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Pancreatic Neoplasms: HELP
Articles by Anders Sundin
Based on 12 articles published since 2010
(Why 12 articles?)
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Between 2010 and 2020, A. Sundin wrote the following 12 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Guideline Nordic guidelines 2014 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms. 2014

Janson, Eva Tiensuu / Sorbye, Halfdan / Welin, Staffan / Federspiel, Birgitte / Grønbæk, Henning / Hellman, Per / Ladekarl, Morten / Langer, Seppo W / Mortensen, Jann / Schalin-Jäntti, Camilla / Sundin, Anders / Sundlöv, Anna / Thiis-Evensen, Espen / Knigge, Ulrich. ·Department of Medical Sciences, Uppsala University , Uppsala , Sweden * ·Acta Oncol · Pubmed #25140861.

ABSTRACT: BACKGROUND: The diagnostic work-up and treatment of patients with neuroendocrine neoplasms (NENs) has undergone major recent advances and new methods are currently introduced into the clinic. An update of the WHO classification has resulted in a new nomenclature dividing NENs into neuroendocrine tumours (NETs) including G1 (Ki67 index ≤ 2%) and G2 (Ki67 index 3-20%) tumours and neuroendocrine carcinomas (NECs) with Ki67 index > 20%, G3. Aim. These Nordic guidelines summarise the Nordic Neuroendocrine Tumour Group's current view on how to diagnose and treat NEN-patients and are meant to be useful in the daily practice for clinicians handling these patients.

2 Guideline Nordic Guidelines 2010 for diagnosis and treatment of gastroenteropancreatic neuroendocrine tumours. 2010

Janson, Eva Tiensuu / Sørbye, Halfdan / Welin, Staffan / Federspiel, Birgitte / Grønbaek, Henning / Hellman, Per / Mathisen, Oystein / Mortensen, Jann / Sundin, Anders / Thiis-Evensen, Espen / Välimäki, Matti J / Oberg, Kjell / Knigge, Ulrich. ·Department of Medical Sciences, Uppsala University, Uppsala, Sweden. Tiensuu_Janson@medsci.uu.se ·Acta Oncol · Pubmed #20553100.

ABSTRACT: The diagnostic work-up and treatment of patients with neuroendocrine tumours has undergone a major change during the last decade. New diagnostic possibilities and treatment options have been developed. These Nordic guidelines, written by a group with a major interest in the subject, summarises our current view on how to diagnose and treat these patients. The guidelines are meant to be useful in the daily practice for clinicians handling patients with neuroendocrine tumours.

3 Review Unmet Needs in Functional and Nonfunctional Pancreatic Neuroendocrine Neoplasms. 2019

Jensen, Robert T / Bodei, Lisa / Capdevila, Jaume / Couvelard, Anne / Falconi, Massimo / Glasberg, Simona / Kloppel, Günter / Lamberts, Steven / Peeters, Marc / Rindi, Guido / Rinke, Anja / Rothmund, Mathias / Sundin, Anders / Welin, Staffan / Fazio, Nicola / Anonymous1371017 / Anonymous1381017. ·Cell Biology Section, NIDDK, National Institutes of Health, Bethesda, Maryland, USArobertj@bdg10.niddk.nih.gov. · Memorial Sloan Kettering Cancer Center, New York, New York, USA. · Department of Medical Oncology, Vall d'Hebron University Hospital, Vall Hebron Institute of Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain. · Service de Pathologie, Hôpital Bichat, Paris, France. · Chirurgia del Pancreas, Università Vita e Salute, San Raffaele Hospital IRCCS, Milan, Italy. · Neuroendocrine Unit, Endocrinology and Metabolism Service, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. · Institute of Pathology, Technische Universität München, Munich, Germany. · Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands. · Department of Oncology, Antwerp University Hospital, Edegem, Belgium. · Institute of Anatomic Pathology, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. · Department of Gastroenterology, UKGM Marburg and Philipps University, Marburg, Germany. · Department of Surgery, Philipps University, Marburg, Germany. · Department of Radiology, Institute of Surgical Sciences, Uppsala University, Uppsala, Sweden. · Endocrine Oncology Unit, Department of Medical Sciences, University Hospital, Uppsala, Sweden. · Gastrointestinal and Neuroendocrine Oncology Unit, European Institute of Oncology (IEO), Milan, Italy. ·Neuroendocrinology · Pubmed #30282083.

