Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours

Abstract

Transcatheter arterial chemoembolisation (TACE) has been reported to be an efficient treatment of liver metastases of endocrine tumours in short series of patients. However, several factors seem to affect its results. The aim of this work is to identify predictors of response to TACE for liver metastases of endocrine tumours. A total of 163 TACE procedures were performed in 67 patients between 1994 and 2004. Forty-four patients were treated with streptozotocin and 23 with doxorubicin. Primary tumour was located in the pancreas for 19 patients, and had been removed in 43. Thirty-eight tumours were functioning. Response rate was 37% (confidence interval [CI] 95%: 28 -49%). Median time to progression (TTP) was 14.5 months (CI 95%: 9 -41). In multivariate analysis (n ¼ 43), predictors of tumour response were body mass index (BMI) (odds ratio [OR]: 1.3; CI 95%: 1.04 -1.63; P ¼ 0.022), functioning type of tumour (OR: 7.31; CI 95%: 1.26 -42.5; P ¼ 0.027), arterial phase enhancement on abdominal computed tomography (CT) (OR: 8.11; CI 95%:1.06 -62; P ¼ 0.044) and use of streptozotocin for cytotoxic agent (OR: 21.3; CI 95%: 1.48 -306; P ¼ 0.025). Analysis of TTP predictors showed that BMI (hazard ratio [HR]: 0.85; CI 95%: 0.76 -0.86; P ¼ 0.01) and arterial phase enhancement (HR: 0.3; CI 95%: 0.12 -0.73; P ¼ 0.008) were associated with delayed progression. This large study confirms the previously reported results of TACE regarding its efficacy for the treatment of liver metastases of endocrine tumours. Arterial phase enhancement on abdominal CT and BMI are predictors of treatment's efficacy. Streptozotocin should be the preferred cytotoxic agent in order to save anthracycline for systemic chemotherapy.

Ki-67 index, tumor differentiation, and extent of liver involvement are independent prognostic factors in patients with liver metastases of digestive endocrine carcinomas

“…Hepatic chemoembolization was indicated in patients without extra-hepatic metastases, especially in those with small bowel primary (Dominguez et al 1999, Marrache et al 2007.…”

Hepatic Arterial Embolization versus Chemoembolization in the Treatment of Liver Metastases from Well-Differentiated Midgut Endocrine Tumors: A Prospective Randomized Study

“…The combination of these therapeutic methods may increase intratumoral drug concentration and dwelling time in cancer cells [14]. Moreover, certain drugs are more efficient on anoxic cells [15]. Trans-catheter arterial HACE and embolization are effective in controlling hormonal symptoms and reducing tumor size [14,16,17,18,19].…”

Therapeutic management of patients with gastroenteropancreatic neuroendocrine tumours

“…Symptomatic response is achieved in 40-80%, biochemical response in 50-60% with overall 5-year survival, and 50-60% post-embolisation , Brown et al 1999, Dominguez et al 1999, 2000, Kim et al 1999, Yao et al 2001, Roche et al 2003, Marrache et al 2007, Sward et al 2009). The mechanism is to induce ischaemia in tumour cells, thus reducing their hormone output.…”