Research Advances in the Role of Keratins in Gastrointestinal Cancer / 中国医学科学杂志(英文版)

The incidence and mortality rates of gastrointestinal (GI) cancer remain high. Despite constant improvements in diagnostic and therapeutic techniques, the early diagnosis, mid- and late-stage treatment, drug tolerance, and cancer recurrence and metastasis in GI cancer remain challenging. In this review article we summarize the recent research advance in the roles of keratins in GI cancer, with the hope that they will become efficient biomarkers for the prediction, diagnosis, or treatment of these malignancies.

Caracterización de paciente con tumores estromales gastrointestinales en Hospital Clínico-Quirúrgico "Arnaldo Milián Castro" / Characterization of Patients with Stromal Gastrointestinal Tumors in Arnaldo Milián Castro Clinical-Surgical Hospital

Introducción: El tumor estromal gastrointestinal es la neoplasia mesenquimal más frecuente en el tracto digestivo, su diagnóstico y tratamiento aun es controvertido por ser infrecuente. Objetivo: Caracterizar los pacientes con tumores estromales gastrointestinales atendidos en nuestro servicio. Métodos: Se realizó un estudio observacional descriptivo longitudinal en pacientes con tumores estromales gastrointestinales atendidos en el servicio de cirugía del Hospital Clínico-Quirúrgico "Arnaldo Milián Castro" desde 2015 hasta 2018. La muestra fue de 17 pacientes. Resultados: Predominaron los pacientes entre 60 y 69 años (35,3 por ciento) del sexo femenino (58,82 por ciento). El dolor abdominal como síntoma más frecuente (58,82 por ciento). El (47,1 por ciento) de los tumores midieron más de 10 cm, celularidad fusiforme (58,8 por ciento), índice mitótico menor de 5 (70,6 por ciento), sin patrón de crecimiento infiltrante (70,6 por ciento). La metástasis ausente en el (82,4 por ciento). Presente con igual frecuencia en estómago e intestino delgado (N = 8), fue igual la presencia de comportamiento agresivo bajo y alto (35,3 por ciento). Predominaron los marcadores CD.117 (41,2 por ciento) y CD.34 (35,3 por ciento). La recesión segmentaria de intestino delgado con anastomosis término-terminal fue la técnica quirúrgica más empleada (35,3 por ciento). Conclusiones: A pesar de ser mayormente grandes y encontrarse en porciones altas del tubo digestivo, muchos presentaron índice mitótico bajo, no obstante, un grupo considerable presentó comportamiento agresivo. Si bien es cierto que casi la totalidad de pacientes egresaron vivos, falta un seguimiento en el centro, lo cual resultaría interesante evaluar en futuros estudios(AU)

Introduction: Gastrointestinal stromal tumor is the most frequent mesenchymal neoplasm in the digestive tract, its diagnosis and treatment is still controversial because it is infrequent. Objective: To characterize the patients with gastrointestinal stromal tumors treated in our service. Methods: A longitudinal descriptive observational study was carried out in patients with gastrointestinal stromal tumors treated in the surgery service of the "Arnaldo Milián Castro" Clinical-Surgical Hospital from 2015 to 2018. The sample consisted of 17 patients. Results: Female patients between 60 and 69 years old (35.3 percent) predominated (58.82 percent). Abdominal pain as the most frequent symptom (58.82 percent). Tumors (47.1 percent) measured more than 10 cm, spindle cell cellularity (58.8 percent), mitotic index less than 5 (70.6 percent), and no infiltrative growth pattern (70.6 percent). Metastasis absent in (82.4 percent). Present with equal frequency in the stomach and small intestine (N = 8), the presence of low and high aggressive behavior (35.3 percent) was the same. The markers CD.117 (41.2 percent) and CD.34 (35.3 percent) predominated. Segmental recession of the small intestine with end-to-end anastomosis was the most widely used surgical technique (35.3 percent). Conclusions: Despite being mostly large and found in high portions of the digestive tract, many presented a low mitotic index, however, a considerable group presented aggressive behavior. Although it is true that almost all the patients were discharged alive, there is a lack of follow-up at the center, which would be interesting to evaluate in future studies(AU)

Interpretation of updated international guidelines for diagnosis and treatment of gastroenter-opancreatic neuroendocrine neoplasms / 中华胃肠外科杂志

