Gastrointestinal cancer research : GCR最新文献

Background: Neuroendocrine tumors (NETs) are neoplasms arising most often in the GI tract, pancreas, or lung. Diagnosis of NETs is often delayed until the disease is advanced, because of the variable and nonspecific nature of the initial symptoms. Surgical resection for cure is therefore not an option for most patients.

Methods: Somatostatin analogues represent the cornerstone of therapy for patients with NETs. This article reviews the important role that somatostatin analogues continue to play in the treatment of patients with NETs.

Results: Octreotide was the first somatostatin analogue to be developed; more than 30 years of data have accumulated demonstrating its efficacy and safety. Lanreotide is another somatostatin analogue in clinical use, and pasireotide is a promising somatostatin analogue in development. Newer long-acting depot formulations are now available offering once-monthly administration. Although octreotide was initially developed for symptom control, recent results indicate that it also has an antiproliferative effect, significantly increasing time to progression in patients with midgut NETs. Combinations of octreotide with other targeted therapies may further improve patient outcomes. Findings in recent studies of the combination of octreotide and the mTOR inhibitor everolimus are encouraging. The combinations of octreotide with other agents (eg, interferon-α, bevacizumab, cetuximab, AMG-706, and sunitinib) are being investigated.

Conclusions: Somatostatin analogues have been used to treat the symptoms of NETs for decades and also have an antineoplastic effect, markedly prolonging progression-free survival. Somatostatin analogues are likely to remain the cornerstone of treatment for most patients with advanced NETs. Promising new combination therapies are undergoing clinical investigation.

Background: The estimated prevalence of hydrocephalus in all age groups is between 1% and 1.5%. Placement of a ventriculoperitoneal (VP) shunt in such patients offers them relatively normal lives. There are minimal data concerning the risk of postoperative complications in patients with shunts who undergo subsequent major visceral operations. We hypothesized that healthy adults who had VP shunts placed for acquired conditions and later underwent surgery for gastric or colon cancer would frequently have dense, shunt-related adhesions and high rates of adverse outcomes, particularly infection.

Methods: We assumed that all veterans were healthy on entry into military service. We searched national Department of Veterans Affairs databases from October 1994 through September 2003 to identify all Department of Veterans Affairs patients with shunts for acquired conditions and a curative-intent operation for stomach or colon cancer. We conducted chart reviews to determine their clinical courses.

Results: Five patients had codes for VP shunt, gastric cancer, and gastrectomy; 3 met our inclusion criteria. Fourteen had codes for VP shunt, colon cancer, and colectomy; 4 met our criteria. One of the evaluable gastrectomy patients had dense, shunt-related adhesions. None of the colectomy patients had notable adhesions. There were no postoperative complications in any of the seven patients.

Conclusion: We believe this is the first report analyzing the clinical course of adults with VP shunts who later had major abdominal cancer surgery. The presence of a shunt was associated with dense adhesions in 1 (14%) of the 7 patients in this series, but not with an increased risk of postoperative complications.