Calcaneal inferior spurs are bony outgrowth that can arise from multiple sites. Compressive and traction forces are theorized to be the etiology behind their genesis. Blunt trauma to the plantar aspect of the foot can lead to calcaneal inferior spur fracture. We present a case of a 38-years-old male presenting inability to bear weight on his left foot with point tenderness after falling from a 3-meters height. Radiographic examination revealed fracture of calcaneal inferior spur, from which the patient was conservatively treated successfully. Fracture inferior calcaneal spur is a rare cause of heel pain. The reviewed literature showed how both conservative and surgical managements are used, the former more frequently.
{"title":"Calcaneal Inferior Spur Fracture Obvious but Easily Missed","authors":"Ahmedelmustafa A Musa, Alaa A Al-Taie","doi":"10.26502/acmcr.96550449","DOIUrl":"https://doi.org/10.26502/acmcr.96550449","url":null,"abstract":"Calcaneal inferior spurs are bony outgrowth that can arise from multiple sites. Compressive and traction forces are theorized to be the etiology behind their genesis. Blunt trauma to the plantar aspect of the foot can lead to calcaneal inferior spur fracture. We present a case of a 38-years-old male presenting inability to bear weight on his left foot with point tenderness after falling from a 3-meters height. Radiographic examination revealed fracture of calcaneal inferior spur, from which the patient was conservatively treated successfully. Fracture inferior calcaneal spur is a rare cause of heel pain. The reviewed literature showed how both conservative and surgical managements are used, the former more frequently.","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69343566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a dramatic case in which an initially minor superficial wound with an area of approximately 4 cm in diameter, increased in size to ~300 cm and more than 1cm deep, during 8 months of hospitalization. This deterioration occurred despite a wide range of standard of care procedures, such as OR debridement of necrotic tissue, systemic and local antibiotics administration, application of a variety of antimicrobial wound dressings, wound washes, Negative Pressure Wound Therapy, pressure chamber treatment, and two skin grafts after escharotomy. Resolution of the wound progression, subsequent granulation tissue formation, epithelialization, wound healing and almost complete wound closurewas achieved only after treatment with copper oxide impregnated wound dressings. This case strongly supports the potential role of copper in the healing process of hard-to-heal wounds.
{"title":"Copper Dressings to the Wound Rescue after Everything Else Failed: Case Report","authors":"Cernica Chausha Weitman, Tohar Roth, G. Borkow","doi":"10.26502/acmcr.96550499","DOIUrl":"https://doi.org/10.26502/acmcr.96550499","url":null,"abstract":"We report a dramatic case in which an initially minor superficial wound with an area of approximately 4 cm in diameter, increased in size to ~300 cm and more than 1cm deep, during 8 months of hospitalization. This deterioration occurred despite a wide range of standard of care procedures, such as OR debridement of necrotic tissue, systemic and local antibiotics administration, application of a variety of antimicrobial wound dressings, wound washes, Negative Pressure Wound Therapy, pressure chamber treatment, and two skin grafts after escharotomy. Resolution of the wound progression, subsequent granulation tissue formation, epithelialization, wound healing and almost complete wound closurewas achieved only after treatment with copper oxide impregnated wound dressings. This case strongly supports the potential role of copper in the healing process of hard-to-heal wounds.","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69343595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Barbara Faganel Kotnik, Tomaž Prelog, Marko Kavi, Simona Lucija Avin, J. Jazbec, L. Kitanovski, Vita Dolan
Low-dose Methotrexate (LD-MTX) and 6-mercaptopurine (6-MP) are used in the maintenance phase of treatment of childhood acute lymphoblastic leukaemia. It was reported that individuals with reduced activity of two of the enzymes involved in the pathway of purine metabolism, thiopurine S-methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15), will be exposed to higher levels of active metabolites and will be at higher risk of side effects, such as myelosupression. Therefore, dosing recommendations for 6-MP based on TPMT and NUDT15 genotype have been approved by FDA and have been published by the Clinical Pharmacogenetics Implementation Consortium and the Ditch Working Group. Though several studies were conducted on the toxicity of LD and HD-MTX in childhood ALL patients, none of the genetic markers so far have been used in MTX therapy protocols due to the lack of a clear association with the response and/or toxicity. We describe two pediatric patients who suffered from gastrointestinal toxicity following peroral administration of LD-MTX during maintenance therapy of ALL that diminished after switching to parenteral administration of the drug.