The incidence of neuroendocrine neoplasms (NEN) is continuously increasing with gastrointestinal tract and pancreas being the most common primary sites. Currently, the guidelines proposed by European Neuroendocrine Tumor Society (ENETS), National Comprehensive Cancer Network (NCCN), European Society for Medical Oncology (ESMO) and North American Neuroendocrine Tumor Society (NANETS) are being widely applied. Among these, ENETS and NANETS guidelines were proposed in 2017 while ESMO and NCCN recently updated their guidelines for gastroenteropancreatic NEN in 2020 and 2021, respectively. This article interprets the diagnosis and treatment of gastroenteropancreatic NEN based on the newly updated ESMO and NCCN guidelines. The diagnosis of gastroenteropancreatic NEN depends on histological assessment including morphological evaluation, grading and immunohistochemistry results. Combination of different imaging methods can help determine tumor staging and risk assessment. Decision-making of treatment and follow-up strategies is based on primary tumor site, tumor classification, tumor grade, tumor type, functional status etc.

Prehabilitation for gastrointestinal cancer patients / 中华胃肠外科杂志

Gastrointestinal cancer and related treatments (surgery and chemoradiotherapy) are associated with declined functional status (FS) that has impact on quality of life, clinical outcome and continuum of care. Psychological distress drives an impressive burden of physiological and psychiatric conditions in oncologic care. Cancer patients often experience anxiety, depression, low self-esteem and fears of recurrence and death. Cancer prehabilitation is a process from cancer diagnosis to the beginning of treatment, which includes psychological, physical and nutritional assessments for a baseline functional level, identification of comorbidity, and targeted interventions that improve patient's health and functional capacity to reduce the incidence and the severity of current and future impairments with cancer, chemoradiotherapy and surgery. Multimodal prehabilitation program encompasses a series of planned, structured, repeatable and purposive interventions including comprehensive physical exercise, nutritional therapy, and relieving anxiety and depression, which integrates into best perioperative management ERAS pathway and aims at using the preoperative period to prevent or attenuate the surgery-related functional decline, to cope with surgical stress and to improve the consequences. However, a number of questions remain in regards to prehabilitation in gastrointestinal cancer surgery, which consists of the optimal makeup of training programs, the timing and approach of the intervention, how to improve compliance, how to measure functional capacity, and how to make cost-effective analysis. Therefore, more high-level evidence-based studies are expected to evaluate the value of implementation of prehabilitation into standard practice.

Análise de redes na regulação do tratamento do câncer do aparelho digestivo / Network analysis of the regulation of gastrointestinal cancer treatment / Análisis de redes en la regulación del tratamiento del cáncer del aparato digestivo

Resumo: A alta complexidade é componente fundamental da Política Nacional para a Prevenção e Controle do Câncer no âmbito do Sistema Único de Saúde (SUS) brasileiro. Tem como obrigação garantir cuidado integral aos pacientes. A regulação é parte da estrutura organizacional, sendo responsável por definir os fluxos de atendimento. No Rio de Janeiro, a Central de Regulação iniciou as atividades em junho de 2015, organizando procedimentos ambulatoriais de alta complexidade. O presente trabalho tem como objetivo analisar o deslocamento para o tratamento de pessoas com tumores digestivos no Estado do Rio de Janeiro, antes e após a atuação da regulação, sob a perspectiva da Análise de Redes Sociais (ARS). Foi desenvolvido um estudo ecológico, comparando os períodos anterior (2013) e posterior (2016) à implantação da central reguladora. A pesquisa foi desenvolvida com a utilização de dados secundários provenientes do Departamento de Informática do SUS. Desse modo, foram desenhados dois sociogramas referentes aos anos 2013 e 2016, relacionando local de residência com local de internação. Com essa abordagem foi possível identificar algumas mudanças na dinâmica das relações entre as microrregiões do estado após a implantação da regulação. As microrregiões que apresentam estabelecimentos de Alta Complexidade em Oncologia exibiram um incremento no número de internações no segundo ano estudado. Observa-se ainda que a microrregião Rio de Janeiro mantém centralidade de grau nos dois momentos. A utilização da ARS para a avaliação de políticas públicas pode trazer uma importante contribuição para planejamento e gestão em saúde.

