Hepatic arterial embolization in patients with neuroendocrine tumors

Abstract

Liver metastases occur in 46-93% of patients with neuroendocrine neoplasms (NENs). Presence and extension of liver metastases are considered important prognostic factors, as they may significantly impair the patient’s quality of life, because of either tumor bulk or hormonal hypersecretion. Therapies for NEN liver metastases include surgical resection, liver transplantation, chemotherapy and biotherapy. Surgery is the gold standard for curative therapy, but in most of NEN patients with liver metastases, when surgery can not be applied, minimally invasive therapeutic approaches are adopted. They include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), radiofrequency thermal ablation and new emerging techniques.TAE is based on selective infusion of particles in the branch of the hepatic artery supplying the tumor lesions. The goal of TAE is to occlude tumor blood vessels resulting in ischemia and necrosis. Many reports have shown that TAE can reduce tumor size and hormone output, resulting in palliation of symptoms without the use of cytotoxic drugs, resulting in better tolerability. This review will focus on TAE performance and safety in NEN patients with liver metastases.

Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

“…These patients are rarely cured surgically and thus are candidates for various forms of liver-directed therapies, particularly when the primary tumor is resected[1, 20, 21, •22, 68, •69, 70]. Liver-directed therapies include trans-arterial embolization (TAE), trans-arterial chemo-embolization(TACE), radioembolization or selective internal radiation therapy(SIRT), as well as radio-frequency ablation(RFA) and cytoreductive surgery.…”

“…TAE and TACE can be safely performed because NET metastases in the liver are highly vascular and derive their blood supply primarily from tributaries of the hepatic artery, whereas normal liver parenchyma is supplied primarily by the portal vein[17, 20, 21, 22, 68, 71]. Consequently, interruption of the tributaries of the hepatic artery affects the tumor deposits much more than the normal liver.…”

“…Consequently, interruption of the tributaries of the hepatic artery affects the tumor deposits much more than the normal liver. This interruption can be performed at surgery, but is usually performed percutaneously and can be either occlusion only (TAE) or with the co-administration of chemotherapeutic agents(TACE) (usually doxorubicin, mitomycin C, streptozotocin, fluorouracil, cisplatin)[17, 20, 21, •22, 68, 71]. …”

“…TAE or TACE are usually performed for palliative treatment of liver-predominant disease which is not surgically resectable to reduce the hepatic tumor mass and 25–85% of patients have an objective tumor response, with a mean duration of response of 6–45 months[17, 20, 21, •22, 68, 71]. This approach has been particularly considered in patients with hepatic symptoms or refractory malignant F-NET syndromes[17, 20, 21, •22, 68, 71].…”

A new angiographic imaging platform reduces radiation exposure for patients with liver cancer treated with transarterial chemoembolization

“…Transarterial chemoembolization (TACE) has become an important treatment option for a number of primary and secondary liver malignancies [6][7][8][9][10]. In most patients, TACE is performed repeatedly because of the multifocal nature of the disease, incompletely treated lesions or disease recurrence.…”