Liver Metastases of Neuroendocrine Tumors: Treatment With Hepatic Transarterial Chemotherapy Using Two Therapeutic Protocols

Vogl, Thomas J.; Gruber, Tatjana; Naguib, N; Hammerstingl, Renate; Nour-Eldin, Nour-Eldin A.

doi:10.2214/ajr.08.1879

Cited by 57 publications

(27 citation statements)

References 23 publications

(20 reference statements)

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“…Location of the primary did not influence overall survival in this series of patients. A recent small study, using combination chemotherapy, might yield longer survival [23]. Unlike pancreatic adenocarcinomas, location was not a significant predictor in this series of patients.…”

Section: Discussionmentioning

confidence: 50%

Hepatic artery chemoembolization for the treatment of liver metastases from neuroendocrine tumors: a long-term follow-up in 123 patients

Dong

Carr

2010

Med Oncol

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Neuroendocrine tumors (NETs) of the gastrointestinal tract have a propensity for hepatic metastases. Surgical resection for hepatic metastases remains the gold standard for long-term survival, but many patients present with multifocal tumors, precluding surgery with increasing use of chemoembolization. However, there are few studies examining long-term survival factors. We reviewed our 15-year experience with chemoembolization in 123 patients with unresectable NET liver metastases, whose prognosis was evaluated upon baseline clinical factors. There were 64 males (53%) and 59 females (47%). Average age at presentation was 56 years (range: 14.3-85.5 years). Abdominal pain (44%) was the most common presenting symptom, followed by diarrhea (30%) and weight lost (22%). Patients underwent an average 7.3 cycles of chemoembolization (range 1-32 cycles). Responses: 62% of patients had PR; 24% had stable disease and 14% had tumor progression. Overall 3-, 5- and 10-year survivals were 59, 36 and 20% of patients with a mean follow-up of 3.2 years (range 2 weeks-18.3 years) and mean survival of 3.3 years. Univariate analysis showed that age greater than 60 years had worse outcome (P < 0.01), as did baseline serum albumin of ≤ 3.5 g/dL and prothrombin time >13 s. Location of the primary tumor (P = 0.68), gender (P = 0.4) and serum NET peptide levels did not influence survival. However, multivariate analysis showed that a low baseline serum albumin level was an independent factor for prognosis (P = 0.003). Chemoembolization for unresectable NETs metastatic to liver is useful for tumor size reduction, symptom palliation and can be associated with prolonged survival.

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Section: Discussionmentioning

confidence: 50%

Hepatic artery chemoembolization for the treatment of liver metastases from neuroendocrine tumors: a long-term follow-up in 123 patients

Dong

Carr

2010

Med Oncol

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“…11 In brief, a mixture of iodized oil (range, 10-20 cc) (Lipiodol, Guerbet, Aulnay-sous-Bois, France) and solution containing 50-100 mg of doxorubicin (Adriamycin; Pharmacia and Upjohn Co, Kalamazoo, MI), 50-100 mg of cisplatin, 10 mg of mitomycin-C (Kyowa Hakko Kogyo, Tokyo, JP) were infused into the superselective artery for single lesions, or to a lobar artery for multiple lesions. Then embolic agents either 45-150 µm or 300-500 µm polyvinyl alcohol particles (Contour, Boston Scientific, USA) were infused in order to reduce arterial inflow and prevent washout of the chemotherapeutic agent.…”

Section: Methodsmentioning

confidence: 99%

Transarterial Chemo and Radioembolization (Yttrium90) of Hepatic Metastasis of Neuroendocrine Tumors: Single Center Experience