Abstract: High complexity is a fundamental component of Brazil's National Policy for Cancer Prevention and Control under the Unified National Health System (SUS). The policy mandates guaranteeing comprehensive patient care. Regulation is part of the organizational structure and is responsible for defining treatment flows. In Rio de Janeiro, the Central Regulating Office launched its activities in June 2015, organizing high-complexity outpatient procedures. The current study aims to analyze commuting for treatment by individuals with gastrointestinal tumors in the state of Rio de Janeiro, before and after the implementation of regulation, from the perspective of Social Network Analysis. This ecological study compared the periods before (2013) and after (2016) implementation of the Central Regulating Office. The study drew on secondary data from the Brazilian Health Informatics Department. Two sociograms were designed for the years 2013 and 2016, correlating place of residence with place of hospitalization. This approach allowed identifying some changes in the dynamics of relations between the state's microregions after implementation of the regulation. The microregions with high-complexity oncology establishments displayed an increase in the number of hospitalizations in 2016. The microregion of Rio de Janeiro also maintained degree centrality in the two moments. The use of Social Network Analysis to assess public policies can contribute to health planning and management.

Resumen: La alta complejidad es un componente fundamental de la Política Nacional para la Prevención y Control del Cáncer en el ámbito del Sistema Único de Salud (SUS) brasileño. Tiene como obligación garantizar el cuidado integral a los pacientes. La regulación es parte de la estructura organizacional, siendo responsable de definir los flujos de atención. En Río de Janeiro, la Central de Regulación inició sus actividades en junio de 2015, organizando procedimientos ambulatorios de alta complejidad. El presente trabajo tiene como objetivo analizar el desplazamiento para el tratamiento de personas con tumores digestivos en el Estado de Río de Janeiro, antes y después de la actuación de la regulación, desde la perspectiva del Análisis de Redes Sociales (ARS). Se desarrolló un estudio ecológico, comparando los períodos anterior (2013) y posterior (2016) a la implementación de la central reguladora. La investigación fue desarrollada con la utilización de datos secundarios provenientes del Departamento de Informática del SUS. De este modo, se diseñaron dos sociogramas referentes a los años 2013 y 2016, relacionando lugar de residencia con local de internamiento. Con este abordaje fue posible identificar algunos cambios en la dinámica de las relaciones entre las microrregiones del Estado tras la implementación de la regulación. Las microrregiones que presentan establecimientos de Alta Complejidad en Oncología mostraron un incremento en el número de internamientos en el segundo año estudiado. Se observa incluso que la microrregión Río de Janeiro mantiene centralidad de nivel/grado en los dos momentos. La utilización de la ARS para la evaluación de políticas públicas puede conllevar una importante contribución para la planificación y gestión en salud.

Current approaches to immunotherapy in noncolorectal gastrointestinal malignancies

Noncolorectal gastrointestinal (GI) malignancies are among the most frequently diagnosed cancers. Despite the undeniable progress in systemic treatments in recent decades, further improvements using cytotoxic chemotherapy seem unlikely. In this setting, recent discoveries regarding the mechanism underlying immune evasion have prompted the study of molecules capable of inducing strong antitumor responses. Thus, according to early data, immunotherapy is a very promising tool for the treatment of patients with GI malignancies. Noncolorectal GI cancers are a major public health problem worldwide. Traditional treatment options, such as chemotherapy, surgery, radiation therapy, monoclonal antibodies and antiangiogenic agents, have been the backbone of treatment for various stages of GI cancers, but overall mortality remains a major problem. Thus, there is a substantial unmet need for new drugs and therapies to further improve the outcomes of treatment for noncolorectal GI malignancies. "Next-generation" immunotherapy is emerging as an effective and promising treatment option in several types of cancers. Therefore, encouraged by this recent success, many clinical trials evaluating the efficacy of immune checkpoint inhibitors and other strategies in treating noncolorectal GI malignancies are ongoing. This review will summarize the current clinical progress of modern immunotherapy in the field of noncolorectal GI tumors.

Transcatheter arterial embolization of acute gastrointestinal tumor hemorrhage with Onyx.

