Evolving diagnostic and treatment strategies for pancreatic neuroendocrine tumors.

Evolving diagnostic and treatment strategies for pancreatic neuroendocrine tumors.
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DOI:
10.1186/1756-8722-4-29
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发表时间:
2011-06-14
影响因子:
28.5
通讯作者:
Yao J
Yao J
中科院分区:
医学1区
文献类型:
--
作者:
Kulke MH;Bendell J;Kvols L;Picus J;Pommier R;Yao J

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胰腺神经内分泌肿瘤(Net)临床表现多样。有激素分泌症状的患者可能需要在抗肿瘤干预之前进行特定的医疗干预以控制这些症状。在一些患者中,胰腺肿瘤可能是隐匿性的,可能需要专门的诊断成像或手术才能诊断。其他患者可能出现更严重的疾病,表现为肿瘤肿块的症状,而不是激素分泌。晚期胰腺神经内分泌肿瘤患者的治疗选择包括手术切除和肝脏定向治疗,包括部分肝切除、肝动脉栓塞术或其他消融技术。以链脲佐菌素或替莫唑胺为基础的化疗方案对胰腺网有积极的作用,在晚期疾病患者的缓解中也可以发挥重要作用。一些针对血管内皮生长因子和mTOR信号通路的生物靶向药物最近显示出希望,最近的试验表明,VEGFR酪氨酸激酶抑制剂sunitinib或mTOR抑制剂everolimus的治疗提高了晚期Net患者的无进展生存率。
Pancreatic neuroendocrine tumors (NET) have diverse clinical presentations. Patients with symptoms of hormone secretion may require specific medical interventions to control those symptoms prior to antitumor intervention. In some patients, tumors in the pancreas may be occult and specialized diagnostic imaging or surgery may be required for diagnosis. Other patients may present with more advanced disease, presenting with symptoms of tumor bulk rather than hormone secretion. Treatment options for patients with advanced pancreatic neuroendocrine tumors include surgical resection and hepatic directed therapies, including partial hepatectomy, hepatic artery embolization, or other ablative techniques. Streptozocin or temozolomide-based chemotherapy regimens are active against pancreatic NET, and can also play an important role in the palliation of patients with advanced disease. A number of biologically targeted agents targeting the VEGF and mTOR signaling pathways have recently shown promise, with recent trials showing treatment with the VEGFR tyrosine kinase inhibitor sunitinib or the mTOR inhibitor everolimus improves progression-free survival in patients with advanced NET.
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