Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors

Abstract

BACKGROUND.The objective of this study was to determine the prognostic variables that influence response and survival in patients with metastatic neuroendocrine tumors who are treated with hepatic arterial embolization (HAE) or chemoembolization (HACE). METHODS.Patients with metastatic neuroendocrine tumors who underwent HAE or HACE were included in this retrospective study. Follow-up imaging studies were compared with baseline imaging to determine the radiologic response. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to assess the prognostic variables that affected response and survival. RESULTS.The study included 69 patients with carcinoid tumors and 54 patients with pancreatic islet cell carcinomas. Patients who had carcinoid tumors had a higher response rate (66.7% vs. 35.2%; P ϭ 0.0001) and had longer PFS (22.7 mos vs. 16.1 mos; P ϭ 0.046) and OS (33.8 mos vs. 23.2 mos; P ϭ 0.012) compared with patients who had islet cell carcinomas. For patients with carcinoid tumors, multivariate analysis identified male gender as the only independent risk factor for poor survival (P ϭ 0.05). Octreotide was predictive marginally for PFS (P ϭ 0.06). Patients who were treated with HAE had a higher response rate than patients who were treated with HACE (P ϭ 0.004). For patients with islet cell carcinoma, an intact primary tumor, Ն 75% liver involvement, and extrahepatic metastases were associated with reduced OS in the univariate analysis; the presence of bone metastases was the only risk factor (P ϭ 0.031) in the multivariate analysis. Patients who were treated with HACE had a prolonged OS (31.5 mos vs. 18.2 mos) and improved response (50% vs. 25%) compared with patients who were treated with HAE, although the differences did not reach statistical significance. CONCLUSIONS.Patients with carcinoid tumors had better outcomes than patients with islet cell carcinomas. The addition of intraarterial chemotherapy to HAE did not improve the outcome of patients with carcinoid tumors, but it seemed to benefit patients with islet cell carcinomas. In patients who had carcinoid tumors, male gender predicted a poor outcome, and a trend toward prolonged PFS was observed in patients who received concomitant octreotide.An intact primary tumor, extensive liver disease, and bone metastases were associated with reduced survival in patients with islet cell carcinomas. Cancer

68Ga-DOTA-Tyr3-Octreotide PET in Neuroendocrine Tumors: Comparison with Somatostatin Receptor Scintigraphy and CT

“…bone metastases are considered as a negative prognostic factor, possibly requiring a more aggressive treatment regime (23,24). On the other hand, some limitations can be found in the detection of liver metastases using 68 Ga-DOTA-TOC, as it is also known for SPECT (7,8).…”

Predictors of Long-Term Outcome in Patients with Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors After Peptide Receptor Radionuclide Therapy with 177Lu-Octreotate

“…The overall response rates of 36.5% (partial response) and 54.1% (regression rate; partial response plus minor response) and the median PFS and OS (26 and 55 mo, respectively) are highly promising and compare favorably with those achieved with other treatment modalities (14)(15)(16)(17)(18). The data were analyzed in accordance with the new World Health Organization criteria (2010) and should help with comparisons of outcome data from different patient cohorts in various treatment studies.…”

“…However, because of the general lack of available prospective studies, potential predictors of outcome for patients with NET have been predominantly analyzed by use of retrospective data (16,35,36,38,(41)(42)(43)(44). The advantage of the present study is that our cohort of patients underwent the same treatment modality.…”

Bone Metastases in Patients with Neuroendocrine Tumor: 68Ga-DOTA-Tyr3-Octreotide PET in Comparison to CT and Bone Scintigraphy

“…Furthermore, bone involvement in neuroendocrine tumor is associated with a poor prognosis (9) and is a contraindication for extended surgical resection (10). Thus, diagnosis of bone metastases by different imaging strategies offers the possibility of adequate management at an early stage.…”