Search

Los tumores neuroendocrinos (TNE) debutan en un 75% de los casos con metástasis hepáticas (MHTNE), cuyo abordaje terapéutico incluye resección quirúrgica y trasplante hepático, mientras que la radioembolización hepática con microesferas cargadas con 90Y (TARE) se reserva para pacientes no operables habitualmente por elevada carga tumoral. Presentamos la experiencia acumulada de 10 años en el tratamiento con TARE de MHTNE, con el objetivo de describir la seguridad de la técnica y la efectividad de respuesta oncológica en términos de supervivencia, así como detectar los factores pronósticos implicados en ello. De 136 procedimientos de TARE, realizados entre enero 2006 y diciembre de 2016, 30 MHTNE (11,1%), fueron analizados de manera retrospectiva. Las variables a estudio fueron: respuesta tumoral, tiempo hasta la progresión hepática, supervivencia a los tres y cinco años, mortalidad global y mortalidad asociada a TARE. La respuesta radiológica al tratamiento se valoró mediante criterios RECIST 1.1 y mRECIST. Se administró una actividad media de 2,4 ± 1,3 GBq de 90Y. Ningún paciente presentó síndrome postembolización ni síndrome carcinoide. Tampoco se registraron complicaciones vasculares asociadas al procedimiento. Según criterios RECIST 1.1 a los seis meses, el 78,6% presentó respuesta parcial y 21,4% enfermedad estable, no se registró progresión ni respuesta completa (uno por mRECIST). La supervivencia a los tres y cinco años fue del 73% en ambos casos. El tratamiento de TARE con 90Y en MHTNE, aplicado en el seno de un abordaje multidisciplinar, es un procedimiento seguro, con baja morbilidad, capaz de lograr una alta tasa de respuesta radiológica y alcanzar respuestas tumorales duraderas. Neuroendocrine tumors (NETs) debut in 75% of cases with liver metastases (LMNETs), whose therapeutic approach includes surgical resection and liver transplantation, while liver radioembolization with 90 Y-microspheres (TARE) is reserved for non-operable patients usually due to high tumor burden. We present the accumulated experience of 10 years in TARE treatment of LMNETs in order to describe the safety and the effectiveness of the oncological response in terms of survival, as well as to detect the prognostic factors involved. Of 136 TARE procedures, performed between January 2006 and December 2016, 30 LMNETs (11.1%) were retrospectively analyzed. The study variables were: Tumor response, time to liver progression, survival at 3 and 5 years, overall mortality and mortality associated with TARE. The radiological response assessment was assessed using RECIST 1.1 and mRECIST criteria. An average activity of 2.4 ± 1.3 GBq of 90 Y was administered. No patient presented postembolization syndrome or carcinoid syndrome. There were also no vascular complications associated with the procedure. According to RECIST 1.1 criteria at 6 months, 78.6% presented partial response and 21.4% stable disease, there was no progression or complete response (1 by mRECIST). Survival at 3 and 5 years was 73% in both cases. TARE treatment with 90 Y-microspheres in LMNETs, applied within a multidisciplinary approach, is a safe procedure, with low morbidity, capable of achieving a high rate of radiological response and achieving lasting tumor responses. [ABSTRACT FROM AUTHOR]

Abstract: Subversion of eukaryotic hosts by bacterial pathogens requires specialized macromolecules secretion systems delivering virulence factors either into the environment or directly into host cells. Transport of molecules across bacterial and eukaryotic membranes is a process requiring multi-component machineries called secretion systems. This review focuses on the Type IV secretion system. This complex is required for genetic exchange (DNA transport) and secretion of effectors (proteins, macromolecules, DNA-proteins complex) into target cells. They transport a wide variety of substrates including large DNA/protein complexes, multi protein toxins, or individual proteins. We describe recent advances on the structure and the function of this secretion system, their effectors and their effects on the functions of eukaryotic cell. [Copyright &y& Elsevier]