BACKGROUND: Endovascular embolization has been used to control gastrointestinal tumor bleeding. Lots of embolic agents have been applied in embolization, but liquid embolic materials such as Onyx have been rarely used because of concerns about severe ischemic complications. AIM: To evaluate the clinical efficacy and safety of transcatheter arterial embolization (TAE) with Onyx for acute gastrointestinal tumor hemorrhage. MATERIALS AND METHODS: Between September 2011 and July 2013, nine patients were diagnosed as acute gastrointestinal tumor hemorrhage by clinical feature and imaging examination. The angiographic findings were extravasation of contrast media in the five patients. The site of hemorrhage included upper gastrointestinal bleeding in seven cases and lower gastrointestinal bleeding in two cases. TAE was performed using Onyx in all the patients, and the blood pressure and heart rate were monitored, the angiographic and clinical success rate, recurrent bleeding rate, procedure related complications and clinical outcomes were evaluated after therapy. The clinical parameters and embolization data were studied retrospectively. RESULTS: All the patients (100%) who underwent TAE with Onyx achieved complete hemostasis without rebleeding and the patients were discharged after clinical improvement without a second surgery. No one of the patients expired during the hospital course. All the patients were discharged after clinical improvement without a second surgery. Postembolization bowel ischemia or necrosis was not observed in any of the patients who received TAE with Onyx. CONCLUSIONS: TAE with Onyx is a highly effective and safe treatment modality for acute gastrointestinal tumor hemorrhage, even with pre‑existing coagulopathy.

Tumores estromales gastrointestinales: evaluación clinicopatológica y sobrevida en el Hospital Rebagliati / Gastrointestinal stromal tumors: clinicopathologic and survival evaluation in Rebagliati Hospital

OBJETIVO: Determinar las manifestaciones clínicas, radiológicas, histopatológicas y sobrevida de los pacientes con Tumor Estromal Gastrointestinal (GIST) en el Hospital Nacional Edgardo Rebagliati Martins (HNERM), de Lima, Perú. MATERIAL Y MÉTODOS: El presente es un estudio descriptivo, retrospectivo. El cual se realizó a partir de las historias clínicas de 103 pacientes con GIST confirmado por inmunohistoquímica que fueron evaluados y tratados en el HNERM, desde Enero del 2002 hasta Diciembre de 2010. RESULTADOS: En los 103 pacientes el promedio de edad fue 64 años (entre 30 y 88 años). Predominó en mujeres (52%). El tiempo de enfermedad promedio fue 7 meses. La forma de presentación más frecuente fue sangrado digestivo (48.3%). El diagnóstico se hizo más por endoscopía (50.5%). La prevalencia por órganos fue más frecuente en estómago 56.3%. El promedio de tamaño fue 98mm, (49% entre 50mm y 100mm), el tumor de mayor tamaño alcanzaba 260 mm. El estadio tumoral más frecuente fue localizado (70.9%). Presentaron otro cáncer asociado el 9.7% de pacientes El patrón histológico predominante fue fusiforme 73.8%. El 84.5% tuvo bajo índice mitótico. La inmunohistoquímica mostró la expresión de KIT (CD 117) 94.17%, CD 34 77.5%, Vimentina 96.6%, NSE 84.9%, Alfa actina 52.7%, CD56 44.4%, S-100 32.3% y Actina 20.0%. La característica tomográfica más frecuente fue tumor heterogéneo (43.6%). La distribución según clasificación de riesgo fue: muy bajo riesgo 3.9%, bajo riesgo 28.2%, riesgo intermedio 37.7% y alto riesgo 30.1%. La resección quirúrgica completa se realizó en 87.4% de pacientes, 4.9% de pacientes recibió Imatinib. La sobrevida global acumulada a 5 años fue 31.07%. En el análisis bivariado se encontró asociación estadística entre el haber sobrevivido con: ausencia de cáncer asociado p= 0.004, CD 34 p=0.01, índice mitótico bajo p=0.00 y tratamiento quirúrgico recibido p= 0.000. En el análisis multivariado se encontró asociación estadística de mayor sobrevida con: los de menor tamaño del tumor p=0.015 (IC -3.67, -0.41), estadio tumoral localizado p=0.036 (IC -5.83, -0.19), menor índice mitótico p=0.038 (IC -0.86, 0.02), paciente asintomático p=0.009 (IC 1.25, 8.62), no recidiva del tumor p=0.01 (IC -8.49, -1.17) y el no presentar metástasis p=0.001 (IC 2.66, 10.62). CONCLUSIONES: Los resultados de nuestro estudio fueron similares a lo que reporta la literatura internacional. Los factores que se asociaron a mayor sobrevida fueron: haber recibido tratamiento quirúrgico, pacientes con menor tamaño tumoral, estadio tumoral localizado, índice mitótico bajo, paciente asintomático, no recidiva del tumor, no metástasis y no cáncer asociado.