{"title":"A Gastrointestinal Toxicity during Low-Dose Methotrexate Treatment in Two Pediatric Patients with Acute Lymphoblastic Leukemia","authors":"Barbara Faganel Kotnik, Tomaž Prelog, Marko Kavi, Simona Lucija Avin, J. Jazbec, L. Kitanovski, Vita Dolan","doi":"10.26502/acmcr.96550513","DOIUrl":"https://doi.org/10.26502/acmcr.96550513","url":null,"abstract":"Low-dose Methotrexate (LD-MTX) and 6-mercaptopurine (6-MP) are used in the maintenance phase of treatment of childhood acute lymphoblastic leukaemia. It was reported that individuals with reduced activity of two of the enzymes involved in the pathway of purine metabolism, thiopurine S-methyltransferase (TPMT) and nudix hydrolase 15 (NUDT15), will be exposed to higher levels of active metabolites and will be at higher risk of side effects, such as myelosupression. Therefore, dosing recommendations for 6-MP based on TPMT and NUDT15 genotype have been approved by FDA and have been published by the Clinical Pharmacogenetics Implementation Consortium and the Ditch Working Group. Though several studies were conducted on the toxicity of LD and HD-MTX in childhood ALL patients, none of the genetic markers so far have been used in MTX therapy protocols due to the lack of a clear association with the response and/or toxicity. We describe two pediatric patients who suffered from gastrointestinal toxicity following peroral administration of LD-MTX during maintenance therapy of ALL that diminished after switching to parenteral administration of the drug.","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69343773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pramod Gaudel, Autumn Brubaker, Caitlyn Huang, L. Verkruyse, Chao Huang
Background: Ibrutinib is an irreversible inhibitor of Bruton tyrosine kinase (BTK) which is FDA approved for treatment of chronic lymphocytic leukemia (CLL) and multiple other B-cell lymphoproliferative disorders. Ibrutinib therapy is associated with increased risk of bleeding. We report an unusual but life-threatening case of hemorrhage with subcapsular renal hematoma and large hemothorax secondary to Ibrutinib. Case Presentation: An 85-year-old male with history of CLL started on a reduced dose of ibrutinib presented with acute onset left sided flank Archives of Clinical and Medical Case Reports and acute kidney failure. Imaging revealed moderate to large left sided pleural effusion and a renal mass concerning for renal neoplasm. He underwent thoracentesis revealing hemothorax. The patient was managed conservatively with intravenous hydration for his acute renal failure, blood transfusions and pain medications. His pain resolved; blood counts eventually stabilized and he was discharged from the hospital. The renal mass was later diagnosed as a large subcapsular renal hematoma after further review by another radiologist who determined that the Hounsfield unit of the mass was consistent with blood. Conclusions: This case illustrates a case of life-threatening hemorrhage that required hospitalization after 2 weeks of initiation of ibrutinib. Hemorrhage can occur despite reduced dose, and can result in hemorrhagic pleural effusion and bleeding in solid organs like the kidney. The presence of sudden large masses in a solid organ in a patient on ibrutinib should elicit the differential of intra-organ hemorrhage. Initiation of ibrutinib should be done cautiously, especially in elderly patients.
