphonate scheme (4 mg of zoledronic acid monthly for 2 consecutive years) versus a conventional scheme. Overall, 30(40.5%) patients succumbed because of their disease with an overall survival 67.1±76(1-447) months since the NEN diagnosis.
Conclusion: The present multicentre registry of patients with NENs and mBD highlights the validity of Ga-PET for mBD identification and implies that there is no need of an intensified treatment at least for bisphosphonates despite the higher mortality rate of this subgroup of patients with NENs.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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