OBJECTIVE: To determine the clinical, radiological, histopathological manifestations and survival of patients with gastrointestinal stromal tumor (GIST)in the National Hospital Edgardo Rebagliati Martins (HNERM) from Lima, Perú. MATERIAL AND METHODS: This is a descriptive and retrospective study, which was based on the medical records of 103 patients with confirmed GIST with immunohistochemical. All the patients were evaluated and treated at the HNERM, from January 2002 until December 2010. RESULTS: In 103 patients between 30 and 88 years the average age was 64 years. The tumor was more frequent in females (52%). The mean disease duration was 7 months. The most frequent form of presentation was gastrointestinal bleeding (48.3%). The diagnosis was made more by endoscopy (50.5%). The prevalence of GISTs by organs was more frequent in stomach (56.3%). The average size of the tumors was 98mm, 49% had a size between 50mm and 100mm, the largest tumor was 260 mm. Tumor stage more frequent was localized (70:9%). GIST associated with another cancer was 9.7% of patients. The predominant histologic pattern was fusiform (73.8%). The 84.5% had low mitotic index. Immunohistochemistry showed expression KIT (CD 117) was 94.17%, CD34 77.5%, Vimentin 96.6%, NSE 84.9%, alpha actin 52.7%, CD56 44.4%, S-100 32.3% and Actin 20%. The tomographic characteristic more frequent was heterogeneous tumor (43.6%).The distribution according to risk classification was: very low risk 3.9%, low risk 28.2, intermediate risk 37.7% and high risk 30.1%. Complete surgical resection was performed in 87.4% of patients and 4.9% of patients received imatinib. The cumulative overall survival at 5 years was 31.07%. In bivariate analysis statistical association was found between surviving with: no presence of cancer associated p = 0.004, CD 34 p = 0.01, low mitotic index p = 0.00 and received surgical treatment p = 0.000. In multivariate analysis one found statistical association of longer survival with smaller tumor size p = 0.015 (CI -3.67, -0.41), localized tumor stage p = 0.036 (CI -5.83, -0.19), lower mitotic index p = 0.038 (CI -0.86, 0.02), asymptomatic patient p=0.009 (CI 1.25, 8.62), no tumor recurrence p = 0.01 (CI -8.49, -1.17), and no metastasis p = 0.001 (CI 2.66, 10.62). CONCLUSIONS: The results of our study were similar to what was reported in international literature. Factors that were associated with longer survival were receiving surgical treatment, patients with smaller tumor size, tumor stage localized, low mitotic index, asymptomatic patient, not tumor recurrence, not metastasis and no cancer associated.

Tumores del estroma gastrointestinal (GIST) / Gastrointestinal stromal tumors (GIST)

Gastrointestinal stromal tumors are rare but are the most common mesenchymal tumors of the gastrointestinal tract. They originate from the interstitial cells of Cajal and mostly expressing positive c-kit (CD117). These are an heterogeneous group of injuries ranging from benign to aggressive. To date, the tumor size and number of mitosis are the most useful tool for predicting the risk of malignancy. Endosonography is an excellent imaging method for characterizing lesions and it allows obtaining material for pathological diagnosis. Surgical resection is the therapy of choice for localized disease and good prognosis. The use of imatinib in advanced disease has improved survival.

Los tumores del estroma gastrointestinal son poco frecuentes, pero son los tumores del mesénquima más frecuentes del tubo digestivo. Se originan de las células intersticiales de Cajal y expresan en su gran mayoría c-kit (CD117) positivo. Son un grupo heterogéneo de lesiones que van desde un comportamiento benigno a uno altamente agresivo. Hasta la fecha el tamaño tumoral y el número de mitosis son los elementos más útiles para predecir el riesgo de malignidad. La endosonografía es un excelente método de imagen para caracterizar las lesiones y, además, permite la obtención de material para diagnóstico anatomopatológico. La resección quirúrgica es la terapia de elección para la enfermedad localizada y con buen pronóstico. El uso de Imatinib en la enfermedad avanzada ha mejorado la sobrevida en los pacientes.

