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Objective: To determine the effectiveness of hepatic artery occlusion alone and with sequenced chemotherapy for patients with hepatic-dominant metastases of islet cell carcinomas and carcinoid tumors.Design: Nonrandomized, observational study with follow-up from 2.5 to 10 years.Patients: 111 ambulatory patients referred to a multidisciplinary tertiary care center who had histologically proven islet cell carcinoma or carcinoid tumor and symptomatic measurable metastatic lesions in the liver or hormonal abnormalities or both. The patients were ambulatory but were having substantial symptoms because of their endocrine syndromes or their tumors.Intervention: All patients had hepatic artery occlusion done surgically or by catheterization and embolization. After this procedure, 71 patients were selected for chemotherapy with alternating two-drug regimens of doxorubicin plus dacarbazine and streptozocin plus fluorouracil. Main outcome measures of response to therapy were rates of tumor regression, rates of improvement in endocrine abnormalities, symptomatic improvement, and duration of favorable response.Results: Objective regressions were observed in 60% of patients treated with occlusion alone and in 80% with chemotherapy added. Regressions were associated with substantial or complete relief from the endocrine syndromes. With occlusion alone, the median duration of regression was 4.0 months and with chemotherapy added, it was 18.0 months. Any comparative inferences about the two treatment regimens must be guarded, because this was not a randomized trial and marked differences occurred in the distribution of prognostic factors between the patient groups. Side effects of arterial occlusion included fever, nausea, pain, and abnormalities in liver function. Side effects of chemotherapy included nausea, vomiting, leukopenia, and alopecia.Conclusions: Hepatic arterial occlusion can frequently produce major regression of neuroendocrine tumors with relief from the hormonal syndromes. Sequential chemotherapy may improve the rate and duration of the regression. [ABSTRACT FROM AUTHOR]

Background: Based on physical properties, 99mTc-labeled perfusion agents offer several advantages over 201Tl for myocardial perfusion imaging. The results of in vivo and experimental studies, along with preliminary experience in human subjects, have shown 99mTc-labeled furifosmin to be a promising new perfusion tracer. The purpose of this study was to evaluate the safety of a new myocardial perfusion agent, 99mTc-labeled furifosmin (Q12), and determine the concordance of furifosmin perfusion scintigraphy to 201Tl imaging. In addition, we sought to determine the normalcy rate of myocardial scintigraphy with furifosmin.Methods and Results: One hundred fifty patients constituted the study group in this multicenter trial. Patients underwent exercise testing with furifosmin injected at peak exercise, and tomographic imaging was begun 15 to 30 minutes afterward. After a separate injection, resting images were obtained 3 to 4 hours later. Thallium scintigraphy was performed within 2 weeks of the furifosmin scans, after a similar exercise workload. Patients with a low likelihood of coronary artery disease (n = 39) also underwent furifosmin imaging. All images were processed and displayed in uniform manner and interpreted by a panel of readers. No adverse effects or clinically important laboratory alterations were related to furifosmin imaging. Image quality was slightly better with furifosmin than with thallium. The overall concordance between the perfusion studies was 86% (kappa value = 0.669). The normalcy rate for furifosmin scintigraphy was 100%.Conclusions: 99mTc-labeled furifosmin is a promising new 99mTc-labeled myocardial perfusion agent, providing diagnostic results similar to those obtained with 201Tl. [ABSTRACT FROM AUTHOR]

Introduction: Patients with lymph-node positive midgut NETs (stage IIIB) represent a heterogeneous group. While some have microscopic lymph node involvement on pathological evaluation, others may develop large, desmoplastic, unresectable tumors in the root of the mesentery. Aim(s): To assess whether unresectable lymph node metastases in the root of the mesentery represent a distinct prognostic group among patients with stage IIIB midgut NETs. Materials and methods: Within a database of jejunal-ileal NETs seen at the Moffitt Cancer Center between 2000 and 2010, we identified patients with lymph-node involvement (stage IIIB). We then compared overall survival between resectable and unresectable lymph node metastases using log-rank analysis. Results: One-hundred and eighty-four patients with stage IIIB midgut NETs were identified. Among these patients, 158 had resectable disease and 26 patients had unresectable tumors in the root of the mesentery that were presumed to represent lymph node metastases or tumor/lymph node complexes. Five-year survival rates were 95% among patients with resectable stage IIIB tumors v. 77% among patients with unresectable tumors (p=0.027). Conclusion: Patients with unresectable tumors in the root of the mesentery represent a unique prognostic group with a survival rate that is distinct from patients with resectable lymph node metastases. TNM staging classifications should recognize this unique subset of patients with locally-advanced midgut NETs. [ABSTRACT FROM AUTHOR]

Introduction: Thymic neuroendocrine tumors are rare, with an estimated annual incidence of 0.2 per million. They are generally considered chemoresistant and there have been no reported cases of an objective response to therapy. Aim(s): To review a case of a metastatic neuroendocrine tumor of the thymus in which an objective partial radiographic response was obtained using systemic chemotherapy consisting of capecitabine and temozolomide. Materials and methods: Case report with clinicopathologic reivew and radiographic evaluation of response using RECIST 1.1 criteria. Results: A 48-year-old man with metastatic intermediategrade thymic neuroendocrine tumor and history of ectopic Cushing's syndrome was treated with capecitabine and temozolomide. A partial radiographic response on CT scans (52% decrease in sum of tumor diameters) was obtained 19 months after initiation of therapy. The patient also experienced a significant reduction in pain related to skeletal metastases. Conclusion: The combination of capecitabine and temozolomide may be an active regimen for treatment of thymic neuroendocrine tumors. [ABSTRACT FROM AUTHOR]

Introduction: The American Joint Committee on Cancer (AJCC) and ENETS have independently introduced a novel TNM staging classification for jejunal-ileal NETs. Aim(s): To assess the prognostic relevance of the AJCC/ENETS staging classification for midgut (jejunal-ileal) NETs. Materials and methods: Patients with jejunal-ileal NETs treated at the Moffitt Cancer Center between 2000 and 2010 were assigned stages (I-IV) based on the AJCC/ENETS TNM staging classification. Overall survival from time of initial diagnosis was measured, and statistical significance was calculated using the log-rank test. Results: Six-hundred and fifty-six patients with histologically-proven jejunal-ileal NETs were identified. The AJCC/ENETS classification in aggregate was highly prognostic for overall survival (p<0.00001). Five-year overall survival rates for stages I-IV were 100%, 100%, 90% and 72%, respectively. The survival difference between stages III and IV was significant (p<0.00001); the difference between stages I/II v. III was borderline significant (p=0.1). Conclusion: The AJCC/ENETS staging classification for midgut NETs is statistically prognostic for overall survival. However, stages I and II are associated with a similarly favorable outcome and are unlikely to be prognostically distinct for overall survival. [ABSTRACT FROM AUTHOR]