Authors:Beata Kos-Kudła, Wanda Foltyn, Anna Malczewska, Tomasz Bednarczuk, Marek Bolanowski, Małgorzata Borowska, Ewa Chmielik, Jarosław B. Ćwikła, Iwona Gisterek, Daria Handkiewicz-Junak, Alicja Hubalewska-Dydejczyk, Barbara Jarząb, Michał Jarząb, Roman Junik, Dariusz Kajdaniuk, Grzegorz Kamiński, Agnieszka Kolasińska-Ćwikła, Aldona Kowalska, Leszek Królicki, Maciej Krzakowski, Jolanta Kunikowska, Katarzyna Kuśnierz, Andrzej Lewiński, Łukasz Liszka, Magdalena Londzin-Olesik, Bogdan Marek, Anna Nasierowska-Guttmejer, Ewa Nowakowska-Duława, Marianne E. Pavel, Joanna Pilch-Kowalczyk, Jarosław Reguła, Violetta Rosiek, Marek Ruchała, Grażyna Rydzewska, Lucyna Siemińska, Anna Sowa-Staszczak, Teresa Starzyńska, Zoran Stojčev, Janusz Strzelczyk, Michał Studniarek, Anhelli Syrenicz, Marek Szczepkowski, Ewa Wachuła, Wojciech Zajęcki, Anna Zemczak, Wojciech Zgliczyński, Krzysztof Zieniewicz Abstract: Continuous progress in the diagnostics and treatment of neuroendocrine neoplasms (NENs), the emerging results of new clinical trials, and the new guidelines issued by medical societies have prompted experts from the Polish Network of Neuroendocrine Tumours to update the 2017 recommendations regarding the management of neuroendocrine neoplasms. This article presents the general recommendations for the management of NENs, resulting from the findings of the experts participating in the Fourth Round Table Conference, entitled “Polish Guidelines for the Diagnostics and Treatment of Neuroendocrine Neoplasms of the gastrointestinal tract, Żelechów, June 2021”. Drawing from the extensive experience of centres treating these cancers, we hope that we have managed to formulate the optimal method of treating patients with NENs, applying the latest reports and achievements in the field of medicine, which can be effectively implemented in our country. The respective parts of this work present the approach to the management of: NENs of the stomach and duodenum (including gastrinoma), pancreas, small intestine, and appendix, as well as large intestine. PubDate: 2022-06-30 Issue No:Vol. 73 (2022)
Authors:Grażyna Rydzewska, Janusz Strzelczyk, Tomasz Bednarczuk, Marek Bolanowski, Małgorzata Borowska, Ewa Chmielik, Jarosław B. Ćwikła, Wanda Foltyn, Iwona Gisterek, Daria Handkiewicz-Junak, Alicja Hubalewska-Dydejczyk, Ksenia Janas, Michał Jarząb, Roman Junik, Dariusz Kajdaniuk, Grzegorz Kamiński, Agnieszka Kolasińska-Ćwikła, Magorzata Kołos, Aldona Kowalska, Leszek Królicki, Jolanta Kunikowska, Katarzyna Kuśnierz, Andrzej Lewiński, Łukasz Liszka, Magdalena Londzin-Olesik, Bogdan Marek, Anna Malczewska, Anna Nasierowska-Guttmejer, Ewa Nowakowska-Duława, Marianne E. Pavel, Joanna Pilch-Kowalczyk, Jarosław Reguła, Violetta Rosiek, Marek Ruchała, Lucyna Siemińska, Anna Sowa-Staszczak, Teresa Starzyńska, Zoran Stojčev, Michał Studniarek, Anhelli Syrenicz, Marek Szczepkowski, Ewa Wachuła, Wojciech Zajęcki, Anna Zemczak, Wojciech Zgliczyński, Krzysztof Zieniewicz, Beata Kos-Kudła Abstract: After another meeting of experts of the Polish Network of Neuroendocrine Tumours, updated recommendations for the management of patients with gastric and duodenal neuroendocrine neoplasms, including gastrinoma, have been issued. As before, the epidemiology, pathogenesis and clinical symptoms of these neoplasms have been discussed, as well as the principles of diagnostic procedures, including biochemical and histopathological diagnostics and tumour localisation, highlighting the changes introduced in the recommendations. Updated principles of therapeutic management have also been presented, including endoscopic and surgical treatment, and the options of pharmacological and radioisotope treatment. The importance of monitoring patients with gastric and duodenal NENs, including gastrinoma, has also been emphasised. PubDate: 2022-06-30 Issue No:Vol. 73 (2022)
