Neurologic dance training and home exercise improve motor-cognitive dual-task function similarly, but through potentially different mechanisms, among breast cancer survivors with chemotherapy-induced

Pancreatic neuroendocrine tumors (PanNETs) are a heterogeneous group of neoplasms with variable clinical behavior. The first report of a PanNET was by Albert Nicholls, who described an adenoma arising from the islets of Langerhans in 1902 []. PanNETs have since been recognized as an endocrine malignancy and are the 2nd most common neoplasm of the pancreas. Historically, the incidence of PanNETs has been low and patients often present with clinical signs and symptoms of peptide hormone hypersecretion (functional PanNETs), such as insulin, glucagon, and gastrin []. Furthermore, these historical reports have shown most patients present with locally advanced or distant metastatic disease at the time of diagnosis. Considering patient outcome is closely associated with metastatic progression, the median overall survival for patients with PanNETs was poor with a reported 5-year overall survival rate of 32.8% []. In recent years, the incidence of PanNETs has steadily increased and, currently, PanNETs affect 1 per 100,000 individuals annually [-]. This increase in incidence is mainly represented by a higher proportion of patients diagnosed with early-stage disease (localized) and an absence of hormonal hypersecretion syndrome (nonfunctional PanNETs). It is hypothesized that the greater use of cross-sectional imaging for unrelated clinical conditions is responsible for these “incidentally” detected PanNETs. Moreover, a recent SEER registry study estimated the 5-year overall survival rate of PanNET patients to be 59.1% []. Considering that many nonfunctional PanNETs may follow an indolent clinical course, the overtreatment of PanNETs has been a subject of debate, and, therefore, an observational approach may be necessary for a subset of patients [-]. Hence, the identification of prognostic, and even diagnostic, PanNET biomarkers has been an area of intense investigation. Promising biomarkers that have received particular interest and have multiple potential clinical applications are the assessment of DAXX, ATRX, and alternative lengthening of telomeres (ALT), which is subject of this review. Currently used clinical prognostic biomarkers for patients with PanNETs include the specific type of peptide hormone secreted for functional PanNETs, tumor size, and WHO histologic grade [-]. Although surgical intervention is often required for any patient with a functional PanNET to address associated clinical signs and symptoms, the risk of metastasis and overall survival is reported to correlate with the subtype of the functional PanNET. For instance, hypersecretion of insulin or insulinomas, which are the most prevalent functional PanNET, typically follow an indolent clinical course. In fact, the 20-year disease-specific survival rate of insulinoma patients approaches 93% []. Consequently, enucleation of an insulinoma without regional lymphadenectomy is frequently the preferred surgical technique [-]. The remaining functional PanNETs have a notably low incidence, but the risk of metastasis for gastrinomas, glucagonomas, VIPomas, and somatostatinomas is statistically higher and ranges from 50 to 92% []. Because of the rarity of noninsulinoma functional PanNETs, a large series examining disease-specific survival based on individual subtype is lacking, but gastrinomas are associated with a 5-year disease-specific survival rate of 35% []. Therefore, a nodal dissection of noninsulinoma functional PanNETs at the time of surgery is commonly indicated. However, approximately 10% of insulinomas can develop metastatic disease, and, thus, other factors are likely to influence the metastatic spread of functional PanNETs.