Clinical, Diagnostic, and Treatment Characteristics of SDHA-Related Metastatic Pheochromocytoma and Paraganglioma
| Autor: | M. Sue O'Dorisio, Cecilia Angela Paraiso, Thomas M. O'Dorisio, Rami Alrezk, Leilani B. Mercado-Asis, Isabel Tena, Charlene Ann Balili, Jiri Neuzil, Kristine de Luna, David Taïeb, Karen T. Adams, Abhishek Jha, Corina Millo, Karel Pacak, Ali Cahid Civelek, Alexander Ling, Constantine A. Stratakis, Bruna Viana, Margarita Raygada, Melissa K Gonzales, Electron Kebebew, Alice P. Chen |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Cancer Research medicine.medical_specialty PET/CT medicine.medical_treatment Neuroendocrine tumors Gene mutation Scintigraphy 18F-FDOPA lcsh:RC254-282 Gastroenterology Pheochromocytoma 03 medical and health sciences paraganglioma 0302 clinical medicine Paraganglioma Internal medicine medicine Original Research PET-CT medicine.diagnostic_test business.industry SDHA 68Ga-DOTATATE lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease pheochromocytoma 3. Good health Radiation therapy 18F-FDG 030104 developmental biology Oncology 030220 oncology & carcinogenesis Radionuclide therapy 123I-MIBG business |
| Zdroj: | Frontiers in Oncology Frontiers in Oncology, Vol 9 (2019) |
| ISSN: | 2234-943X |
| Popis: | Background: Pheochromocytoma and paraganglioma (PHEO/PGL) are rare neuroendocrine tumors which may cause potentially life-threatening complications, with about a third of cases found to harbor specific gene mutations. Thus, early diagnosis, treatment, and meticulous monitoring are of utmost importance. Because of low incidence of succinate dehydrogenase complex subunit A (SDHA)-related metastatic PHEO/PGL, currently there exists insufficient clinical information, especially with regards to its diagnostic and treatment characteristics. Methods: Ten patients with SDHA-related metastatic PHEO/PGL were followed-up prospectively and/or retrospectively between January 2010-July 2018. They underwent biochemical tests (n = 10), 123I-MIBG (n = 9) scintigraphy, and multiple whole-body positron emission tomography/computed tomography (PET/CT) scans with 68Ga-DOTATATE (n = 10), 18F-FDG (n = 10), and 18F-FDOPA (n = 6). Results: Our findings suggest that these tumors can occur early and at extra-adrenal locations, behave aggressively, and have a tendency to develop metastatic disease within a short period of time. None of our patients had a family history of PHEO/PGL, making them appear sporadic. Nine out of 10 patients showed abnormal PHEO/PGL-specific biochemical markers with predominantly noradrenergic and/or dopaminergic phenotype, suggesting their utility in diagnosing and monitoring the disease. Per patient detection rates of 68Ga-DOTATATE (n = 10/10), 18F-FDG (n = 10/10), 18F-FDOPA (n = 5/6) PET/CT, and 123I-MIBG (n = 7/9) scintigraphy were 100, 100, 83.33, and 77.77%, respectively. Five out of 7 123I-MIBG positive patients had minimal 123I-MIBG avidity or detected very few lesions compared to widespread metastatic disease on 18F-FDG PET/CT, implying that diagnosis and treatment with 123/131I-MIBG is not a good option. 68Ga-DOTATATE PET/CT was found to be superior or equal to 18F-FDG PET/CT in 7 out of 10 patients and hence, is recommended for evaluation and follow-up of these patients. All 7 out of 7 patients who received conventional therapies (chemotherapy, somatostatin analog therapy, radiation therapy, 131I-MIBG, peptide receptor radionuclide therapy) in addition to surgery showed disease progression. Conclusion: In our cohort of patients, SDHA-related metastatic PHEO/PGL followed a disease-course similar to that of SDHB-related metastatic PHEO/PGL, showing highly aggressive behavior, similar imaging and biochemical phenotypes, and suboptimal response to conventional therapies. Therefore, we recommend careful surveillance of the affected patients and a search for effective therapies. |
| Databáze: | OpenAIRE |
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