Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model

Abstract

Objective To compare efficacy, survival outcome and prognostic factors of conventional transarterial chemoembolization (cTACE), drug-eluting beads TACE (DEB-TACE) and 90Yttrium-radioembolization (Y90) for the treatment of liver metastases from gastro-entero-pancreatic (GEP) neuroendocrine tumors (NELM). Methods This retrospective analysis included 192 patients (58.6years mean age, 56%men) with NELM treated with cTACE(N=122), DEB-TACE(N=26), or Y90(N=44) between 2000 and 2014. Radiologic response to therapy was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) using peri-procedural MR imaging. Survival analysis included Propensity score analysis (PSA), median overall survival (MOS), hepatic progression-free survival, Kaplan-Meier using log-rank test and the uni-and multivariate Cox proportional hazards model (MVA). Results MOS of the entire study population was 28.8months. As for cTACE, DEB-TACE and Y90, MOS was 33.8months, 21.7months and 23.6months, respectively. According to the MVA, cTACE demonstrated a significantly longer MOS as compared to DEB-TACE(p=.04) or Y90(p=.032). The five-year survival rate after initial cTACE, DEB-TACE and Y90 was 28.2%, 10.3% and 18.5%, respectively. Conclusions Upon PSA, our study suggests significant survival benefits for patients treated with cTACE as compared to DEB-TACE and Y90. This data supports the therapeutic decision for cTACE as the primary intra-arterial therapy option in patients with unresectable NELM until proven otherwise.

Intra-arterial versus standard intravenous administration of lutetium-177-DOTA-octreotate in patients with NET liver metastases: study protocol for a multicenter, randomized controlled trial (LUTIA trial)

“…The difference between TARE, TACE, and TAE is controversial, since similar PFS has been obtained. However, side effects are probably more likely to occur after TACE/TAE [1,34,39,40]. Even though the most recent ENETS guidelines suggest that loco-regional therapies can be applied in the absence of extrahepatic disease, more and more studies suggest that there is room for radioembolization even though extrahepatic disease is present [1,34,37,41].…”

Palliative TACE for hepatic metastases of chromophobe renal cell carcinoma

“…Chemoembolisation has been shown to offer palliative and locally effective treatment of liver metastases in patients with unresectable hepatocellular carcinoma (HCC), primary breast cancer, non-small cell lung cancer, pancreatic cancer, soft-tissue sarcoma, melanoma, colorectal cancer (CRC), gastric cancer and neuroendocrine tumours (table 1). 12–23 While TACE has been used to palliate various malignancies with liver metastases, it has specifically been reported as a down-staging measure ahead of surgical resection in a Japanese patient with metastatic chRCC, although impact on survival or quality of life remains unknown 24. TARE, performed through transarterial infusion of yttrium-90 microspheres to the tumour vascular bed to selectively deliver the therapeutic radiation dose over 2 weeks, can be indicated for unresectable metastatic liver tumours.…”

The Role of Interventional Radiology for the Treatment of Hepatic Metastases from Neuroendocrine Tumor: An Updated Review

“…Regarding OS, heterogeneity in the design of published studies do not allow firm conclusions to be drawn. The largest and most recent studies report OS ranging from 12 to 84 months after TAE or TACE [ 55 , 75 , 76 ]. When sub-group analyses are performed to compare pancreatic NELMs and gastroenteric NELMs, TAE is associated with a better OS compared to TACE in patients with gastroenteric NELMs [ 19 ].…”