Liver Embolisation for Patients with Neuroendocrine Neoplasms: Systematic Review

Abstract

Background: Liver embolisation is one of the treatment options available for patients diagnosed with neuro-endocrine neoplasms (NEN). It is still uncertain whether the benefits of the various types of embolisation treatments truly outweigh the complications in NENs. This systematic review assesses the available data relating to liver embolisation in patients with NENs. Methods: Eligible studies (identified using MED-LINE-PubMed) were those reporting data on NEN patients who had undergone any type of liver embolisation. The primary end points were best radiological response and symptomatic response; secondary end-points included progression-free survival (PFS), overall survival (OS) and toxicity. Results: Of 598 studies screened, 101 were eligible: 16 were prospective (15.8%). The eligible studies included a total of 5,545 NEN patients, with a median of 39 patients per study (range 5-214). Pooled rate of partial response was 36.6% (38.9% achieved stable disease) and 55.2% of patients had a symptomatic response to therapy when pooled data were analysed. The median PFS and OS were 18.4 months (95% CI 15.5-21.2) and 40.7 months (95% CI 35.2-46.2) respectively. The most common toxicities were found to be abdominal pain (48.8%) and nausea (48.1%). Outcome did not significantly vary depending on the type of embolisation performed. Conclusion: Liver embolisation provides adequate symptom relief for patients with carcinoid syndrome and is also able to reach partial response in a significant proportion of patients and a reasonable PFS. Quality of studies was limited, highlighting the need of further prospective studies to confirm the most suitable form of liver embolisation in NENs.

Advanced small-bowel well-differentiated neuroendocrine tumours: An international survey of practice on 3rd-line treatment

“…Based on our findings, interferon-alpha seems to have a minor role in the management of SBNETs and to be rarely used in clinical practice. Liver embolization was a preferred treatment option for patients with functioning tumours, in keeping with data from recent systematic review and meta-analysis[ 17 ], which reported a pooled symptomatic response of 55.2%. Chemotherapy was mainly used as a rescue treatment when progression to other available treatments was shown, and was mainly suggested for patients with rapid progression.…”

“…However, the right choice for third-line treatment remains unclear and practice regarding the use of everolimus, chemotherapy and other therapy options is likely to vary significantly between different institutions. Such therapeutic options may include everolimus[ 16 ] (approved for patients with non-functioning SBNETs), liver embolization[ 17 ], chemotherapy (mainly alkylating-based or oxaliplatin-based and generally combined with fluoropyrimidine)[ 18 , 19 ] and interferon-alpha[ 20 , 21 ].…”

Nordic guidelines 2021 for diagnosis and treatment of gastroenteropancreatic neuroendocrine neoplasms

“…Radio-embolisation with intrahepatic infusion of 90 Ycoated resin or glass particles has shown promising results. In systematic reviews, there has not been shown any differences in effect between bland-chemo-and radioembolization of the liver [53]. Orthotopic liver transplantation is rarely indicated, but may be considered in carefully selected young patients without extrahepatic disease and with a Ki-67 index <10%.…”

Predictive Factors for Resistant Disease with Medical/Radiologic/Liver-Directed Anti-Tumor Treatments in Patients with Advanced Pancreatic Neuroendocrine Neoplasms: Recent Advances and Controversies

“…The importance of neuroendocrine liver metastases (NELM) in the survival of patients with advanced panNENs is represented not only by the fact that presence of liver metastases is associated with worse survival [ 11 , 70 , 155 , 162 , 337 , 338 , 339 , 340 , 341 ], but also by a significant correlation between the higher tumor burden of NELM and worse outcomes with PRRT [ 59 , 62 , 186 , 213 ], SSA [ 173 , 174 , 177 , 179 , 225 ], liver-directed therapy [ 342 ], and chemotherapy [ 321 ] ( Table 5 ). Several studies have reported the efficacy of liver-directed therapies including TACE/TAE and radio-embolization using 90 Y-labeled microspheres (selective internal radiotherapy [SIRT]), in controlling focal progression of NELM [ 69 , 70 , 71 , 72 , 74 , 341 , 343 ], as well as in controlling symptoms due to the liver metastases or hormone excess state of a F-panNENs [ 9 , 39 , 70 , 71 , 74 , 341 , 344 ]. The mean overall ORR to radio-embolization in a review of 12 studies including >400 patients with unresectable NELM was 55% (range 12–89%) and stable disease in 32% (range 10–60%) [ 9 ].…”

“…These results are increasingly supported by additional recent non-prospective studies [ 25 , 56 , 57 , 60 , 61 , 62 , 63 ]. Several studies have reported the anti-tumor efficacy of various chemotherapies [ 13 , 14 , 18 , 31 , 64 , 65 , 66 , 67 , 68 ], as well as liver-directed therapies including transarterial chemoembolization/embolization (TACE/TAE) or radio-embolization [ 14 , 18 , 31 , 69 , 70 , 71 , 72 , 73 , 74 ].…”