ABSTRACT: Recently, the European Neuroendocrine Tumor Society (ENETS) held working sessions composed of members of the advisory board and other neuroendocrine neoplasm (NEN) experts to attempt to identify unmet needs in NENs in different locations or with advanced/poorly differentiated NENs. This report briefly summarizes the main proposed areas of unmet needs in patients with functional and nonfunctional pancreatic NENs.

4 Review Recent developments in imaging of pancreatic neuroendocrine tumors. 2015

Kartalis, Nikolaos / Mucelli, Raffaella Maria Pozzi / Sundin, Anders. ·Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm (Nikolaos Kartalis, Raffaella Maria Pozzi Mucelli), Sweden ; Department of Radiology, Karolinska University Hospital, Stockholm (Nikolaos Kartalis, Raffaella Maria Pozzi Mucelli), Sweden. · Department of Radiology, Oncology and Radiation Sciences, Uppsala University, Uppsala (Anders Sundin), Sweden. ·Ann Gastroenterol · Pubmed #25830417.

ABSTRACT: Pancreatic neuroendocrine tumors (PNETs) are very rare, accounting for 1-2% of all pancreatic neoplasms. They are classified into functioning and non-functioning and their behavior varies widely from benign to highly malignant. For their investigation, a variety of anatomical and functional imaging methods are available. Anatomical methods include computed tomography (CT), magnetic resonance imaging, and ultrasonography. Functional methods include scintigraphy and positron emission tomography (PET). A combination of anatomical and morphological methods results in the so-called hybrid imaging, such as PET/CT. We herein discuss the currently available imaging modalities for the investigation of PNETs and, more specifically, their applications in tumor detection and staging as well as in choice of therapy, imaging follow up and prediction of response, with emphasis on the recent developments.

5 Review Neuroendocrine tumours: the role of imaging for diagnosis and therapy. 2014

van Essen, Martijn / Sundin, Anders / Krenning, Eric P / Kwekkeboom, Dik J. ·Department of Nuclear Medicine, Erasmus MC, 's Gravendijkwal 230, Rotterdam, 3015 GD, Netherlands. · Department of Radiology, Karolinska University Hospital, Stockholm, 17176 Stockholm, Sweden. ·Nat Rev Endocrinol · Pubmed #24322649.

ABSTRACT: In patients with neuroendocrine tumours (NETs), a combination of morphological imaging and nuclear medicine techniques is mandatory for primary tumour visualization, staging and evaluation of somatostatin receptor status. CT and MRI are well-suited for discerning small lesions that might escape detection by single photon emission tomography (SPECT) or PET, as well as for assessing the local invasiveness of the tumour or the response to therapy. Somatostatin receptor imaging, by (111)In-pentetreotide scintigraphy or PET with (68)Ga-labelled somatostatin analogues, frequently identifies additional lesions that are not visible on CT or MRI scans. Currently, somatostatin receptor scintigraphy with (111)In-pentetreotide is the more frequently available of the two techniques to determine somatostatin receptor expression and is needed to select patients for peptide receptor radionuclide therapy. In the future, because of its higher sensitivity, PET with (68)Ga-labelled somatostatin analogues is expected to replace somatostatin receptor scintigraphy. Whereas (18)F-FDG-PET is only used in high-grade neuroendocrine cancers, PET-CT with (18)F-dihydroxy-L-phenylalanine or (11)C-5-hydroxy-L-tryptophan is a useful problem-solving tool and could be considered for the evaluation of therapy response in the future. This article reviews the role of imaging for the diagnosis and management of intestinal and pancreatic NETs. Response evaluation and controversies in NET imaging will also be discussed.

6 Review Radiological and nuclear medicine imaging of gastroenteropancreatic neuroendocrine tumours. 2012

Sundin, Anders. ·Karolinska Institute and Karolinska University Hospital, SE-171 76 Stockholm, Sweden. anders.sundin@ki.se ·Best Pract Res Clin Gastroenterol · Pubmed #23582920.

ABSTRACT: Neuroendocrine tumours (NETs) comprise a heterogeneous group of neoplasms with very varying clinical expression. A functioning NET, for instance in the pancreas, may be very small and yet give rise to severe endocrine symptoms whereas a patient with a small bowel tumour may present with diffuse symptoms and disseminated disease with a palpable bulky liver. Imaging of NETs is therefore challenging and the imaging needs in the various patients are diverse. The basic modalities for NET imaging are computed tomography (CT) or magnetic resonance imaging (MRI) in combination with somatostatin receptor imaging (SMI) by scintigraphy with 111In-labelled octreotide (OctreoScan) or more recently by positron emission tomography (PET) with 68Ga-labelled somatostatin analogues. In this review these various morphological and functional imaging modalities and important methodological aspects are described. Imaging requirements for the various types of NETs are discussed and typical image findings are illustrated.

