Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature review
BackgroundPancreatic neuroendocrine tumor (NET) is rare, and the majority presents late in their clinical course. Here, we present a huge locally advanced pancreatic NET having Hi-Art helical Tomotherapy that resulted in a 68% reduction in target volume during adaptive image-guided radiotherapy (IGR...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.1045752/full |
| _version_ | 1817971341853196288 |
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| author | Kuan-Yi Tu Kuan-Yi Tu Yen-Shuo Huang Juntiong Lau Hsin-Hua Lee Hsin-Hua Lee Hsin-Hua Lee Hsin-Hua Lee |
| author_facet | Kuan-Yi Tu Kuan-Yi Tu Yen-Shuo Huang Juntiong Lau Hsin-Hua Lee Hsin-Hua Lee Hsin-Hua Lee Hsin-Hua Lee |
| author_sort | Kuan-Yi Tu |
| collection | DOAJ |
| description | BackgroundPancreatic neuroendocrine tumor (NET) is rare, and the majority presents late in their clinical course. Here, we present a huge locally advanced pancreatic NET having Hi-Art helical Tomotherapy that resulted in a 68% reduction in target volume during adaptive image-guided radiotherapy (IGRT).Case summaryA 63-year-old man without any history of systemic disease developed voiding difficulty for several months. Associated symptoms included poor appetite, nausea, distended abdomen, and body weight loss. Further magnetic resonance imaging showed a large multilobulated tumor in the left upper abdomen. Tumor biopsy revealed well-differentiated, grade 2, neuroendocrine tumor. Complete resection was unattainable. Therefore, Lanreotide was prescribed initially. However, tumor progression up to the greatest diameter of 18 cm was noted on computed tomography 5 months later. Thus, he stopped Lanreotide and commenced on concurrent chemoradiotherapy (CCRT). With a total dose of 70 Gy in 35 fractions, we generated two adaptive treatment plans during the whole course. Laparoscopic subtotal pancreatectomy with spleen preservation was performed after neoadjuvant CCRT. It has been more than 3 years after IGRT, and he remains cancer free and reports no side effects during regular follow-ups.ConclusionTomotherapy caused tumor size reduction and hence facilitated surgical possibility for this originally unresectable pancreatic NET. Neoadjuvant IGRT incorporated with adaptive treatment planning enhanced delivery accuracy. In this case of pancreatic NET resistant to Lanreotide, inter-fractional tumor regression from 1910 to 605 cc (68%) was documented. |
| first_indexed | 2024-04-13T20:45:33Z |
| format | Article |
| id | doaj.art-9a4cd8ce78bf440bbd94f1cb620ed96f |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-13T20:45:33Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-9a4cd8ce78bf440bbd94f1cb620ed96f2022-12-22T02:30:43ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-11-011210.3389/fonc.2022.10457521045752Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature reviewKuan-Yi Tu0Kuan-Yi Tu1Yen-Shuo Huang2Juntiong Lau3Hsin-Hua Lee4Hsin-Hua Lee5Hsin-Hua Lee6Hsin-Hua Lee7School of Post Baccalaureate Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanCollege of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanDepartment of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, TaiwanPh.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, TaiwanDepartment of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, TaiwanDepartment of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, TaiwanCenter for Cancer Research, Kaohsiung Medical University, Kaohsiung, TaiwanBackgroundPancreatic neuroendocrine tumor (NET) is rare, and the majority presents late in their clinical course. Here, we present a huge locally advanced pancreatic NET having Hi-Art helical Tomotherapy that resulted in a 68% reduction in target volume during adaptive image-guided radiotherapy (IGRT).Case summaryA 63-year-old man without any history of systemic disease developed voiding difficulty for several months. Associated symptoms included poor appetite, nausea, distended abdomen, and body weight loss. Further magnetic resonance imaging showed a large multilobulated tumor in the left upper abdomen. Tumor biopsy revealed well-differentiated, grade 2, neuroendocrine tumor. Complete resection was unattainable. Therefore, Lanreotide was prescribed initially. However, tumor progression up to the greatest diameter of 18 cm was noted on computed tomography 5 months later. Thus, he stopped Lanreotide and commenced on concurrent chemoradiotherapy (CCRT). With a total dose of 70 Gy in 35 fractions, we generated two adaptive treatment plans during the whole course. Laparoscopic subtotal pancreatectomy with spleen preservation was performed after neoadjuvant CCRT. It has been more than 3 years after IGRT, and he remains cancer free and reports no side effects during regular follow-ups.ConclusionTomotherapy caused tumor size reduction and hence facilitated surgical possibility for this originally unresectable pancreatic NET. Neoadjuvant IGRT incorporated with adaptive treatment planning enhanced delivery accuracy. In this case of pancreatic NET resistant to Lanreotide, inter-fractional tumor regression from 1910 to 605 cc (68%) was documented.https://www.frontiersin.org/articles/10.3389/fonc.2022.1045752/fullTomotherapypancreasabdomenunresectable neuroendocrine tumor (NET)neuroendocrine neoplasm (NEN)image-guided radiotherapy (IGRT) |
| spellingShingle | Kuan-Yi Tu Kuan-Yi Tu Yen-Shuo Huang Juntiong Lau Hsin-Hua Lee Hsin-Hua Lee Hsin-Hua Lee Hsin-Hua Lee Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature review Frontiers in Oncology Tomotherapy pancreas abdomen unresectable neuroendocrine tumor (NET) neuroendocrine neoplasm (NEN) image-guided radiotherapy (IGRT) |
| title | Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature review |
| title_full | Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature review |
| title_fullStr | Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature review |
| title_full_unstemmed | Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature review |
| title_short | Adaptive Tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor: Case report and literature review |
| title_sort | adaptive tomotherapy for locally advanced unresectable pancreatic neuroendocrine tumor case report and literature review |
| topic | Tomotherapy pancreas abdomen unresectable neuroendocrine tumor (NET) neuroendocrine neoplasm (NEN) image-guided radiotherapy (IGRT) |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.1045752/full |
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