ABSTRACT
Paragangliomas (PGLs) are neuroendocrine tum-ors that arise embryologically from the neural crest. Sympathetic PGLs can be located in the thoracic-abdominal region while parasympathetic PGLs are mainly situated in the head and neck region. Most PGLs are sporadic, but in 30% of cases they are hereditary (associated with mutations of SDHB, SDHC, SDHD, SDHAF2, SDHA, TMEM, MAX, and VHL); they can be classified into 4 different paraganglioma syndromes: PGL1, PGL2, PGL3, and PGL4. Surgery is the treatment of choice for both sympathetic and parasympathetic PGLs. Other types of treatment include medical agents (such as gemcitabine, cisplatin, or sunitinib) and radiotherapy (external-beam radiotherapy or stereotactic surgery). Surgery and radiotherapy, however, can cause important side effects such as vascular complications and peripheral nerve damage (hypoglossal, recurrent laryngeal, glossopharyngeal, and vagus). Another possible treatment option is the use of peptide receptor radionuclide therapy (PRRT), including PRRT with 177Lu-DOTATATE. We studied 4 patients with hereditary nonmetastatic paraganglioma syndrome type 1 (PGL1), with progressive disease, in whom surgical excision was not possible. They were treated with 177Lu-DOTATATE (3-5 cycles) and all had a partial response (PR) or a stable disease (SD) to the treatment. In conclusion, a good alternative treatment when surgical or radiation therapy are contraindicated could be radiometabolic therapy with 177Lu-DOTATATE.
Subject(s)
Head and Neck Neoplasms/radiotherapy , Mediastinal Neoplasms/radiotherapy , Octreotide/analogs & derivatives , Organometallic Compounds/therapeutic use , Paraganglioma/radiotherapy , Receptors, Peptide/therapeutic use , Adult , Aged , Female , Humans , Octreotide/therapeutic useABSTRACT
The study is based on the methodology of the contemporary interdisciplinary cognitive images of the information entity of the surgical sphere, reflected in the phenomenology of the journal "Surgery", which is gathering --as a publication of the Scientific Society of Surgeons--the kaleidoscope of the genealogy of the scientific and practical thought in Bulgaria in the treated area for an impressive historical lapse of time. The information image observed is represented in the form of a triptych: I. Macrostructure of the periodicals in the field of medicine in the years 30 of XX century: Bibliographic analysis: Historiographical description [: Background]; II. Microstructure of the journal "Surgery" (1934-2004): Periodization [1934-1944: non-party system with priority of the monarchy; 1944-1989: totalitarian epoch; 1989-2004: democracy and pluralism]: Scientometrical synthesis: Transformatism of the information modeling [: History]; III. Status of the surgical field in the intelligible prism of the journal "Surgery" (1934-2004): Interdisciplinary deduction: Cognitological proscopy [: Classification]. The ontological synthesis concludes the study by which is expressed the systemic dynamical entity of the relation "surgical field"--"its scientific expression in a periodical" as a base of future scientific research--as well as a complex scientific and applied field of knowledge, and a social important phenomenon. The Supplements and References and notes are an empirical base and a fragment of the expose.
