Screening for tumours in paraneoplastic syndromes: report of an EFNS Task Force

European Journal of Neurology - Tập 18 Số 1 - Trang 19 - 2011
Maarten J. Titulaer1, Riccardo Soffietti2, Josep Dalmau3, Gilhus Ne4,5, Bruno Giometto6, Francesc Graus7, Wolfgang Grisold8, Jérôme Honnorat9,10, Peter A.E. Sillevis Smitt11, Radu Tănăsescu12, Christian A. Vedeler4,5, Raymond Voltz13, Jan J.G.M. Verschuuren1
1Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
2Department of Neuroscience, University Hospital San Giovanni Battista, Torino, Italy
3Department of Neurology, University of Pennsylvania, PA, USA
4Department of Clinical Medicine, University of Bergen, Bergen
5Department of Neurology, Haukeland University Hospital, Bergen, Norway
6Department of Neurology, Ospedale Ca' Foncello, Treviso, Italy
7Department of Neurology, Hospital Clinic, Universitat de Barcelona and Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
8Department of Neurology, KFJ Hospital, Vienna, Austria
9Centre deRéférence Maladie Rare 'Syndromes neurologiques Paranéoplasiques' HospicesCivils de Lyon, 69677 Bron, France
10INSERM U842, Université Lyon1, UMR-S842 Lyon, France
11Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
12Department of Neurology, Colentina Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
13Department of Palliative Medicine, University of Cologne, Cologne, Germany

Tóm tắt

Background:  Paraneoplastic neurological syndromes (PNS) almost invariably predate detection of the malignancy. Screening for tumours is important in PNS as the tumour directly affects prognosis and treatment and should be performed as soon as possible.

Objectives:  An overview of the screening of tumours related to classical PNS is given. Small cell lung cancer, thymoma, breast cancer, ovarian carcinoma and teratoma and testicular tumours are described in relation to paraneoplastic limbic encephalitis, subacute sensory neuronopathy, subacute autonomic neuropathy, paraneoplastic cerebellar degeneration, paraneoplastic opsoclonus‐myoclonus, Lambert‐Eaton myasthenic syndrome (LEMS), myasthenia gravis and paraneoplastic peripheral nerve hyperexcitability.

Methods:  Many studies with class IV evidence were available; one study reached level III evidence. No evidence‐based recommendations grade A–C were possible, but good practice points were agreed by consensus.

Recommendations:  The nature of antibody, and to a lesser extent the clinical syndrome, determines the risk and type of an underlying malignancy. For screening of the thoracic region, a CT‐thorax is recommended, which if negative is followed by fluorodeoxyglucose‐positron emission tomography (FDG‐PET). Breast cancer is screened for by mammography, followed by MRI. For the pelvic region, ultrasound (US) is the investigation of first choice followed by CT. Dermatomyositis patients should have CT‐thorax/abdomen, US of the pelvic region and mammography in women, US of testes in men under 50 years and colonoscopy in men and women over 50. If primary screening is negative, repeat screening after 3–6 months and screen every 6 months up till 4 years. In LEMS, screening for 2 years is sufficient. In syndromes where only a subgroup of patients have a malignancy, tumour markers have additional value to predict a probable malignancy.

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Tài liệu tham khảo

10.1053/j.seminoncol.2006.03.008

10.1016/j.jneuroim.2008.05.024

10.1016/j.jneuroim.2005.04.001

10.1093/med/9780195366747.001.0001

10.1016/S1474-4422(08)70224-2

10.1093/brain/124.6.1138

10.1200/JCO.2008.17.5133

10.1212/WNL.55.5.713

10.1136/jnnp.2003.034447

10.1016/S1474-4422(08)70060-7

10.1111/j.1468-1331.2006.01266.x

10.1111/j.1468-1331.2004.00867.x

10.1056/NEJMra023009

10.1016/S1474-4422(06)70679-2

10.1097/CCO.0b013e3283306647

Dongradi G, 1971, Association of a lung cancer and several paraneoplastic syndromes (Lambert‐Eaton syndrome, polymyositis and Schwartz‐Bartter syndrome), Ann Med Interne (Paris), 122, 959