Authors:Beata Kos-Kudła, Violetta Rosiek, Małgorzata Borowska, Tomasz Bednarczuk, Marek Bolanowski, Ewa Chmielik, Jarosław B. Ćwikła, Wanda Foltyn, Iwona Gisterek, Daria Handkiewicz-Junak, Alicja Hubalewska-Dydejczyk, Michał Jarząb, Roman Junik, Dariusz Kajdaniuk, Grzegorz Kamiński, Agnieszka Kolasińska-Ćwikła, Aldona Kowalska, Leszek Królicki, Jolanta Kunikowska, Katarzyna Kuśnierz, Andrzej Lewiński, Łukasz Liszka, Magdalena Londzin-Olesik, Bogdan Marek, Anna Malczewska, Anna Nasierowska-Guttmejer, Ewa Nowakowska-Duława, Marianne E. Pavel, Joanna Pilch-Kowalczyk, Jarosław Reguła, Marek Ruchała, Grażyna Rydzewska, Lucyna Siemińska, Anna Sowa-Staszczak, Teresa Starzyńska, Zoran Stojčev, Janusz Strzelczyk, Michał Studniarek, Anhelli Syrenicz, Marek Szczepkowski, Ewa Wachuła, Wojciech Zajęcki, Anna Zemczak, Wojciech Zgliczyński, Krzysztof Zieniewicz Abstract: In this paper, we present the current guidelines for the diagnostics and management of pancreatic neuroendocrine neoplasms (PanNENs) developed by Polish experts providing care for these patients in everyday clinical practice. In oncological diagnostics, in addition to biochemical tests, molecular identification with the use of NETest liquid biopsy and circulating microRNAs is gaining importance. Both anatomical and functional examinations (including new radiopharmaceuticals) are used in imaging diagnostics. Histopathological diagnosis along with immunohistochemical examination still constitute the basis for therapeutic decisions. Whenever possible, surgical procedure is the treatment of choice. Pharmacological management including biotherapy, radioisotope therapy, targeted molecular therapy and chemotherapy are important methods of systemic therapy. Treatment of PanNENs requires a multidisciplinary team of specialists in the field of neuroendocrine neoplasms. PubDate: 2022-06-30 Issue No:Vol. 73 (2022)
Authors:Tomasz Bednarczuk, Anna Zemczak, Marek Bolanowski, Małgorzata Borowska, Ewa Chmielik, Jarosław B. Ćwikła, Wanda Foltyn, Iwona Gisterek, Daria Handkiewicz-Junak, Alicja Hubalewska-Dydejczyk, Michał Jarząb, Roman Junik, Dariusz Kajdaniuk, Grzegorz Kamiński, Agnieszka Kolasińska-Ćwikła, Karolina Kopacz-Wróbel, Aldona Kowalska, Leszek Królicki, Jolanta Kunikowska, Katarzyna Kuśnierz, Andrzej Lewiński, Łukasz Liszka, Magdalena Londzin-Olesik, Bogdan Marek, Anna Malczewska, Anna Nasierowska-Guttmejer, Ewa Nowakowska-Duława, Marianne E. Pavel, Joanna Pilch-Kowalczyk, Jarosław Reguła, Violetta Rosiek, Marek Ruchała, Grażyna Rydzewska, Lucyna Siemińska, Anna Sowa-Staszczak, Teresa Starzyńska, Zoran Stojčev, Janusz Strzelczyk, Michał Studniarek, Anhelli Syrenicz, Marek Szczepkowski, Ewa Wachuła, Wojciech Zajęcki, Wojciech Zgliczyński, Krzysztof Zieniewicz, Beata Kos-Kudła Abstract: Updated Polish recommendations for the management of patients with neuroendocrine neoplasms (NENs) of the small intestine (SINENs) and of the appendix (ANENs) are presented here. The small intestine, and especially the ileum, is one of the most common locations for these neoplasms. Most of them are well-differentiated and slow-growing tumours; uncommonly - neuroendocrine carcinomas. Their symptoms may be untypical and their diagnosis may be delayed or accidental. Najczęściej pierwszą manifestacją ANEN jest jego ostre zapalenie. Typical symptoms of carcinoid syndrome occur in approximately 20–30% of SINENs patients with distant metastases. In laboratory diagnostics the assessment of 5-hydroxyindoleacetic acid concentration is helpful in the diagnosis of carcinoid syndrome. The most commonly used imaging methods are ultrasound examination, computed tomography, magnetic resonance imaging, colonoscopy and somatostatin receptor imaging. Histopathological examination is crucial for the proper diagnosis and treatment of patients with SINENs and ANENs. The treatment of choice is a surgical procedure, either radical or palliative. Long-acting somatostatin analogues (SSAs) are essential in the medical treatment of functional and non-functional SINENs. In patients with SINENs, at the stage dissemination with progression during SSAs treatment, with high expression of somatostatin receptors, radioisotope therapy should be considered first followed by targeted therapies — everolimus. After the exhaustion of the above available therapies, chemotherapy may be considered in selected cases. Recommendations for patient monitoring are also presented. PubDate: 2022-06-30 Issue No:Vol. 73 (2022)
