Hepatic Arterial Chemoembolization Using Drug-Eluting Beads in Gastrointestinal Neuroendocrine Tumor Metastatic to the Liver

Gaur, Shantanu; Friese, J.; Sadow, Cheryl A.; Ayyagari, Raj; Binkert, Christoph A.; Schenker, Matthew P.; Kulke, Matthew H.; Baüm, Richard

doi:10.1007/s00270-011-0122-1

Cited by 56 publications

(36 citation statements)

References 39 publications

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“…This trial was therefore discontinued prematurely for seriousness of the adverse events. A similar efficacy was reported in a historical series for Lipiodol-TACE and DEB-TACE with TTP of 16-18 months (7,50), and 14-15 months respectively (46,47). In the absence of randomized clinical trials, and obviously no signal of better efficacy of DEB-TACE as illustrated above, it is advisable to use Lipiodol-TACE especially when the total liver is treated.…”

Section: Chemoembolization and Embolizationsupporting

confidence: 73%

“…DEB-TACE combines the theoretical advantages of an aggressive embolization, high tumor exposure to a chemotherapy drug, and low systemic passage of the drug in animal tumor models (22,45). Early publications reporting on DEB-TACE in NET liver metastases show a high response rate of 57-80% according to mRECIST, with TTP of 14-15 months (46,47). After these two early reports, our institution reported a series of 120 patients with GEP-NET liver metastasis treated with either DEB-TACE or Lipiodol-TACE.…”

Section: Chemoembolization and Embolizationmentioning

confidence: 99%

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GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

Baère

Deschamps

Tselikas

et al. 2015

European Journal of Endocrinology

110

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Neuroendocrine tumors from gastro-pancreatic origin (GEP-NET) can be responsible for liver metastases. Such metastases can be the dominant part of the disease as well due to the tumor burden itself or the symptoms related to such liver metastases. Intra-arterial therapies are commonly used in liver only or liver-dominant disease and encompass trans-arterial chemoembolization (TACE), trans-arterial embolization (TAE), and radioembolization (RE). TACE performed with drug emulsified in Lipiodol has been used for the past 20 years with reported overall survival in the range of 3-4 years, with objective response up to 75%. Response to TACE is higher when treatment is used as a first-line therapy and degree of liver involvement is lower. Benefit of TACE over TAE is unproven in randomized study, but reported in retrospective studies namely in pancreatic NETs. RE provides early interesting results that need to be further evaluated in terms of benefit and toxicity. Radiofrequency ablation allows control of small size and numbered liver metastases, with low invasiveness. Ideal metastases to target are one metastasis !5 cm, or three metastases !3 cm, or a sum of diameter of all metastases below 8 cm. Ablation therapies can be applied in the lung or in the bones when needed, and more invasive surgery should be probably saved for large-size metastases. Even if the indication of image-guided therapy in the treatment of GEP-NET liver metastases needs to be refined, such therapies allow for manageable invasive set of treatments able to address oligometastatic patients in liver, lung, and bones. These treatments applied locally will save the benefit and the toxicity of systemic therapy for more advanced stage of the disease.

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Section: Chemoembolization and Embolizationsupporting

confidence: 73%

Section: Chemoembolization and Embolizationmentioning

confidence: 99%

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

Baère

Deschamps

Tselikas

et al. 2015

European Journal of Endocrinology

110

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“…The EASL criteria have been applied to patients with NETs with liver metastases treated with hepatic arterial chemoembolization with doxorubicin-eluting beads (18,19) or with 90 Y radioembolization (20). The Choi criteria have been applied to a patient with a pancreatic NET treated with sunitinib and Octreotide LAR.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Response Evaluation in Patients with Gastroenteropancreatic and Thoracic Neuroendocrine Tumors After Treatment with [¹⁷⁷Lu-DOTA⁰,Tyr³]Octreotate

et al. 2013

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Response Evaluation Criteria In Solid Tumors (RECIST) (unidimensional), Southwest Oncology Group (SWOG) solid tumor response criteria (bidimensional), and their modified variants are commonly used in the tumor response assessment after treatment of gastroenteropancreatic and thoracic neuroendocrine tumors (NETs). In the current study, RECIST, SWOG criteria, modified RECIST (mRECIST), and modified SWOG (mSWOG) criteria were compared in patients with NETs treated with [ 177 Lu-DOTA 0 ,Tyr 3 ]octreotate ( 177 Luoctreotate). Methods: Two-hundred sixty-eight Dutch patients with NETs who had been treated with 177 Lu-octreotate between January 2000 and April 2007 were studied. CT or MR imaging scans were analyzed using RECIST, SWOG criteria, mRECIST, and mSWOG criteria (including the tumor response class minor response [decrease of 13%-30% for mRECIST and 25%-50% for mSWOG]). The outcomes were correlated with progression-free survival (PFS) and overall survival (OS). Results: Eleven patients had an unknown tumor response and were excluded. The rates of objective response (OR) (complete response 1 partial response [1minor response for mRECIST/mSWOG]), stable disease, and progressive disease (PD) were 28%, 49%, and 24%, respectively, according to RECIST; 25%, 49%, and 26%, respectively, according to SWOG; 44%, 33%, and 24%, respectively, according to mRECIST; and 45%, 29%, and 26%, respectively, according to mSWOG. In patients who had OR, stable disease, or PD, the median PFS was 26-30, 27-34, and 8 mo, respectively, with any of the 4 response criteria. In patients who had OR, stable disease, or PD, the median OS was 55-57, 56-74, and 11-12 mo, respectively, with any of the 4 response criteria. Subanalyses for patients who had progression before treatment start were comparable. Conclusion: Patients with PD as treatment outcome had significantly shorter PFS and OS than patients with an OR or stable disease with all 4 scoring systems. PFS and OS were comparable for patients with tumor regression and stable disease. The addition of the response class minor response did not improve the correlation with PFS and OS. The 4 scoring systems gave comparable results in terms of PFS and OS per categorized outcome.