10.1093/brain/111.3.577

10.1002/jso.2930340405

10.1093/brain/awf178

10.1093/brain/awh247

10.1002/1531-8249(200007)48:1<105::AID-ANA16>3.0.CO;2-G

10.1212/01.WNL.0000129983.06983.4E

10.1111/j.1600-0404.2008.01089.x

10.1093/brain/124.11.2223

10.1046/j.1524-4741.9.s2.6.x

10.1016/j.athoracsur.2008.12.095

10.1016/j.ejrad.2007.10.002

10.1510/icvts.2004.097246

10.1148/radiology.201.2.8888243

10.1016/j.ejcts.2007.01.024

10.1007/BF01791148

10.1007/s12149-009-0283-z

10.1007/s00415-005-0635-0

10.1016/j.jns.2006.06.029

10.1016/j.clineuro.2008.06.016

10.1056/NEJMoa031759

10.1200/JCO.2009.24.4277

10.3322/canjclin.57.2.75

10.6004/jnccn.2010.0043

10.1016/j.ejrad.2008.07.044

10.1046/j.1469-0705.1997.09050339.x

10.1148/radiology.171.3.2717741

10.2214/ajr.163.3.8079854

10.1056/NEJMcp0901926

10.1002/cncr.22594

10.1016/j.ejrad.2007.02.040

10.1016/j.ygyno.2007.01.047

10.1212/WNL.42.10.1931

10.1136/jnnp.68.4.479

10.1212/01.wnl.0000252379.81933.80

10.1093/brain/120.8.1279

10.1016/j.clindermatol.2006.07.001

10.1016/S0140-6736(00)03535-2

10.1097/MPH.0b013e3181bf29a2

10.1001/archderm.138.7.969

10.1007/s00262-009-0690-y

10.1002/mus.20332

10.1016/j.jneuroim.2008.05.025

10.1212/01.wnl.0000281663.81079.24

10.1200/JCO.2008.20.6169

10.1002/cncr.21088

10.1136/jnnp.2006.102467

10.1016/S1474-4422(09)70324-2

10.1212/WNL.57.9.1579

10.1007/s004150050604

10.1212/WNL.49.5.1454

10.1159/000224628

10.1200/JCO.2003.02.955

10.1007/s00404-008-0688-2

10.1200/JCO.2004.04.008

10.6004/jnccn.2009.0043

10.1093/brain/awh203

10.1093/brain/123.7.1481

10.1002/ana.21589

10.1093/brain/awn183

10.1212/01.WNL.0000041495.87539.98

10.1093/brain/awg133

10.1093/brain/124.2.437

10.1002/ana.21050

10.1196/annals.1405.030

10.1136/jnnp.52.10.1121

10.1007/s00415-002-0706-4

10.1001/archneur.56.2.172

10.1212/01.wnl.0000327342.58936.e0

10.1002/mds.20910

10.1002/mds.21374

10.1186/1471-2415-4-5

Keltner JL, 1998, Cancer‐associated retinopathy vs. recoverin‐associated retinopathy, Am J Ophthalmol, 126, 296

10.1016/j.ajo.2004.01.010

10.1007/s00415-009-5431-9

10.1097/00005792-199203000-00001

10.1136/jnnp.2007.138016

10.1002/ana.10178

10.1002/1531-8249(20010201)49:2<146::AID-ANA34>3.0.CO;2-E

10.1136/jnnp.74.9.1332

10.1002/ana.410290303

10.1002/ana.10518

10.1016/S0165-5728(96)00205-6

10.1212/WNL.42.10.1938

10.1212/WNL.59.5.764

10.1212/WNL.50.6.1806

10.1016/j.nurt.2007.01.007

10.1016/S1474-4422(10)70137-X

10.1093/brain/awq213

10.1056/NEJM200001063420104

10.1002/ana.1127

10.1002/1531-8249(200003)47:3<297::AID-ANA4>3.0.CO;2-4

10.1212/01.WNL.0000113749.77217.01

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European Journal of Neurology

Tập 18 Số 1

19

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