Tumor estromal gastrointestinal: experiência no tratamento da doença localizada e avançada no Hospital de Clínicas da Universidade Federal do Paraná / Gastrointestinal stromal tumor: experience in the treatment of localized and advanced disease at the Clinical Hospital of Parana Federal University

Introdução: Tumores estromais gastrointestinais (GIST) são neoplasias raras que se originam das células intersticiais de Cajal. Objetivo: Descrever a experiência do Hospital de Clínicas de Curitiba no tratamento do GIST localizado e avançado, com análise das características clínicas e anatomopatológicas e uso do imatinibe. Método: Estudo retrospectivo com 32 pacientes com diagnóstico por imuno-histoquímica, c-Kit positivo, no período de 2003 a 2008. Resultados: Idade mediana: 66 anos; tamanho mediano do tumor de 8,4 cm; e as localizações mais frequentes foram estômago em 46,9 por cento e intestino delgado em 40,9 por cento. Pacientes com alto risco de agressividade: 37,5 por cento; apresentavam doença localizada no diagnóstico 23 pacientes: 39,1 por cento recaíram e 9 com doença avançada. O seguimento mediano foi de 43,7 meses, com sobrevida global em 5 anos no grupo total de 56,2 por cento. Na doença localizada, a sobrevida global em 5 anos foi de 73,8 por cento e na avançada de 37,5 por cento (p=0,03). Não ocorreu impacto dos fatores prognósticos na sobrevida. Utilizou-se omesilato de imatinibe em 16 pacientes: 43,8 por cento por metástase inicial, 37,5 por cento recaída a distância, 12,5 por cento recaída local e 6,2 por cento margem comprometida. A sobrevida global com uso do imatinibe mediana foi de 53 meses e a sobrevida livre de primeira progressão de 32,9 meses. Houve boa tolerabilidade ao imatinibe e apenas dois pacientes utilizaram osunitinibe. Conclusão: A maioria dos tumores era grande, de localização gástrica e de alto risco de agressividade. A taxa de recaída na doença localizada foi alta. E a sobrevida global dos pacientes de doença localizada e que utilizaram o imatinibe foi considerada satisfatória.

Clinicopathologic characteristics and therapeutic outcomes of primary gastrointestinal non-Hodgkin's lymphomas: 10 years of experience from a single center in Eastern Anatolia

The objective of this retrospective study was to report the clinicopathological data and the treatment outcomes in patients with primary gastrointestinal non-Hodgkin's lymphoma. We carried out a retrospective analysis of 41 patients [22 females, 18 males, median age 58 and range 18-90 years] who presented to our department with histopathological diagnosis of primary gastrointestinal non-Hodgkin's lymphoma between 1995 and 2004. The stomach was the most common extranodal site and was seen in 25 of 41 [61%] patients. At presentation 28 [68.3%] patients had gastrointestinal symptoms while 27 [65.9%] had B symptoms. The range of follow-up was 2-84 months with a median of 9 months. The overall survival rate was 3 years for 25 [61.21%] patients. The 3-year overall survival rate was better in patients with early-stage disease [stages I and II[1]] who were treated with surgery plus chemotherapy and/or radiation therapy than in those treated with chemotherapy alone [91.6 vs. 50%, p<0.05]. The disease had a significant impact on both the progression-free survival and overall survival rates. Our data showed that surgical resection prior to postoperative chemotherapy was a better option for patients with early-stage disease with better patient survival

Neuroendocrine tumors: a registry of 1000 patients / Tumores neuroendócrinos: registro de 1000 pacientes