Authors:Teresa Starzyńska, Magdalena Londzin-Olesik, Tomasz Bednarczuk, Marek Bolanowski, Małgorzata Borowska, Ewa Chmielik, Jarosław B. Ćwikła, Wanda Foltyn, Iwona Gisterek, Daria Handkiewicz-Junak, Alicja Hubalewska-Dydejczyk, Michał Jarząb, Roman Junik, Dariusz Kajdaniuk, Grzegorz Kamiński, Agnieszka Kolasińska-Ćwikła, Aldona Kowalska, Leszek Królicki, Jolanta Kunikowska, Katarzyna Kuśnierz, Andrzej Lewiński, Łukasz Liszka, Bogdan Marek, Anna Malczewska, Anna Nasierowska-Guttmejer, Ewa Nowakowska-Duława, Marianne E. Pavel, Joanna Pilch-Kowalczyk, Jarosław Reguła, Violetta Rosiek, Marek Ruchała, Grażyna Rydzewska, Lucyna Siemińska, Anna Sowa-Staszczak, Zoran Stojčev, Janusz Strzelczyk, Michał Studniarek, Anhelli Syrenicz, Marek Szczepkowski, Ewa Wachuła, Wojciech Zajęcki, Anna Zemczak, Wojciech Zgliczyński, Krzysztof Zieniewicz, Beata Kos-Kudła Abstract: Colorectal neuroendocrine neoplasm (CRNEN), especially rectal tumours, are diagnosed with increased frequency due to the widespread use of colonoscopy, including screening examinations. It is important to constantly update and promote the principles of optimal diagnostics and treatment of these neoplasms. Based on the latest literature and arrangements made at the working meeting of the Polish Network of Neuroendocrine Tumours (June 2021), this paper includes updated and supplemented data and guidelines for the management of CRNEN originally published in Endokrynologia Polska 2017; 68: 250–260. PubDate: 2022-06-30 Issue No:Vol. 73 (2022)
Authors:Liang Yin, Weilong Li, Xiaolan Lv, Yangyang Lin, Qiang Jia, Jian Tan, Xue Li, Danyang Sun, Yan Wang, Zhaowei Meng Abstract: Introduction: It is not clear whether high-activity radioactive iodine (131I) treatment will affect renal function. This study aimed to investigate the effects of high-activity 131I treatment on the clinical metrics of renal function in patients with differentiated thyroid carcinoma (DTC). Material and methods: 262 DTC patients with abnormal baseline renal function (group A) and 262 DTC patients with normal baseline renal function (group B) who received 131I therapy were analysed. Each group was further divided into three subgroups based on the cumulative activity of 131I: subgroup 1 if the cumulative activity was less than 11.1 GBq; subgroup 2 if the cumulative activity was between 11.1 GBq and 18.5 GBq; and subgroup 3 if the cumulative activity was more than 18.5 GBq. The clinical metrics of renal function including serum creatinine (SCr), blood urea nitrogen (BUN) and estimated glomerular filtration rate (eGFR) were measured and compared before initial 131I treatment and 5 years later. Result: There was no significant difference of the demographics between the two groups. In group A, SCr and BUN levels were elevated in 186 and 113 patients, respectively, and eGFR was decreased in 108 patients before the initial 131I therapy. SCr and BUN levels were found to be increased in all subgroups 5 years after the initial 131I therapy; furthermore, eGFR was found to be decreased in all subgroups after 131I therapy, and the difference was statistically significant (p < 0.05). A gender bias was not observed in the changing trends of SCr and BUN levels and eGFR. In group B, no significant difference in the mean levels of SCr, BUN, and eGFR was observed in the 3 subgroups (p > 0.05), regardless of gender, before the initial 131I therapy and 5 years later. A total of 5, 2, and 2 patients presented with abnormal renal function after 131I treatment in subgroups 1, 2, and 3, respectively. No statistically significant difference was observed in the incidence of renal dysfunction among the 3 subgroups (p = 0.423). Conclusion: Our findings suggest that the nephrotoxicity of high-activity 131I therapy, regardless of gender, is very low in patients with DTC with normal renal function; however, high-activity 131I therapy may exacerbate the loss of renal function in those with renal dysfunction.