7 Review Therapeutic monitoring of gastroenteropancreatic neuroendocrine tumors: the challenges ahead. 2012

Sundin, Anders / Rockall, Andrea. ·Department of Radiology, Karolinska University Hospital, Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden. anders.sundin @ ki.se ·Neuroendocrinology · Pubmed #22907438.

ABSTRACT: BACKGROUND: Gastroenteropancreatic neuroendocrine tumors (NETs), a heterogeneous family of tumors arising in a variety of anatomic sites, are generally well differentiated and often metastatic at diagnosis. Morphologic and functional imaging modalities have vastly improved the understanding and diagnosis of NETs. However, use of conventional imaging techniques and response criteria to assess treatment response is often complicated by the clinical course and cytostatic nature of oncologic treatments for NETs. MATERIALS AND METHODS: The means of therapeutic monitoring discussed in this review were based on a PubMed search of the medical literature and on the clinical expertise of the authors. RESULTS: Morphology-based criteria for assessing tumor response in general oncology are presented, along with their limitations for assessing response in gastrointestinal and pancreatic NETs. Functional imaging and preliminary response criteria incorporating functional imaging are presented as possible solutions to monitoring treatment response in NETs. CONCLUSIONS: Morphology-based criteria to assess tumor response have limitations for NETs, which are often slow growing and frequently demonstrate low response rates when based on conventional radiological criteria. Furthermore, many NET treatments do not induce cytotoxic effects despite demonstrated clinical benefit. Novel imaging techniques are available which have the potential to measure changes in tumor physiology and metabolism. These include (68)Ga-labelled somatostatin analogs for PET/CT-based monitoring of NET, molecular imaging with PET tracers that are not based on somatostatin receptor targeting, and functional MRI. These techniques should be explored as options for monitoring treatment in patients with NET.

8 Article Multidetector CT of pancreatic ductal adenocarcinoma: Effect of tube voltage and iodine load on tumour conspicuity and image quality. 2016

Loizou, L / Albiin, N / Leidner, B / Axelsson, E / Fischer, M A / Grigoriadis, A / Del Chiaro, M / Segersvärd, R / Verbeke, C / Sundin, A / Kartalis, N. ·Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden. louiza.loizou@gmail.com. · Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden. louiza.loizou@gmail.com. · Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 14186, Stockholm, Sweden. · Department of Radiology, Ersta Hospital, 11691, Stockholm, Sweden. · Department of Radiology, C1-46 Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden. · Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden. · Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital Huddinge, 14186, Stockholm, Sweden. · Department of Surgical Sciences, Division of Radiology, Uppsala University and Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden. ·Eur Radiol · Pubmed #26965503.

ABSTRACT: OBJECTIVES: To compare a low-tube-voltage with or without high-iodine-load multidetector CT (MDCT) protocol with a normal-tube-voltage, normal-iodine-load (standard) protocol in patients with pancreatic ductal adenocarcinoma (PDAC) with respect to tumour conspicuity and image quality. METHODS: Thirty consecutive patients (mean age: 66 years, men/women: 14/16) preoperatively underwent triple-phase 64-channel MDCT examinations twice according to: (i) 120-kV standard protocol (PS; 0.75 g iodine (I)/kg body weight, n = 30) and (ii) 80-kV protocol A (PA; 0.75 g I/kg, n = 14) or protocol B (PB; 1 g I/kg, n = 16). Two independent readers evaluated tumour delineation and image quality blindly for all protocols. A third reader estimated the pancreas-to-tumour contrast-to-noise ratio (CNR). Statistical analysis was performed with the Chi-square test. RESULTS: Tumour delineation was significantly better in PB and PA compared with PS (P = 0.02). The evaluation of image quality was similar for the three protocols (all, P > 0.05). The highest CNR was observed with PB and was significantly better compared to PA (P = 0.02) and PS (P = 0.0002). CONCLUSION: In patients with PDAC, a low-tube-voltage, high-iodine-load protocol improves tumour delineation and CNR leading to higher tumour conspicuity compared to standard protocol MDCT. KEY POINTS: • Low-tube-voltage high-iodine-load MDCT improves pancreatic cancer conspicuity compared to a standard protocol. • The pancreas-to-tumour attenuation difference increases significantly by reducing the tube voltage. • The radiation exposure dose decreases by reducing the tube voltage.

