Abstract
Purpose
In patients with metastatic functional gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), it is unknown what degree of tumor reduction is required to eliminate hormonal symptoms. We aimed to reduce hormonal symptoms derived from advanced GEP-NENs by efficient minimal intervention, constructing a hormonal tumor map of liver metastases.
Methods
Between 2013 and 2019, we treated 12 insulinoma or gastrinoma patients with liver metastases. Liver segments containing hormone-producing tumors were identified by injecting calcium gluconate via the hepatic arteries and monitoring the change in serum hormone concentration in the three hepatic veins. A greater-than-twofold increase in hormone concentration indicated a tumor-feeding vessel.
Results
Cases included eight insulinomas and four gastrinomas. Primary lesions were functional in three patients and nonfunctional in 9. Nine patients showed hormonal step-up indicating the presence of functional lesions; eight showed step-up in tumor-bearing liver segments, while one with synchronous liver metastases showed step-up only in the pancreatic region. Five patients underwent surgery. Serum hormone concentration decreased markedly after removing the culprit lesions in 3; immediate improvement in hormonal symptoms was achieved in all patients. Three patients with previous surgical treatment who showed step-up underwent transcatheter arterial embolization, achieving temporary improvement of hormonal symptoms. Four patients showed unclear localization of the hormone-producing tumors; treatment options were limited, resulting in poor outcomes.
Conclusion
Hormonal tumor mapping demonstrated heterogeneity in hormone production among primary and metastatic tumors of GEP-NENs. Minimally invasive treatment based on hormonal mapping may be a viable alternative to conventional cytoreduction.
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Acknowledgements
This work was supported by a Grant-in-Aid for Scientific Research (C), grant number 19K09041.
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This work was supported by Grant-in-Aid for Scientific Research (C) (Grant Number: 19K09041).
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Study concepts: AK. Study design: AM, AK. Data acquisition: AM, YM, SW, YI, HU, KA, KO, HO, MK. Quality control of data: AM, YM, YK. Data analysis and interpretation: YK, MK, AK. Manuscript preparation: AM, AK. Manuscript editing: AK. Manuscript review: ST, MT.
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This study was approved by the ethics committees of the faculty of Tokyo Medical and Dental University (approval number M2000-1080).
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432_2021_3650_MOESM1_ESM.pptx
Supplementary file1 (PPTX 43 kb) Fig. S1 Perioperative changes in serum hormone concentration. (a) Case 2. (b) Case 4. BG, blood glucose; IO-1, start of operation; IO-2, 2 hours after extraction of the resected culprit lesion; IRG, immunoreactive gastrin; IRI, immunoreactive insulin; POD, postoperative day; POM, postoperative month
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Maekawa, A., Kudo, A., Kishino, M. et al. Hormonal tumor mapping for liver metastases of gastroenteropancreatic neuroendocrine neoplasms: a novel therapeutic strategy. J Cancer Res Clin Oncol 148, 697–706 (2022). https://doi.org/10.1007/s00432-021-03650-2
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DOI: https://doi.org/10.1007/s00432-021-03650-2