{"title":"Ibrutinib-Associated Life-Threatening Hemorrhage with Subcapsular Renal Hematoma and Hemothorax","authors":"Pramod Gaudel, Autumn Brubaker, Caitlyn Huang, L. Verkruyse, Chao Huang","doi":"10.26502/acmcr.96550480","DOIUrl":"https://doi.org/10.26502/acmcr.96550480","url":null,"abstract":"Background: Ibrutinib is an irreversible inhibitor of Bruton tyrosine kinase (BTK) which is FDA approved for treatment of chronic lymphocytic leukemia (CLL) and multiple other B-cell lymphoproliferative disorders. Ibrutinib therapy is associated with increased risk of bleeding. We report an unusual but life-threatening case of hemorrhage with subcapsular renal hematoma and large hemothorax secondary to Ibrutinib. Case Presentation: An 85-year-old male with history of CLL started on a reduced dose of ibrutinib presented with acute onset left sided flank Archives of Clinical and Medical Case Reports and acute kidney failure. Imaging revealed moderate to large left sided pleural effusion and a renal mass concerning for renal neoplasm. He underwent thoracentesis revealing hemothorax. The patient was managed conservatively with intravenous hydration for his acute renal failure, blood transfusions and pain medications. His pain resolved; blood counts eventually stabilized and he was discharged from the hospital. The renal mass was later diagnosed as a large subcapsular renal hematoma after further review by another radiologist who determined that the Hounsfield unit of the mass was consistent with blood. Conclusions: This case illustrates a case of life-threatening hemorrhage that required hospitalization after 2 weeks of initiation of ibrutinib. Hemorrhage can occur despite reduced dose, and can result in hemorrhagic pleural effusion and bleeding in solid organs like the kidney. The presence of sudden large masses in a solid organ in a patient on ibrutinib should elicit the differential of intra-organ hemorrhage. Initiation of ibrutinib should be done cautiously, especially in elderly patients.","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69343815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Zaki, N. -, Yasmin Abdul Rashid, Adnan Abdul Jabbar
Background: GBM is the most common and aggressive primary malignant brain tumor. Despite multimodality approach in the treatment of brain tumor, survival of the patients with GBM remains poor. The median survival of glioblastoma patients is ˷12 months. However, 35% of the patients survives for more than 3 years and are referred to as long-term survivors. When disease progression occurs 6-month progression-free survival (PFS) is usually lower than 15%. Case Presentation: A 68-years-old gentleman presented with a space occupying lesion in right frontoparietal region in March 2011, work up showed space (solid enhancing 4.3 x 4.2 x 2.7 cm & cystic component 3.6 x 3.5 x 3 cm). He underwent craniotomy for excision of the lesion, Post-operaticve scan confirmed gross total resection. Histopathology revealed Glioblastoma Multiforme. He received concomitant chemoradiation (60 Gy/30 Fr) with Temozolomide 75mg/m 2 followed by monthly temozolomide (day 1-5 q 28 day cycle)., He was continued on monthly temozolomide (from July 2011- July 2015) with imaging Q 3 montly which revealed no residual disease. Patient primary oncologist was changed and since there was no residual disease and no evidence of prolong use of TMZ, it was stopped and was put on surveillance. He remained in remission till September 2017, when he developed recurrent disease. . He underwent right redo craniotomy & excision of SOL in November 2017. Histopathology revealed GBM. He was started on monthly temozolomide q 28day cycle from December 2017 till February 2018, interim scans in Feb shows disease progression he then received Bevacizumab and irrinotecan Q3weekly till April 2018 interim scans shows disease progression at his time his clinical condition also deteriorated and was not a candidate for any further systemic treatment hence advised palliative care and patient expired in May 2018. This is a rare case which reported such a long survival in GBM. Conclusion: GBM has poor prognosis however we describe a case with prolong outcome. Tumor biology of the patient might be the key to his differential outcome.