Neuroendocrine tumors (NET) can originate diffusely in most organs, with varying clinical presentations. The relative rarity of these tumors, previously referred to as carcinoids, encouraged several centers worldwide to study NET. Since 2003, a similar group was established in , the GETNE - Grupo de Estudo de Tumores Neuroendocrinos (Neuroendocrine Tumors Study Group) that included 32 centers, from all regions of Brasil. A patient database was initiated, collecting information about NET, regardless of the site of origin. OBJECTIVES: The present study shows initial results of 1000 patients included. METHODS: Descriptive statistical analyses, as well as overall survival rates for different groups of NET patients registered by GETNE. RESULTS: Most patients presented with thoracic NET (71.6 percent), while 20.2 percent had gastro-entero-pancreatic tumors. Median follow-up of all patients included was 33.7 months (range 1-141 months). At the time of the analysis, 29.3 percent of the patients were still alive (of these, 45.7 percent were alive with no evidence of disease). CONCLUSION: This is the largest database of NET in, and further accrual of new patients, as well as individual study results are expected in the near future.

Os tumores neuroendócrinos (TNE) podem se originar da maioria dos órgãos com apresentação clínica variável. A relativa raridade destes tumores, previamente classificados como carcinóides, levou vários centros no mundo a realizar estudos específicos dos TNE. A partir de 2003, um grupo similar foi criado no , GETNE- Grupo de Estudo de Tumores Neuroendocrinos, que incluiu 32 centros médicos de várias regiões do Brasil. Um arquivo de pacientes foi criado, registrando informações individuais sobre TNE, independente do órgão de origem. OBJETIVOS: O presente estudo apresenta os resultados dos primeiros 1000 pacientes incluídos. MÉTODOS: Análise estatística descritiva, assim como análises de sobrevida global dos pacientes registrados no GETNE. RESULTADOS: A maioria dos pacientes foi admitida com TNE torácicos (71,6 por cento), enquanto 20,2 por cento tiveram TNE gastro-entero-pacnreáticos. O seguimento mediano foi de 33,7 meses (variando entre 1-141 meses). Ao término desta análise, 29,3 por cento dos pacientes ainda estavam vivos (destes, 45,7 por cento vivos sem evidência de doença). CONCLUSÃO: Este representa o maior arquivo de TNE no , e a inclusão de novos pacientes, assim como estudos específicos, são esperados no futuro próximo.

Carcinoid syndrome: diagnosis and medical management

Gastro-intestinal carcinoids are slow growing tumors arising from enterochromaffin or Kulchitsky cells. Their clinical presentation depends on what combination of bioactive substances is secreted. Midgut carcinoid can present with the carcinoid syndrome in the presence of liver metastases. Its most typical clinical manifestations include cutaneous flushing and diarrhea. A nonspecific biochemical tumor marker for carcinoid tumors is serum chromogranin A and a specific marker for the carcinoid syndrome is the increased urinary excretion of 5-hydroxy indole acetic acid (5-HIAA). Localizing studies in carcinoid tumors/syndrome are: transabdominal ultrasonography (US), endoscopy, endoscopic US, videocapsule endoscopy, computerized tomography, magnetic resonance imaging, selective abdominal angiography, 111In-pentetreotide scintigraphy (and intraoperative radionuclide probe), 123I (131I)-metaiodobenzylguanidine (MIBG) scintigraphy, bone scintigraphy and 11C-5-HT positron emission tomography (PET). Therapies for carcinoid tumors/syndrome are: surgery, somatostatin analogs, interferon-alpha, radiotherapy, liver dearterialization, liver (chemo, or radio)-embolization, alcohol sclerotherapy of liver metastases, radiofrequency ablation of liver metastases, cryosurgery of liver metastases, occasionally liver transplantation, radiotherapy-coupled somatostatin analogs, 131I-MIBG and occasionally chemotherapy.

Tumores estromais gastrointestinais (GISTs) / Gastroinstestinal stromal tumors (GISTs)

Os autores fazem uma revisão bibliográfica sobre tumores estromais gastrointestinais, conhecidos como GISTs (Gastrointestinal Stromal Tumors). Sua história ao longo dos anos, diagnóstico clínico e histopatológico, graduação, tratamento e controvérsias que envolvem o assunto são abordados

Urgencias quirúrgicas digestivas en oncología / Digestive surgical emergencies in oncology

Se desarrollan los aspectos diagnósticos, terapéuticos y pronósticos de las urgencias quirúrgicas digestivas en oncología, analizando una serie del Instituto Nacional de Oncología y la correspondiente revisión bibliográfica. Por motivos de exposición se desarrolla el tema en cinco sectores del aparato digestivo: esófago, gastroduodeno, intestino delgado, colon y recto. Se describen las complicaciones inflamatorias, hemorrágicas infecciosas, perforativas y oclusivas, que se presentan en cada uno de estos sectores como consecuencia del desarrollo del tumor primario, metástasis, tratamiento instituido o concomitancia de patologías no neoplásicas. Se destaca, dada la complejidad de estos pacientes, la importancia que adquieren los equipos multidisciplinarios para un correcto diagnóstico y tratamiento de las complicaciones detalladas.