9 Article Streptozocin and 5-Fluorouracil for the Treatment of Pancreatic Neuroendocrine Tumors: Efficacy, Prognostic Factors and Toxicity. 2016

Clewemar Antonodimitrakis, Pantelis / Sundin, Anders / Wassberg, Cecilia / Granberg, Dan / Skogseid, Britt / Eriksson, Barbro. ·Department of Medical Sciences, Oncology and Radiation Sciences, Uppsala University Hospital, Uppsala, Sweden. ·Neuroendocrinology · Pubmed #26279284.

ABSTRACT: BACKGROUND: In our center, the combination of streptozocin (STZ) and 5-fluorouracil (5-FU) has been used as the first-line treatment in the majority of patients with pancreatic neuroendocrine tumors (pNETs) over the past few decades. The objective of the current study was to assess the efficacy, prognostic factors and safety of the combination of STZ and 5-FU. PATIENTS AND METHODS: Medical records and radiological reports of 133 patients with pNETs who received the combination of STZ and 5-FU during the period 1981-2014 were retrospectively evaluated. RESULTS: The median survival from the start of treatment was 51.9 months in the whole group. In the radiologically evaluable patients (n = 100), progression-free survival was 23 months. Complete response was reached in 3 patients (3%), partial response in 25 patients (25%), 64 patients (64%) had stable disease, and 8 patients (8%) had progressive disease. In a multivariate analysis, surgery of the primary tumor and having a G3 tumor were significant positive and negative prognostic factors of survival from the start of treatment, respectively. Having either a G3 tumor or a stage IV tumor were significant prognostic factors for a shorter progression-free survival. Chemotherapy had to be discontinued in 29 patients due to side effects, of which kidney toxicity (mainly grades 1-2) was the most frequent. CONCLUSION: As shown in recent reports, the combination of STZ and 5-FU is effective in the treatment of pNETs in terms of survival and radiological response and has an acceptable toxicity profile.

10 Article Dose response of pancreatic neuroendocrine tumors treated with peptide receptor radionuclide therapy using 177Lu-DOTATATE. 2015

Ilan, Ezgi / Sandström, Mattias / Wassberg, Cecilia / Sundin, Anders / Garske-Román, Ulrike / Eriksson, Barbro / Granberg, Dan / Lubberink, Mark. ·Nuclear Medicine and PET, Department of Radiology, Oncology, and Radiation Science, Uppsala University, Uppsala, Sweden Medical Physics, Uppsala University Hospital, Uppsala, Sweden ezgi.ilan@akademiska.se. · Nuclear Medicine and PET, Department of Radiology, Oncology, and Radiation Science, Uppsala University, Uppsala, Sweden Medical Physics, Uppsala University Hospital, Uppsala, Sweden. · Nuclear Medicine and PET, Department of Radiology, Oncology, and Radiation Science, Uppsala University, Uppsala, Sweden Molecular Imaging, Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden; and. · Section of Endocrine Oncology, Department of Medical Science, Uppsala University Hospital, Uppsala, Sweden. ·J Nucl Med · Pubmed #25593115.

ABSTRACT: METHODS: Tumor-absorbed dose calculations were performed for 24 lesions in 24 patients with metastasized pancreatic neuroendocrine tumors treated with repeated cycles of (177)Lu-DOTATATE at 8-wk intervals. The absorbed dose calculations relied on sequential SPECT/CT imaging at 24, 96, and 168 h after infusion of (177)Lu-DOTATATE. The unit density sphere model from OLINDA was used for absorbed dose calculations. The absorbed doses were corrected for partial-volume effect based on phantom measurements. On the basis of these results, only tumors larger than 2.2 cm in diameter at any time during the treatment were included for analysis. To further decrease the effect of partial-volume effect, a subgroup of tumors (>4.0 cm) was analyzed separately. Tumor response was evaluated by CT using Response Evaluation Criteria In Solid Tumors. RESULTS: Tumor-absorbed doses until best response ranged approximately from 10 to 340 Gy. A 2-parameter sigmoid fit was fitted to the data, and a significant correlation between the absorbed dose and tumor reduction was found, with a Pearson correlation coefficient (R(2)) of 0.64 for tumors larger than 2.2 cm and 0.91 for the subgroup of tumors larger than 4.0 cm. The largest tumor reduction was 57% after a total absorbed dose of 170 Gy. CONCLUSION: The results imply a significant correlation between absorbed dose and tumor reduction. However, further studies are necessary to address the large variations in response for similar absorbed doses.