{"title":"Glioblastoma Multiforme with Long Term Survival","authors":"A. Zaki, N. -, Yasmin Abdul Rashid, Adnan Abdul Jabbar","doi":"10.26502/acmcr.96550524","DOIUrl":"https://doi.org/10.26502/acmcr.96550524","url":null,"abstract":"Background: GBM is the most common and aggressive primary malignant brain tumor. Despite multimodality approach in the treatment of brain tumor, survival of the patients with GBM remains poor. The median survival of glioblastoma patients is ˷12 months. However, 35% of the patients survives for more than 3 years and are referred to as long-term survivors. When disease progression occurs 6-month progression-free survival (PFS) is usually lower than 15%. Case Presentation: A 68-years-old gentleman presented with a space occupying lesion in right frontoparietal region in March 2011, work up showed space (solid enhancing 4.3 x 4.2 x 2.7 cm & cystic component 3.6 x 3.5 x 3 cm). He underwent craniotomy for excision of the lesion, Post-operaticve scan confirmed gross total resection. Histopathology revealed Glioblastoma Multiforme. He received concomitant chemoradiation (60 Gy/30 Fr) with Temozolomide 75mg/m 2 followed by monthly temozolomide (day 1-5 q 28 day cycle)., He was continued on monthly temozolomide (from July 2011- July 2015) with imaging Q 3 montly which revealed no residual disease. Patient primary oncologist was changed and since there was no residual disease and no evidence of prolong use of TMZ, it was stopped and was put on surveillance. He remained in remission till September 2017, when he developed recurrent disease. . He underwent right redo craniotomy & excision of SOL in November 2017. Histopathology revealed GBM. He was started on monthly temozolomide q 28day cycle from December 2017 till February 2018, interim scans in Feb shows disease progression he then received Bevacizumab and irrinotecan Q3weekly till April 2018 interim scans shows disease progression at his time his clinical condition also deteriorated and was not a candidate for any further systemic treatment hence advised palliative care and patient expired in May 2018. This is a rare case which reported such a long survival in GBM. Conclusion: GBM has poor prognosis however we describe a case with prolong outcome. Tumor biology of the patient might be the key to his differential outcome.","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69343902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cardiac Surgery Training in Pakistan","authors":"M. Aasim","doi":"10.26502/acmcr.96550531","DOIUrl":"https://doi.org/10.26502/acmcr.96550531","url":null,"abstract":"","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69343971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cancer is the leading cause of mortality in every country in the world [1]. The World Health Organization reported that cancer is one of the major causes of disease-related deaths before the age of 70 [2]. Globally, cancer incidences and mortality is alarming and can often be co-related with the socio-economic development of a given population. This concern was depicted in 4-tier Human Development Index (HDI) of the United Nation [3]. An estimated 19.3 million fresh cases and 10 million deaths were registered globally in 2020. Of these, most new cases are of female breast cancer and maximum mortality rate is of lung cancer among both sexes. The cases of blood cancer are also distressing with 711,795 deaths among 1,278,362 new cases registered in 2020 [4]. Worldwide cancer statistics show disconcerting rates of occurrences and deaths even after recent advances in healthcare. Treatment of cancer continues to beat challenge since it is often difficult to appropriately categorise them, based on their underlying molecular signatures. Therefore, elucidating key signaling markers and their role in different types of cancers is a pre-requisite. Research on the haematological niche has progressed in the recent years [5]. The complexity of the human bone marrow, with context to haematological malignancies, is more difficult to elucidate with the present strategies compared to the niche of solid tumors. There can, however, be few similarities between the two, as the bone marrow is a common site of metastasis of solid tumors too [6]. Relevant information has now been established on solid tumors and their micro-environments, which include immune, endothelial and mesenchymal cells. Albeit a gap in knowledge still exists, the need to discover definite means to interfere with the complex interplay between the niches is imperative to define efficient chemotherapeutic strategies in future.
{"title":"CLEC12A: A Promise Target for Cancer Therapy","authors":"R. Chatterjee, U. Chatterji","doi":"10.26502/acmcr.96550548","DOIUrl":"https://doi.org/10.26502/acmcr.96550548","url":null,"abstract":"Cancer is the leading cause of mortality in every country in the world [1]. The World Health Organization reported that cancer is one of the major causes of disease-related deaths before the age of 70 [2]. Globally, cancer incidences and mortality is alarming and can often be co-related with the socio-economic development of a given population. This concern was depicted in 4-tier Human Development Index (HDI) of the United Nation [3]. An estimated 19.3 million fresh cases and 10 million deaths were registered globally in 2020. Of these, most new cases are of female breast cancer and maximum mortality rate is of lung cancer among both sexes. The cases of blood cancer are also distressing with 711,795 deaths among 1,278,362 new cases registered in 2020 [4]. Worldwide cancer statistics show disconcerting rates of occurrences and deaths even after recent advances in healthcare. Treatment of cancer continues to beat challenge since it is often difficult to appropriately categorise them, based on their underlying molecular signatures. Therefore, elucidating key signaling markers and their role in different types of cancers is a pre-requisite. Research on the haematological niche has progressed in the recent years [5]. The complexity of the human bone marrow, with context to haematological malignancies, is more difficult to elucidate with the present strategies compared to the niche of solid tumors. There can, however, be few similarities between the two, as the bone marrow is a common site of metastasis of solid tumors too [6]. Relevant information has now been established on solid tumors and their micro-environments, which include immune, endothelial and mesenchymal cells. Albeit a gap in knowledge still exists, the need to discover definite means to interfere with the complex interplay between the niches is imperative to define efficient chemotherapeutic strategies in future.","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69344157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Larnaudie, H. Orliac, N. Deny, C. Naessens, R. Serre, P. Clavère
Tracheal cancer is a rare localization with a lack of treatment consensus. A 45-year-old man presented a tracheal squamous cell carcinoma with mediastinal nodes and oesophagus involvement. Treatment consisted in induction chemotherapy, radiochemotherapy and immunotherapy. The different PET realised before, during and after induction chemotherapy helped to precise the radiotherapy volumes. Three months after radiochemotherapy, PET CT showed a partial response. We report choices done in our service in terms of radiotherapy and systemic treatment.