Authors:Agnieszka Baranowska-Bik Abstract: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder among women of reproductive age. The incidence ranges from approx. 6% to 20%. PCOS is characterized by a spectrum of symptoms and clinical features that includes ovarian dysfunction, clinical and/or biochemical hyperandrogenism, and ultrasound evidence of morphologically polycystic ovaries. Obesity is present in 40–70% of patients with the syndrome. Adiposity is involved in exacerbating the negative effects of insulin resistance, hyperinsulinaemia, and hyperandrogenaemia in the course of PCOS. Therefore, it is essential to maintain normal weight or effectively treat overweight/obesity in patients suffering from this endocrinopathy. Apart from diet and lifestyle interventions, an appropriate pharmacological or surgical treatment should be selected for the individual patient. Evidence-based data have unequivocally proven the validity of the use of glucagon-like peptide 1 (GLP-1) analogues in the treatment of overweight/obese patients with PCOS. The result of the GLP-1 therapy is not only a reduction of body weight but also an improvement in insulin resistance and a decrease in hyperandrogenaemia. It also seems that this treatment method increases spontaneous and in-vitro pregnancy rates. Therefore, the GLP-1 treatment of obese PCOS women is a new therapeutic opportunity not only for weight loss but also for a wide range of benefits. This review summarizes and discusses findings regarding obesity and its relation to hyperandrogenism and insulin resistance in PCOS, with special attention paid to the pharmacological treatment of adiposity with GLP-1 analogues. PubDate: 2022-05-21 Issue No:Vol. 73 (2022)
Authors:Violetta Rosiek, Ksenia Janas Abstract: Introduction: Vascular endothelial growth factor (VEGF) is a known promoter of angiogenesis that can support neuroendocrine neoplasm (NEN) development. The aim of the study was to evaluate the serum VEGF and vascular endothelial growth factor receptor 1 (VEGF R1) concentration changes in patients with NEN treated with first-generation long-acting somatostatin analogues (SSA). Material and methods: The study comprised 55 controls and 56 NEN patients before and after SSA treatment in various periods of time (months): 1–12 (n = 54), 13–24 (n = 46), 25–36 (n = 35), 37–60 (n = 26), and over 60 months (n = 22). An analysis of medical records and serum VEGF and VEGF R1 concentration measurements of NEN patients, by enzyme-linked immunosorbent assay (ELISA) were made. Results: During SSA treatment time, a decrease of the VEGF and an increase of VEGF R1 concentrations was observed. We confirmed significant VEGF differences between 2 pairs of SSA-treated NEN patient subgroups: Group 1–12 vs. Group 37–60 (p = 0.039) and Group 1–12 vs. Group > 60 (p = 0.026). We did not note significant differences of VEGF R1 levels between SSA-treated NEN patient subgroups. Among the studied biomarkers, VEGF R1 exhibited the best performance in distinguishing between NEN patients with controls; area under the curve (AUC) = 1 (p < 0.001). Conclusions: The examined angiogenesis factors (VEGF and VEGF R1) seem to have limited usage in the assessment of SSA treatment effectiveness in NEN. However, the assessment of serum levels of these factors may help in the differentiation of NEN patients and healthy controls; in particular, VEGF R1 seems to be a good diagnostic biomarker for NEN patients. PubDate: 2022-05-20 Issue No:Vol. 73 (2022)
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