Summary A review of diagnostic, therapeutic, and prognostic aspects of surgical digestive urgencies in oncology through the analysis of a series of the Instituto Nacional de Oncología along as its corresponding bibliography are presented. The subject has been divided in five sections: esophagus, duodenum, small intestine, colon and rectum. Inflammatory, hemorrhage, infectious, perforative and occlusive complications of primary tumors in each section, metastases, treatment or concomitant non neoplasmic pathology are described. Since the management of these patients is complex, we emphasize the importance of multidisciplinary teams to approach diagnosis and an appropriate treatment of the complications.

Résumé On expose les aspects disgnostiques, thérapeutiques et pronostiques des urgences chirurgicales digestives en oncologie; pour ce faire, on analyse une série de l'Institut National d'Oncologie et la révision bibliographique correspondante. Pour des motifs expositionnels on aborde le sujet en cinq secteurs de l'appareil digestif, oesopha-ge, gastro-duodénum, intestin grêle, côlon et rectum. On décrit les complications inflammatoires, hémorragiques infectieuses, perforatives et occlusives qui sont présentes dans chacun de ces secteurs comme résultat du développe-ment de la tumeur primaire, métastase, traitement fixé ou concomitance de pathologies pas néoplasiques. On signale, tenant compte de la compléxité de ces patients, l'importance des équipes multidisciplinaires pour un correct diagnostic et pour le traitement des troubles ici analysés.

A Case of Primary Intestinal T-Cell Lymphoma Involving Entire Gastrointestinal Tract: Esophagus to Rectum

Primary intestinal T-cell lymphoma is a rare disease entity, which is approximately 10% to 25% of intestinal lymphomas, and most of the lymphomas occur in the small intestine. We report here a case of a 56-year-old woman who has been suffering from chronic diarrhea and weight loss for 6 months. Abdominal CT scan and small bowel series showed diffuse wall thickening of the small bowel. Gastroscopic examination showed diffuse erythematous lesions on the esophagus and small gastric ulcerations on the antrum of the stomach, and colonoscopic examination also showed multiple punched-out ulcerations and erosions on the entire colon, including the sigmoid colon to the terminal ileum. Diffuse infiltration of CD 3 positive lymphoma cells was found on biopsy. The patient was diagnosed as primary intestinal T-cell lymphoma with diffuse involvement of the entire gastrointestinal tracts from the esophagus to the rectum. Although the patient received systemic combination chemotherapy and achieved partial response initially, the lymphoma relapsed repeatedly.

Tumor carcinoide de apéndice cecal: presentación de un caso / Carcinoid tumor of cecal appendix: presentation of a case

Se presenta un caso de una paciente de 39 años en quien se realiza apendicectomía, sin complicaciones, resultando en el exámen histopatológico imágenes compatibles con carcinoide de apéndice. En base a esto, hemos realizado una revisión de los últimos trabajos presentados al respecto, incluyéndo análisis de institutos nacionales para profundizar en esta patología. La mayor parte de dichas investigaciones coincidieron en la frecuencia del carcinoide apendicular como primera neoplasia del apéndice. Con respecto a la frecuencia como neoplasia en el tracto gastrointestinal hubo discrepancia entre diferentes autores, aunque el tratamiento recomendado coinciden las distintas conductas dependiendo de la magnitud del tumor, metástasis y la presencia o no de síndrome carcinoide

Tumor carcinoma de estômago / Carcinoid tumor of the stomach

Os autores apresentam um caso de tumor carcinóide de estômago, dando especial atençao para os aspectos clínicos de apresentaçao da moléstia bem como para os dados sobre o diagnóstico e a elaboraçao terapêutica.