Özkan¹

2013

UHOD

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The aim of this study was to present our single center experience with short (< 3 months) and intermediate-term (> 3 months) follow-up results of patients who underwent transarterial radioembolization with yttrium-90 microsphere (Y-90) or transarterial chemoembolization (TACE) for hepatic metastasis of neuroendocrine tumors (hmNETs). The results of 14 patients treated with either Y-90 or TACE were reviewed retrospectively. Clinical, laboratory, and imaging follow-up was performed. Efficacy was assessed by clinical and morphologic response. Survival was estimated by Kaplan-Meier analysis. Eight patients receiving 12 TACE treatments and 6 patients receiving 7 Y-90 treatments. Response rates were similar with two treatments at short-term follow-up, but there were a lower response rate and higher being progressive disease in the TACE group than Y-90 group at intermediate-term follow-up. However, progression-free survival was lower in Y-90 group (7.5 months) than TACE group (18 months). Regarding our limited experience, both Y-90 treatment and TACE have advantages and disadvantages in treatment of patients with hmNETs, however, randomized controlled studies, are needed.Keywords: Yttrium-90, Chemoembolization, Liver, Neuroendocrine tumors ÖZET Karaci¤er Metastazl› Nöroendokrin Tümörleri olan Hastalara Yap›lan Yttrium-90 Mikroküre (Y-90) ile yap›lan Radyoembolizasyon veya Transarteryel KemoembolizasyonBu çal›flman›n amac› karaci¤er metastazl› nöroendokrin tümörleri olan hastalara yap›lan yttrium-90 mikroküre (Y-90) ile yap›lan radyoembolizasyon veya transarteryel kemoembolizasyon (TAKE) tedavilerinin k›sa (<3 ay) ve orta vadeli (> 3 ay) tek merkez izlem sonuçlar›m›z› tart›flmakt›r. Y-90 veya TAKE ile tedavi edilmifl 14 hastan›n klinik, laboratuar ve bilgisayarl› tomografileri retrospektif olarak de¤erlendirildi. Tedavinin etkinli¤i klinik ve morfolojik yan›t ile de¤erlendirildi. Sa¤kal›m Kaplan-Meier analizi ile hesapland›. Sekiz hastaya 12 TAKE, 6 hastaya 7 Y-90 tedavisi uyguland›. Yan›t oranlar› k›sa vadeli izlemde iki tedavide benzer iken, orta vadede TAKE grubunda Y-90 grubuna göre tedaviye yan›t oran› düflük ve progresyon mevcuttu. Ancak, progresyonsuz sa¤kal›m Y-90 grubunda (7.5 ay) TAKE grubuna (18 ay) göre daha düflüktü. S›n›rl› deneyimlerimize göre, karaci¤er metastazl› nöroendokrin tümörleri olan hastalarda her iki tedavi seçene¤inin de avantaj ve dezavantajlar› olmakla birlikte, randomize kontrollü çal›flmalara ihtiyaç vard›r.

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“…symptomatisches, biochemisches sowie morphologisches (radiologisches) Ansprechen dokumentiert werden [5,11,31,43]. In mehreren Studien wurde eine exzellente symptomatische und biologische Ansprechrate von 70-73% bei Patienten mit Lebermetastasen der NET erreicht [36].…”

Section: Disclosureunclassified

Regionale interventionelle Behandlungsverfahren von Lebermetastasen neuroendokriner Tumoren: Embolisation (TAE), Chemoembolisation (TACE) und selektive interne Radiotherapie (SIRT)

et al. 2010

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Vorstellung technischer Grundlagen, klinischer Einschlusskriterien und der Ergebnisse sequenzieller vaskulärer Therapieverfahren wie transarterielle Embolisation (TAE), transarterielle Chemoembolisation (TACE) und selektive interne Radiotherapie (SIRT) in der Behandlung von Lebermetastasen neuroendokriner Tumoren im Rahmen des interdisziplinären Therapiemanagements. Die Indikation für die lokoregionale vaskuläre, minimalinvasive Therapie stellen in der Regel multiple Lebermetastasen dar, aufgrund ihrer starken Hypervaskularisation und der hiermit verbundenen Vorteile eines transarteriellen Verfahrens mit Embolisation. Die Ergebnisse der TAE zeigen Ansprechraten von 40 bis 54% bei einer mittleren Überlebenszeit von 33,8 Monaten. Für die TACE sind die dokumentierten Daten mit einer Ansprechrate von 23 bis 80% und einer medianen Überlebenszeit von ca. 40 Monaten unwesentlich besser. Für die SIRT liegen die mittleren Überlebenszeiten zwischen 22 und 29,4 Monaten. Regionale interventionelle Behandlungsverfahren der Lebermetastasen neuroendokriner Tumoren erlauben eine Optimierung der lokalen Kontrollrate und führen zur Minderung der Krankheitssymptomatik sowie zur Erhöhung der Überlebensraten bei möglichst höherer Lebensqualität.

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Liver Metastases of Neuroendocrine Tumors: Treatment With Hepatic Transarterial Chemotherapy Using Two Therapeutic Protocols

Abstract: Transarterial hepatic chemotherapy using mitomycin C and gemcitabine can be an effective therapeutic protocol for controlling local metastases and improving survival time in patients with hepatic metastases from neuroendocrine tumors.

Cited by 57 publications

References 23 publications

Hepatic artery chemoembolization for the treatment of liver metastases from neuroendocrine tumors: a long-term follow-up in 123 patients

Hepatic artery chemoembolization for the treatment of liver metastases from neuroendocrine tumors: a long-term follow-up in 123 patients

Transarterial Chemo and Radioembolization (Yttrium90) of Hepatic Metastasis of Neuroendocrine Tumors: Single Center Experience

Regionale interventionelle Behandlungsverfahren von Lebermetastasen neuroendokriner Tumoren: Embolisation (TAE), Chemoembolisation (TACE) und selektive interne Radiotherapie (SIRT)

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