{"title":"Radiochemotherapy and Immunotherapy for A Tracheal Carcinoma","authors":"A. Larnaudie, H. Orliac, N. Deny, C. Naessens, R. Serre, P. Clavère","doi":"10.26502/acmcr.96550551","DOIUrl":"https://doi.org/10.26502/acmcr.96550551","url":null,"abstract":"Tracheal cancer is a rare localization with a lack of treatment consensus. A 45-year-old man presented a tracheal squamous cell carcinoma with mediastinal nodes and oesophagus involvement. Treatment consisted in induction chemotherapy, radiochemotherapy and immunotherapy. The different PET realised before, during and after induction chemotherapy helped to precise the radiotherapy volumes. Three months after radiochemotherapy, PET CT showed a partial response. We report choices done in our service in terms of radiotherapy and systemic treatment.","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69344174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dana M Poloni, Christina M Monaco, Maeghan L Ciampa, Elizabeth Marie Oliver Coffin, Joy N Liang, Eric D Martin.
{"title":"Regenerative Medicine May Mitigate the Need for Amputation in the Setting of a High Society for Vascular Surgery – Wound, Ischemia, Foot Infection (SVS-Wifi) Score","authors":"Dana M Poloni, Christina M Monaco, Maeghan L Ciampa, Elizabeth Marie Oliver Coffin, Joy N Liang, Eric D Martin.","doi":"10.26502/acmcr.96550556","DOIUrl":"https://doi.org/10.26502/acmcr.96550556","url":null,"abstract":"","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69344231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01Epub Date: 2022-07-21DOI: 10.26502/acmcr.96550511
Sebastian Krug, Anja Rinke, Marianne Pavel
Neuroendocrine tumors of the gastroenteropancreatic (GEP-NET) system include sporadic and hereditary diseases which have been increasing in incidence recently [1]. In patients with resectable low grade well-differentiated neuroendocrine tumors (NET) surgery is the mainstay of therapy. However, the majority of patients present with unresectable disease, most frequently with liver metastases. In patients with low grade NET G1 (Ki67<2%) a watch-andwait (W&W) strategy can be recommended in patients with loco-regional lymph node metastases or in patients with liver metastases if the liver tumor burden is low. The current German and European guidelines consider the use of W&W as a safe approach in this patient population [2, 3]. However, absence of symptoms and radiological tumor progression are essential requirements, along with a welldifferentiated morphology and low grade as well as limited metastasis. The clearest evidence for an W&W approach in GEP-NET derives from the CLARINET trial, where a median progression-free survival (mPFS) of 18 months was achieved in the placebo group with tumor stability within 3-6 months prior to start of lanreotide [4]. Out of 103 patients in the placebo arm 60 patients experienced progression within 24 months. However, 43 patients demonstrated stable disease even after 2 years which confirms that a subgroup of patients has no need for therapy even in the long-term. Data on the current prevalence of patients with a W&W strategy are not available. In 2021, we surveyed NET patients in Germany, Austria and Switzerland to assess the medical care under the COVID-19 pandemic. The online survey (constructed by LimeSurvey software) was distributed via personal contact and by the patient organization NETZwerk NET e.V. In this process, 542 out of 684 NET patients completely answered all questions [5]. Of these, 68 (12.5%) patients indicated that they were followed by a W&W strategy. About half were between 41-60 years of age (n=36, 53.0%), 30 affected people were between 61-80 years (n=30, 44.1%). Most participants had a small bowel or pancreatic primary tumor with 25.0% (n=17) and 23.5% (n=16), respectively. 25% of the W&W group (n=17) self-reported a functional-active disease and 66.2% (n=45) displayed symptoms at the time of the survey. In most cases, the diagnosis required more than 12 months (n=30, 44.1%) and almost half of the participants have been living with the disease for more than 5 years (n=33, 48.5%). Present comorbidities were specified as follows: hypertension (44.5%, n=30), diabetes (19.1%, n=13), asthma/COPD (16.2%, n=11), chronic renal failure (13.2%, n=9), heart insufficiency (8.8%, n=6). Only one participant mentioned a chronic infection. Liver cirrhosis as comorbidity was not reported. All clinically available characteristics of the participants are listed in Table 1.
