Improved Outcome With Cytoreduction Versus Embolization for Symptomatic Hepatic Metastases of Carcinoid and Neuroendocrine Tumors

Osborne, Dana; Zervos, Emmanuel E.; Strosberg, J.; Boe, Brian A.; Malafa, Mokenge P.; Rosemurgy, Alexander S.; Yeatman, Timothy J.; Carey, Larry C.; Duhaine, Lisa; Kvols, Larry K.

doi:10.1245/aso.2006.03.071

Cited by 203 publications

(158 citation statements)

References 27 publications

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“…Surgical intervention in selected patients may increase five-year symptom-free survival rate up to 70%. However, options for surgical interventions are limited, and thus, aggressive local therapies such as embolization with or without chemotherapy (20)(21)(22)(23) and external beam radiotherapy (24)(25)(26)(27) (32) showed that the median survival of 63.2% of patients having a good radiologic response to treatment with resin-based 90 Y microspheres was 70 months. Their study was the largest to date, with a median follow-up of 42 months and 7% lost to follow-up; however, it did not include information on prognostic factors for a favorable survival.…”

Section: Discussionmentioning

confidence: 99%

Radioembolization with yttrium-90 resin microspheres for neuroendocrine tumor liver metastases

Peker

Çiçek²,

Soydal³

et al. 2015

Diagn Interv Radiol

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RESULTSThe mean follow-up was 23.0±19.4 months and the median overall survival was 39 months (95% CI, 12.6-65.4 months), with one-and two-year survival rates of 71% and 45%, respectively. Imaging follow-up using RECIST at three-month intervals demonstrated partial response in 43%, complete remission in 3%, stable disease in 37%, and progressive disease in 17% of patients. Extent of tumor involvement was found to have a statistically significant influence on overall survival (P = 0.03). The existence of extrahepatic disease at the time of radioembolization, radiographic response, age, and primary neuroendocrine tumor site were not significant prognostic factors. CONCLUSIONThe current study demonstrates the effectiveness and safety of radioembolization for the treatment of unresectable NETLMs. We identified that the extent of tumor involvement has a significant effect on overall survival. The use of imaging methods reflecting metabolic activity or cellularity such as scintigraphy or diffusion-weighted MRI would be more appropriate, for the response evaluation of liver metastases after radioembolization. N euroendocrine tumors (NETs) are a heterogenous group of slow-growing and hormon-releasing malignant tumors. Even though primary NETs originate from a number of locations, 40%-70% of all carcinoids arise in the small intestine and appendix (1, 2). The most common site for metastasis is the liver. Neuroendocrine tumor liver metastasis (NETLM) results in hormone-secretion-related symptoms leading to carcinoid syndrome, pressure on structures, or liver replacement (1-4). Patients with liver metastasis have a five-year survival rate of less than 20% (5). Over the years, improvements in local treatments yielded better control of the symptoms and survival rates, yet only 10% of the patients have limited illness and are eligible for surgery (6). Patient symptomatology and survival can be improved by transarterial treatments like embolization and chemoembolization (6). Limitations of these techniques include the short duration of the effects and the controversial approaches regarding the optimal timing and sequence of the procedures due to the variability of tumor progression (7,8). Long-term survival benefit was not achieved with systemic chemotherapy (9-11) and treatment with somatostatin analogues is mostly associated with symptomatic relief; there is no clear knowledge of their effect on survival of patients who have carcinoid tumor and metastasis (12).Selective internal radiation therapy (SIRT) has been used to treat unresectable primary and secondary liver cancers for over a decade.

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Section: Discussionmentioning

confidence: 99%

Radioembolization with yttrium-90 resin microspheres for neuroendocrine tumor liver metastases

Peker

Çiçek²,

Soydal³

et al. 2015

Diagn Interv Radiol

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“…As disease progression is a common occurrence, a multimodality treatment approach for progressive disease is necessary (77). For small NET LM, radiofrequency ablation has been proven as safe and effective in prolonging survival and relieving symptoms (78,79).…”

Section: Surgery Of Lmmentioning

confidence: 99%

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

Partelli

Maurizi

Tamburrino

et al. 2014

European Journal of Endocrinology

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The incidence of neuroendocrine tumors (NETs) has increased in the last decades. Surgical treatment encompasses a panel of approaches ranging from conservative procedures to extended surgical resection. Tumor size and localization usually represent the main drivers in the choice of the most appropriate surgical resection. In the presence of small (!2 cm) and asymptomatic nonfunctioning NETs, a conservative treatment is usually recommended. For localized NETs measuring above 2 cm, surgical resection represents the cornerstone in the management of these tumors. As they are relatively biologically indolent, an extended resection is often justified also in the presence of advanced NETs. Surgical options for NET liver metastases range from limited resection up to liver transplantation. Surgical choices for metastatic NETs need to consider the extent of disease, the grade of tumor, and the presence of extra-abdominal disease. Any surgical procedures should always be balanced with the benefit of survival or relieving symptoms and patients' comorbidities.

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“…Significantly better 5-year survival rates have been reported from single centers after active interventions (Wängberg et al 1996, Sarmiento & Que 2003. The only curative treatment is radical surgery, but for palliation of symptoms the treatment can include cytoreductive surgery, ischaemic treatment of liver metastases or medical therapy with somatostatin analogues sometimes combined with interferon a (Kvols et al 1986, Faiss et al 2003, Kölby et al 2003, Roche et al 2003, Osborne et al 2006. Recently, somatostatin receptormediated radiotherapy has been introduced as palliative treatment (Kwekkeboom et al 2005(Kwekkeboom et al , 2008.…”

Section: Introductionmentioning

confidence: 99%

High-resolution genomic profiling reveals gain of chromosome 14 as a predictor of poor outcome in ileal carcinoids

Andersson¹,

Swärd²,

Stenman³

et al. 2009

Endocrine-Related Cancer

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Ileal carcinoids are malignant neuroendocrine tumours of the small intestine. The aim of this study was to obtain a high-resolution genomic profile of ileal carcinoids in order to define genetic changes important for tumour initiation, progression and survival. Forty-three patients with ileal carcinoids were investigated by high-resolution array-based comparative genomic hybridization. The average number of copy number alterations (CNAs) per tumour was 7

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Improved Outcome With Cytoreduction Versus Embolization for Symptomatic Hepatic Metastases of Carcinoid and Neuroendocrine Tumors

Abstract: Cytoreduction for metastatic neuroendocrine tumors resulted in improved symptomatic relief and survival when compared with embolic therapy in this nonrandomized study. Cytoreduction should be pursued whenever possible even if complete resection may not be achievable.

Cited by 203 publications

References 27 publications

Radioembolization with yttrium-90 resin microspheres for neuroendocrine tumor liver metastases

Radioembolization with yttrium-90 resin microspheres for neuroendocrine tumor liver metastases

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

High-resolution genomic profiling reveals gain of chromosome 14 as a predictor of poor outcome in ileal carcinoids

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