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“…9,17,18 This condition is likely due to several reasons. First, it may have been affected by our small sample size.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, transarterial liver-directed therapies including TACE, and Y-90 treatments procedure for tumor regression and symptomatic improvement have proven effective in many patients with unresectable and symptomatic NETs hepatic metastases. [7][8][9] In this study, we present our single center experience with short and intermediate-term follow-up results of either Yttrium-90 microspheres (Y-90) or TACE for hepatic neuroendocrine metastases.…”

Section: Introductionmentioning

confidence: 99%

Transarterial Chemo and Radioembolization (Yttrium90) of Hepatic Metastasis of Neuroendocrine Tumors: Single Center Experience

Özkan¹

2013

UHOD

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The aim of this study was to present our single center experience with short (< 3 months) and intermediate-term (> 3 months) follow-up results of patients who underwent transarterial radioembolization with yttrium-90 microsphere (Y-90) or transarterial chemoembolization (TACE) for hepatic metastasis of neuroendocrine tumors (hmNETs). The results of 14 patients treated with either Y-90 or TACE were reviewed retrospectively. Clinical, laboratory, and imaging follow-up was performed. Efficacy was assessed by clinical and morphologic response. Survival was estimated by Kaplan-Meier analysis. Eight patients receiving 12 TACE treatments and 6 patients receiving 7 Y-90 treatments. Response rates were similar with two treatments at short-term follow-up, but there were a lower response rate and higher being progressive disease in the TACE group than Y-90 group at intermediate-term follow-up. However, progression-free survival was lower in Y-90 group (7.5 months) than TACE group (18 months). Regarding our limited experience, both Y-90 treatment and TACE have advantages and disadvantages in treatment of patients with hmNETs, however, randomized controlled studies, are needed.Keywords: Yttrium-90, Chemoembolization, Liver, Neuroendocrine tumors ÖZET Karaci¤er Metastazl› Nöroendokrin Tümörleri olan Hastalara Yap›lan Yttrium-90 Mikroküre (Y-90) ile yap›lan Radyoembolizasyon veya Transarteryel KemoembolizasyonBu çal›flman›n amac› karaci¤er metastazl› nöroendokrin tümörleri olan hastalara yap›lan yttrium-90 mikroküre (Y-90) ile yap›lan radyoembolizasyon veya transarteryel kemoembolizasyon (TAKE) tedavilerinin k›sa (<3 ay) ve orta vadeli (> 3 ay) tek merkez izlem sonuçlar›m›z› tart›flmakt›r. Y-90 veya TAKE ile tedavi edilmifl 14 hastan›n klinik, laboratuar ve bilgisayarl› tomografileri retrospektif olarak de¤erlendirildi. Tedavinin etkinli¤i klinik ve morfolojik yan›t ile de¤erlendirildi. Sa¤kal›m Kaplan-Meier analizi ile hesapland›. Sekiz hastaya 12 TAKE, 6 hastaya 7 Y-90 tedavisi uyguland›. Yan›t oranlar› k›sa vadeli izlemde iki tedavide benzer iken, orta vadede TAKE grubunda Y-90 grubuna göre tedaviye yan›t oran› düflük ve progresyon mevcuttu. Ancak, progresyonsuz sa¤kal›m Y-90 grubunda (7.5 ay) TAKE grubuna (18 ay) göre daha düflüktü. S›n›rl› deneyimlerimize göre, karaci¤er metastazl› nöroendokrin tümörleri olan hastalarda her iki tedavi seçene¤inin de avantaj ve dezavantajlar› olmakla birlikte, randomize kontrollü çal›flmalara ihtiyaç vard›r.

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Hepatic Arterial Chemoembolization Using Drug-Eluting Beads in Gastrointestinal Neuroendocrine Tumor Metastatic to the Liver

Abstract: Drug-eluting bead chemoembolization is a reasonable alternative to hepatic arterial embolization and chemoembolization for the treatment of metastatic neuroendocrine tumor to the liver.

Cited by 56 publications

References 39 publications

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

Comparison of Response Evaluation in Patients with Gastroenteropancreatic and Thoracic Neuroendocrine Tumors After Treatment with [¹⁷⁷Lu-DOTA⁰,Tyr³]Octreotate

Transarterial Chemo and Radioembolization (Yttrium90) of Hepatic Metastasis of Neuroendocrine Tumors: Single Center Experience

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Hepatic Arterial Chemoembolization Using Drug-Eluting Beads in Gastrointestinal Neuroendocrine Tumor Metastatic to the Liver

Abstract: Drug-eluting bead chemoembolization is a reasonable alternative to hepatic arterial embolization and chemoembolization for the treatment of metastatic neuroendocrine tumor to the liver.

Cited by 56 publications

References 39 publications

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

Comparison of Response Evaluation in Patients with Gastroenteropancreatic and Thoracic Neuroendocrine Tumors After Treatment with [177Lu-DOTA0,Tyr3]Octreotate

Transarterial Chemo and Radioembolization (Yttrium90) of Hepatic Metastasis of Neuroendocrine Tumors: Single Center Experience

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Comparison of Response Evaluation in Patients with Gastroenteropancreatic and Thoracic Neuroendocrine Tumors After Treatment with [¹⁷⁷Lu-DOTA⁰,Tyr³]Octreotate