{"title":"Watch and Wait Strategies in NET Patients: More than Expected.","authors":"Sebastian Krug, Anja Rinke, Marianne Pavel","doi":"10.26502/acmcr.96550511","DOIUrl":"https://doi.org/10.26502/acmcr.96550511","url":null,"abstract":"Neuroendocrine tumors of the gastroenteropancreatic (GEP-NET) system include sporadic and hereditary diseases which have been increasing in incidence recently [1]. In patients with resectable low grade well-differentiated neuroendocrine tumors (NET) surgery is the mainstay of therapy. However, the majority of patients present with unresectable disease, most frequently with liver metastases. In patients with low grade NET G1 (Ki67<2%) a watch-andwait (W&W) strategy can be recommended in patients with loco-regional lymph node metastases or in patients with liver metastases if the liver tumor burden is low. The current German and European guidelines consider the use of W&W as a safe approach in this patient population [2, 3]. However, absence of symptoms and radiological tumor progression are essential requirements, along with a welldifferentiated morphology and low grade as well as limited metastasis. The clearest evidence for an W&W approach in GEP-NET derives from the CLARINET trial, where a median progression-free survival (mPFS) of 18 months was achieved in the placebo group with tumor stability within 3-6 months prior to start of lanreotide [4]. Out of 103 patients in the placebo arm 60 patients experienced progression within 24 months. However, 43 patients demonstrated stable disease even after 2 years which confirms that a subgroup of patients has no need for therapy even in the long-term. Data on the current prevalence of patients with a W&W strategy are not available. In 2021, we surveyed NET patients in Germany, Austria and Switzerland to assess the medical care under the COVID-19 pandemic. The online survey (constructed by LimeSurvey software) was distributed via personal contact and by the patient organization NETZwerk NET e.V. In this process, 542 out of 684 NET patients completely answered all questions [5]. Of these, 68 (12.5%) patients indicated that they were followed by a W&W strategy. About half were between 41-60 years of age (n=36, 53.0%), 30 affected people were between 61-80 years (n=30, 44.1%). Most participants had a small bowel or pancreatic primary tumor with 25.0% (n=17) and 23.5% (n=16), respectively. 25% of the W&W group (n=17) self-reported a functional-active disease and 66.2% (n=45) displayed symptoms at the time of the survey. In most cases, the diagnosis required more than 12 months (n=30, 44.1%) and almost half of the participants have been living with the disease for more than 5 years (n=33, 48.5%). Present comorbidities were specified as follows: hypertension (44.5%, n=30), diabetes (19.1%, n=13), asthma/COPD (16.2%, n=11), chronic renal failure (13.2%, n=9), heart insufficiency (8.8%, n=6). Only one participant mentioned a chronic infection. Liver cirrhosis as comorbidity was not reported. All clinically available characteristics of the participants are listed in Table 1.","PeriodicalId":72280,"journal":{"name":"Archives of clinical and medical case reports","volume":"6 4","pages":"534-536"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9401089/pdf/nihms-1825890.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33437655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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