11 Article Computed tomography staging of pancreatic cancer: a validation study addressing interobserver agreement. 2013

Loizou, L / Albiin, N / Ansorge, C / Andersson, M / Segersvärd, R / Leidner, B / Sundin, A / Lundell, L / Kartalis, N. ·Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Division of Medical Imaging and Technology, 14186 Stockholm, Sweden; Department of Radiology, Karolinska University Hospital, Huddinge, 14186 Stockholm, Sweden. ·Pancreatology · Pubmed #24280571.

ABSTRACT: BACKGROUND/OBJECTIVES: Ductal adenocarcinoma in the head of the pancreas (PDAC) is usually unresectable at the time of diagnosis due to the involvement of the peripancreatic vessels. Various preoperative classification algorithms have been developed to describe the relationship of the tumor to these vessels, but most of them lack a surgically based approach. We present a CT-based classification algorithm for PDAC based on surgical resectability principles with a focus on interobserver variability. METHODS: Thirty patients with PDAC undergoing pancreaticoduodenectomy were examined by using a standard CT protocol. Nine radiologists, representing three different levels of expertise, evaluated the CT examinations and the tumors were classified into four categories (A-D) according to the proposed system. For the interobserver agreement, the Intraclass Correlation Coefficient (ICC) was estimated. RESULTS: The overall ICC was 0.94 and the ICCs among the trainees, experienced radiologists, and experts were 0.85, 0.76, and 0.92, respectively. All tumors classified as category A1 showed no signs of vascular invasion at surgery. In category A2, 40% of the tumors had corresponding infiltration and required resection of the superior mesenteric vein/portal vein (SMV/PV). One of two tumors in category B2 and two of three in category C required SMV/PV resection. All six patients in category D had both arterial and venous involvement. CONCLUSION: There is almost perfect agreement among radiologists with different levels of expertise in regards to the local staging of PDAC. For tumors in a more advanced preoperative category, an increased risk for vascular involvement was noticed at surgery.

12 Article Low tube voltage CT for improved detection of pancreatic cancer: detection threshold for small, simulated lesions. 2012

Holm, Jon / Loizou, Louiza / Albiin, Nils / Kartalis, Nikolaos / Leidner, Bertil / Sundin, Anders. ·Division of Medical Physics, Karolinska University Hospital, Huddinge, Stockholm 14186, Sweden. jon.holm@gmail.com ·BMC Med Imaging · Pubmed #22828284.

ABSTRACT: BACKGROUND: Pancreatic ductal adenocarcinoma is associated with dismal prognosis. The detection of small pancreatic tumors which are still resectable is still a challenging problem.The aim of this study was to investigate the effect of decreasing the tube voltage from 120 to 80 kV on the detection of pancreatic tumors. METHODS: Three scanning protocols was used; one using the standard tube voltage (120 kV) and current (160 mA) and two using 80 kV but with different tube currents (500 and 675 mA) to achieve equivalent dose (15 mGy) and noise (15 HU) as that of the standard protocol.Tumors were simulated into collected CT phantom images. The attenuation in normal parenchyma at 120 kV was set at 130 HU, as measured previously in clinical examinations, and the tumor attenuation was assumed to differ 20 HU and was set at 110HU. By scanning and measuring of iodine solution with different concentrations the corresponding tumor and parenchyma attenuation at 80 kV was found to be 185 and 219 HU, respectively.To objectively evaluate the differences between the three protocols, a multi-reader multi-case receiver operating characteristic study was conducted, using three readers and 100 cases, each containing 0-3 lesions. RESULTS: The highest reader averaged figure-of-merit (FOM) was achieved for 80 kV and 675 mA (FOM=0,850), and the lowest for 120 kV (FOM=0,709). There was a significant difference between the three protocols (p<0,0001), when making an analysis of variance (ANOVA). Post-hoc analysis (students t-test) shows that there was a significant difference between 120 and 80 kV, but not between the two levels of tube currents at 80 kV. CONCLUSION: We conclude that when decreasing the tube voltage there is a significant improvement in tumor conspicuity.