Hepatic intra-arterial therapies in metastatic neuroendocrine tumors: lessons from clinical practice

Grozinsky‐Glasberg, Simona; Kaltsas, Gregory; Kaltsatou, Maria; Lev‐Cohain, Naama; Климов, А. Е.; Vergadis, V.; Uri, Inbal; Bloom, Allan I.; Gross, David J.

doi:10.1007/s12020-018-1537-0

Cited by 28 publications

(15 citation statements)

References 51 publications

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“…Tumor response is objectivized in 25–86% of cases, and the duration of the response ranges from 6 to 45 months [ 77 – 79 ]. In a recent series, clinical improvement and tumor response were observed in 95% of patients, with median time to tumor progression of 14 ± 16 months and median overall survival of 22 ± 18 months [ 80 ].…”

Section: Resultsmentioning

confidence: 99%

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Treatment options for PNET liver metastases: a systematic review

Nigri

Petrucciani

Debs³

et al. 2018

World J Surg Onc

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BackgroundPancreatic neuroendocrine tumors (PNETs) are rare pancreatic neoplasms. About 40–80% of patients with PNET are metastatic at presentation, usually involving the liver (40–93%). Liver metastasis represents the most significant prognostic factor. The aim of this study is to present an up-to-date review of treatment options for patients with liver metastases from PNETs.MethodsA systematic literature search was performed using the PubMed database to identify all pertinent studies published up to May 2018.ResultsThe literature search evaluated all the therapeutic options for patients with liver metastases of PNETs, including surgical treatment, loco-regional therapies, and pharmacological treatment. All the different treatment options showed particular indications in different presentations of liver metastases of PNET. Surgery remains the only potentially curative therapeutic option in patients with PNETs and resectable liver metastases, even if relapse rates are high. Efficacy of medical treatment has increased with advances in targeted therapies, such as everolimus and sunitinib, and the introduction of radiolabeled somatostatin analogs. Several techniques for loco-regional control of metastases are available, including chemo- or radioembolization.ConclusionsTreatment of patients with PNET metastases should be multidisciplinary and must be personalized according to the features of individual patients and tumors.

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Section: Resultsmentioning

confidence: 99%

“…In patients with previous pancreaticoduodenectomy, transarterial therapies are generally contraindicated, due to higher risks of post-procedure morbidity. Liver-directed therapies may also be proposed in patients with extrahepatic metastases to control liver disease and symptoms [ 80 – 83 ].…”

Section: Resultsmentioning

confidence: 99%

Treatment options for PNET liver metastases: a systematic review

Nigri

Petrucciani

Debs³

et al. 2018

World J Surg Onc

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“…Efficacy across modalities appears to be equivalent with imaging and clinical response rates between 60 and 95%. [18][19][20] A multicenter retrospective analysis showed no significant difference in hepatic progression-free survival (PFS) or OS between the different modalities, with median time to progression of approximately 16 months, and outcomes largely determined by liver burden and tumor grade. 21 Comparison between transarterial therapies and indeed across all NET therapies is markedly limited by GEP-NET heterogeneity.…”

Section: Liver-directed Therapymentioning

confidence: 99%

Liver-Directed Therapy for Gastroenteropancreatic NETs in the Era of Peptide Receptor Radionuclide Therapy

González-Aguirre

Ziv

2020

Digestive Disease Interventions

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Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a heterogeneous group of tumors. Current treatment algorithms for these tumors are complex and often require a multidisciplinary approach. Recently, peptide receptor radionuclide therapy (PRRT) was granted Food and Drug Administration approval, making this treatment widely available in the United States. PRRT is now another therapeutic option for patients with GEP-NETs. To date there are no consensus guidelines about how to sequence multiple treatment options. Moreover, there is concern of potential liver toxicity when PRRT is used before or after liver-directed therapies (LDTs). In this review, we describe the characteristics of the most commonly used LDT and their potential interactions with PRRT, as well as specific clinical scenarios that are relevant when deciding on the use of LDT. We also review the limited case series that have been published involving patients treated with different combinations of LDT and PRRT. Finally, we discuss some of the future directions for GEP-NET treatments.

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“…Based on these results, the authors suggested that the presence of extrahepatic metastases or unresected primary tumor should not limit the use of TAE and TACE. In another more recent study, clinical response was observed in 95% of the patients treated with various hepatic intra-arterial therapies[ 26 ]. Data about TARE in the treatment of LM from NEN are still limited, but response rates of 70%-90% have been reported[ 27 ].…”

Section: Catheter-based Treatmentsmentioning

confidence: 99%

Liver-directed therapies for liver metastases from neuroendocrine neoplasms: Can laser ablation play any role?

Sartori¹,

Bianchi²,

Vece³

et al. 2020

WJG

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Aggressive cytoreduction can prolong survival in patients with unresectable liver metastases (LM) from neuroendocrine neoplasms (NEN), and minimally invasive, liver-directed therapies are gaining increasing interest. Catheter-based treatments are used in disseminated disease, whereas ablation techniques are usually indicated when the number of LM is limited. Although radiofrequency ablation (RFA) is by far the most used ablative technique, the goal of this opinion review is to explore the potential role of laser ablation (LA) in the treatment of LM from NEN. LA uses thinner needles than RFA, and this is an advantage when the tumors are in at-risk locations. Moreover, the multi-fiber technique enables the use of one to four laser fibers at once, and each fiber provides an almost spherical thermal lesion of 12-15 mm in diameter. Such a characteristic enables to tailor the size of each thermal lesion to the size of each tumor, sparing the liver parenchyma more than any other liver-directed therapy, and allowing for repeated treatments with low risk of liver failure. A recent retrospective study reporting the largest series of LM treated with LA documents both safety and effectiveness of LA, that can play a useful role in the multimodality approach to LM from NEN.

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Hepatic intra-arterial therapies in metastatic neuroendocrine tumors: lessons from clinical practice

Cited by 28 publications

References 51 publications

Treatment options for PNET liver metastases: a systematic review

Treatment options for PNET liver metastases: a systematic review

Liver-Directed Therapy for Gastroenteropancreatic NETs in the Era of Peptide Receptor Radionuclide Therapy

Liver-directed therapies for liver metastases from neuroendocrine neoplasms: Can laser ablation play any role?

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