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Surgical Versus Nonsurgical Management of Malignant Pheochromocytoma

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Difficult Decisions in Endocrine Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

Malignant pheochromocytomas and paragangliomas are rare. Resection of the primary tumor and metastatic lesions, when feasible, is recommended. Goals of resection include improvement of clinical symptoms, reduction of catecholamine excess, local disease control, improved efficacy of subsequent non-operative therapies, and the possibility of improved survival. A R0 or R1 resection clearly provides more robust biochemical improvement when compared to a R2 resection or ‘surgical debulking.’ Additional non-surgical therapies can be used in conjunction with surgery or as the primary treatment modality in some cases. Non-surgical local therapies include external beam radiation, percutaneous tumor ablation, and directed transarterial chemoembolization. In addition, systemic therapies include radioactive iodine meta-iodobenzylguanidine (131I-MIBG), cytotoxic chemotherapy, and molecular targeted therapy. Care should be taken to provide patients with the appropriate pharmacologic adrenergic blockade prior to the initiation of most therapies. Patients benefit from a multidisciplinary approach at a center familiar with managing malignant pheochromocytoma patients.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Endocrine Surgery, Taubman Center, Ann Arbor, MI, USA

    Travis M. Cotton

  2. Department of Endocrine Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Mark S. Cohen

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  1. Mark S. Cohen
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  2. Travis M. Cotton
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Editor information

Editors and Affiliations

  1. Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA

    Peter Angelos

  2. Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA

    Raymon H. Grogan

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Cohen, M.S., Cotton, T.M. (2018). Surgical Versus Nonsurgical Management of Malignant Pheochromocytoma. In: Angelos, P., Grogan, R. (eds) Difficult Decisions in Endocrine Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-92860-9_29

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  • DOI: https://doi.org/10.1007/978-3-319-92860-9_29

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-92858-6

  • Online ISBN: 978-3-319-92860-9

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