Radioembolisation with 90Y microspheres for neuroendocrine liver metastases: an institutional case series, systematic review and meta-analysis

Frilling, Andrea; Clift, Ashley Kieran; Braat, Arthur J. A. T.; Alsafi, Ali; Wasan, Harpreet; Al‐Nahhas, Adil; Thomas, Robert H.; Drymousis, Panagiotis; Habib, Nagy; Tait, Paul

doi:10.1016/j.hpb.2018.12.014

Cited by 38 publications

(32 citation statements)

References 63 publications

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“…For TACE, the median objective response rate is 58.4%, and median OS from first procedure is 34.9 months [209]. The average objective response rate for SIRT is 51% (95% CI 47-54%), the average disease control rate is 88% (95% CI 85-90%) [210] and the response rates may correlate with survival [211]. One-, 2and 3-year survival post-SIRT is 72.5, 57 and 45%, respectively [212].…”

Section: Non-surgical Therapeutic Strategies For Liver Metastasesmentioning

confidence: 99%

Neuroendocrine Neoplasms of the Small Bowel and Pancreas

et al. 2019

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The traditionally promulgated perspectives of neuroendocrine neoplasms (NEN) as rare, indolent tumours are blunt and have been outdated for the last 2 decades. Clear increments in their incidence over the past decades render them increasingly clinically relevant, and at initial diagnosis many present with nodal and/or distant metastases (notably hepatic). The molecular pathogenesis of these tumours is increasingly yet incompletely understood. Those arising from the small bowel (SB) or pancreas typically occur sporadically; the latter may occur within the context of hereditary tumour predisposition syndromes. NENs can also be associated with endocrinopathy of hormonal hypersecretion. Tangible advances in the development of novel biomarkers, functional imaging modalities and therapy are especially applicable to this sub-set of tumours. The management of SB and pancreatic neuroendocrine tumours (NET) may be challenging, and often comprises a multidisciplinary approach wherein surgical, medical, interventional radiological and radiotherapeu-tic modalities are implemented. This review provides a comprehensive overview of the epidemiology, pathophysiology, diagnosis and treatment of SB and pancreatic NETs. Moreover, we provide an outlook of the future in these tumour types which will include the development of precision oncology frameworks for individualised therapy, multi-analyte predictive biomarkers, artificial intelligence-derived clinical decision support tools and elucidation of the role of the microbiome in NEN development and clinical behaviour.According to SEER version 18, SBNEN and PanNEN incidences are currently estimated at 1.2 and 0.7 per 100,000, respectively [5]. The overall 20-year duration prevalence of all NEN is estimated at 171,321; SBNEN constituting 32,122 patients with 3-fold fewer PanNEN (10,707) [5]. Possible attributable factors for this increase evolving epidemiology include increased use of endoscopy and also improvements in the sensitivity of widely used imaging modalities, leading to increased detection of early-stage, asymptomatic disease [5].The median overall survival (OS) for NEN (irrespective of site and grade) is 9.3 years [5]. For SB (median OS: 14 years), this ranges from 70 months (advanced disease with distant metastases) to 170 months (localised disease) and from 30 months (Grade 3) to 160 months (Grade 1). For pancreas (median OS: 3.6 years): 21 months (advanced) to 235 months (localised disease) and from 15 months (Grade 3) to 140 months (Grade 1) [5].Multivariable analyses have identified that ethnicity, age, differentiation, stage and site all have statistically significant correlations with survival. In general, Caucasian ethnicity, age (< 50 years) and localised, well-differentiated NEN exhibit the best survival. SB tumour patients are approximately 1.5 times more likely to survive longer than those with PanNEN [19]. Many of these correlations are self-evident since they pertain to degree of malignancy, disease duration and patient performance status.OS (median 5-year) app...

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Section: Non-surgical Therapeutic Strategies For Liver Metastasesmentioning

confidence: 99%

Neuroendocrine Neoplasms of the Small Bowel and Pancreas

et al. 2019

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“…When injected selectively, particles will distribute evenly in vessels and stop in distal arteries homogeneously in the tumor without passage in the systemic circulation and consequently no irradiation of healthy organs [ 89 ]. It is possible to inject a high dose of radiation directly in the tumor [ 93 ]. SIRT is not performed with further arterial embolization.…”

Section: Selective Internal Radiation Therapy (Sirt)mentioning

confidence: 99%

“…Absolute contraindications for microsphere-based 90Y treatment include HPS >20% or an estimated lung dose >30Gy and reflux into arteries that supply the gastroduodenal region, which may result in extrahepatic deposition of microspheres, and cause non-target radio-induced complications [ 93 , 112 ]. The preSIRT work-up aims to prevent these complications.…”

Section: Selective Internal Radiation Therapy (Sirt)mentioning

confidence: 99%

“…No multicentric controlled longitudinal trial has been reported. However, two recent meta-analyses including 19 and 11 retrospective studies, and more than 800 patients with NELM found a median global OS of 28 months (range: 14–70 months) and 32 months (range: 18–57 months) after SIRT [ 93 , 111 ].…”

Section: Selective Internal Radiation Therapy (Sirt)mentioning

confidence: 99%

“…Radiological follow-up is performed using RECIST 1.1 or mRECIST criteria [ 110 , 114 ]. Radiological objective responses rate (including CR and PR) range from 12% to 80% with a weighted mean on meta-analyses of 51% (95% CI: 47–54%) [ 93 , 115 ]. Several studies have reported CR that occurred in 1% to 8% of patients, which is not the case for TAE/TACE [ 93 , 110 , 116 , 117 , 118 ].…”

Section: Selective Internal Radiation Therapy (Sirt)mentioning

confidence: 99%

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

Barat

Cottereau

Kedra

et al. 2020

JCM

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Interventional radiology plays an important role in the management of patients with neuroendocrine tumor liver metastasis (NELM). Transarterial embolization (TAE), transarterial chemoembolization (TACE), and selective internal radiation therapy (SIRT) are intra-arterial therapies available for these patients in order to improve symptoms and overall survival. These treatment options are proposed in patients with NELM not responding to systemic therapies and without extrahepatic progression. Currently, available data suggest that TAE should be preferred to TACE in patients with NELM from extrapancreatic origin because of similar efficacy and better patient tolerance. TACE is more effective in patients with pancreatic NELM and SIRT has shown promising results along with good tolerance. However, large randomized controlled trials are still lacking in this setting. Available literature mainly consists in small sample size and retrospective studies with important technical heterogeneity. The purpose of this review is to provide an updated overview of the currently reported endovascular interventional radiology procedures that are used for the treatment of NELM.

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