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Combining imaging and surgical procedures in localising GEP tumors does not improve the curability of this syndromes

1995; Elsevier BV; Volume: 108; Issue: 4 Linguagem: Inglês

10.1016/0016-5085(95)28103-7

1528-0012

Stefano Angeletti, Vito D. Corleto, A Materia, M Marginani, Renato Caviglia, E Polettini, Francesco Scopinaro, Orazio Schillaci, Gianfranco Gualdi, Gianfranço Silecchia, Cesare Bordi, Bruno Annibale, Nicola Basso, EJ Passaro, Gianfranco Delle Fave,

Pituitary Gland Disorders and Treatments

Backg, round-The best way to preoperatively localize gastroente[opancreatic endocrine (GEP) tumors has been improved by combining Octreoscan (Somatostatin Receptor Scintigraphy-SRS) and MR (Magnetic Resonance).SRS and MR are reported to be the most sensitive imaging tecniques for higher curative results in addition to surgical laparotomy but very few studies have been until now adressed to evaluate the curative potentiality of such combined imaging procedures associated to surgical laparotomy.Aim: to evaluate prospectively the combined imaging procedure (SRS and MR) and explorative taparotomy in the cure of syndromes related to GEP tumors.Materials and Methods : 14 patients (9M,5F age 10-56) with clinical and biochemical evidence of GEP tumors (9 ZES; 1VIPOMA; 2 MEN-l; 1 CARC1NOID; 1 Malignant Neuroendoerine Tumor) underwent SRS (lll-In Octreotide "Octreoscan" 180-220 MBq IV, Starcam 2000 gamma camera equipped with a medium energy parallel collimator.Images-plus SPET: Single Photon Emission Tomography-taken at 4 and 24 hours after radinnuclide injection) and MR (Gyroscan T5, 5 mm thickness contiguous scans.256x256 matrix, TI a,d T2 weighted spin echo and stir-sequence); and were eleetively sent to surgery and operated on by the same surgeon in blind.Results: Combined preoperative imaging tecniquas (SRS&MR) localised 28 Presumable Tumor Lesions (PTL), surgical laparotomy 26 while histology verified in 20 of the surgical specimens tumor tissue that means 77% capability to remove tumor tissue; and 23% of combined surgical and imaging diagnostic procedures false positive .The ormnnal tumor markers (Gastrin, VIP and Serotonin) were decreased of about 60 to 70 % respect preoperative values.Only two out of 14 patients (14.2%) were free of symptoms and with negative ormonal tumor marker 6 months later.Conclusions: Even if these combined procedures give the ability to find and remove more tumor mass.the rate of curability of such tumos-related syndromes remains wery poor.