Stereotactic Ablative Radiotherapy for the Management of Liver Metastases from Neuroendocrine Neoplasms: A Preliminary Study

Hudson, John M.; Chung, Hans T.; Chu, William; Taggar, Amandeep; Davis, Laura; Hallet, Julie; Law, Calvin; Singh, Simron; Myrehaug, Sten

doi:10.1159/000514914

Cited by 14 publications

(13 citation statements)

References 45 publications

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“…26 PFS at 1 year was 44%. 26 Another alternative could be the use of brachytherapy. Schippers et al treated a total of 27 oligometastasized NETpatients in a total of 40 therapy sessions and achieved a median PFS of 7.3 month in this retrospective evaluation.…”

Section: Discussionmentioning

confidence: 92%

“…Similarly, oligoprogression stereotactic radiation enabled most patients to maintain SSA-therapy and showed no severe adverse effects. 26 Overall, the use of local ablative therapy could be more beneficial for the patients' quality of life than switching from SSA to another systemic therapy in oligoprogression. It should be considered that systemic therapies available for palliative care in tumor progression are not only limited, but also often associated with a pronounced side effect profile.…”

Section: Discussionmentioning

confidence: 99%

“…A preliminary study by Hudson et al presented stereotactic radiotherapy as an approach to treat hepatic oligoprogression 26 . PFS at 1 year was 44% 26 . Another alternative could be the use of brachytherapy.…”

Section: Discussionmentioning

confidence: 99%

“…24 In the treatment of NETs with hepatic oligoprogression, only two retrospective studies on the use of stereotactic radiotherapy are available so far. 25,26 Other liver directed therapies have not been investigated in the treatment of NETs with hepatic oligoprogression.…”

Section: Discussionmentioning

confidence: 99%

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Radiofrequency and microwave ablation controls hepatic oligoprogression of advanced gastroenteropancreatic neuroendocrine tumors

Matrood

Gress

Rinke

et al. 2023

J Neuroendocrinology

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In progression of multifocal liver metastases of gastroenteropancreatic neuroendocrine tumors (GEP‐NET) escalation of systemic therapy is indicated. The aim of this retrospective study was to investigate the potential of local thermal ablation in hepatic oligoprogression and otherwise stable disease in GEP‐NET. Patients with hepatic oligoprogression and otherwise stable disease, who underwent radiofrequency ablation (RFA) or microwave ablation (MWA) for local control, were included in the study. Thermal ablation was performed while maintaining the ongoing systemic therapy or without addition of a systemic therapy. The effectiveness of this therapeutic approach was evaluated by determination of local treatment success, improvement of progression‐free survival (PFS) and the safety. Seventeen thermal ablation procedures were performed in 13 patients with well differentiated NET including seven ileum NET, four pancreatic NET, one appendix NET and one rectum NET. RFA and MWA of liver metastases were well tolerated without major complications. Thermal ablation resulted in an estimated median PFS of 62.6 weeks (mean 50.5 weeks; range 10.1–78.9 weeks) per procedure. In four patients, two ablation procedures were performed throughout the course of their disease resulting in an estimated median PFS of 69.1 weeks (mean 71.6 weeks; range 10.1–123.1 weeks) per patient. Start or change of systemic therapy could be delayed up to 123.1 weeks by using thermal ablations for isolated progression of single liver metastases. 88% of thermal ablations prolonged PFS. Thermal ablation of liver metastases in a non‐curative intent has the potential to provide focal growth control and to prolong PFS in GEP‐NET patients with hepatic oligoprogression.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Radiofrequency and microwave ablation controls hepatic oligoprogression of advanced gastroenteropancreatic neuroendocrine tumors

Matrood

Gress

Rinke

et al. 2023

J Neuroendocrinology

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“…Therefore, these techniques provide 70-100% local control, which is comparable to surgical resection. SBRT is used in unresectable tumours of the lung, rectum, pancreas, or liver [301][302][303].…”

Section: Radiotherapy In Neuroendocrine Neoplasmsmentioning

confidence: 99%

Update of the diagnostic and therapeutic guidelines for gastro-entero-pancreatic neuroendocrine neoplasms (recommended by the Polish Network of Neuroendocrine Tumours) [Aktualizacja zaleceń ogólnych dotyczących postępowania diagnostyczno-terapeutycznego w nowotworach neuroendokrynnych układu pokarmowego (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)]

et al. 2022

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This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially  388 Guidelines Beata Kos-Kudła et al. Guidelinespersons/year, with the primary lesion most frequently found in the small intestine (37.4%). Since 2000, rectal NENs have been diagnosed more frequently than small intestine NENs [2, 6-8]. The incidence of GEP-NETs in the USA, based on SEER data, was 3.56/100,000 persons/year. In Europe, the incidence of GEP-NETs is also increasing -from 1.33 to 2.33/100,000 persons/year; however, these data come from different registries and are mainly retrospective. Higher incidence is observed among men (5.35/100,000 persons/year) compared to women (4.76/100,000 persons/year) [1, 5-7]. The vast majority of NENs are sporadic, well-differentiated tumours. However, GEP-NETs originating from the pancreas, duodenum, stomach, and much less frequently, from the thymus and lungs sometimes constitute an element of multiple endocrine neoplasia type 1 (MEN-1) syndrome. Pancreatic neuroendocrine tumours (PanNETs) may also be associated with von Hippel-Lindau (VHL) syndrome, tuberous sclerosis complex (TSC), and neurofibromatosis (NF). In these congenital diseases, NETs can be multifocal and occur 10-20 years earlier than in sporadic cases. The frequency of the hereditary causes (MEN-1, VHL) is estimated at about 5%. Genome studies revealed the presence of germline mutations in, e.g., MUTYH, CHEK2, and BRCA2 and a propensity to PanNETs in approximately 17% of the studied population [1]. Diagnostics Biochemical diagnosticsBiochemical diagnostics of NENs involves the following: A. Non-specific markersThe most frequently used diagnostic method is determination of the chromogranin A (CgA) concentration in the serum (less frequently in the plasma) [1,8,9]. CgA is a relatively stable protein in blood. However, there are two different methods for determining the concentration of CgA: radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) in Neuroendocrine neoplasms (NENs) arise from the disseminated system of neuroendocrine cells and can occur in various parts of the body. However, they are most often found in the gastrointestinal tract and lungs. The term NENs includes both well-differentiated neuroendocrine tumours and neuroendocrine carcinomas (NECs), which account for 10-20% of all NENs. The following characteristics of NENs should be considered in the diagnostic and therapeutic process: proliferative activity, presence of somatostatin receptors (SSTRs), tumour growth rate, and extent of the neoplastic disease [1].

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Update in the management of gastroenteropancreatic neuroendocrine tumors

Sedlack,

Varghese,

Naimian

et al. 2024

Cancer

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Neuroendocrine neoplasms are a diverse group of neoplasms that can occur in various areas throughout the body. Well‐differentiated neuroendocrine tumors (NETs) most often arise in the gastrointestinal tract, termed gastroenteropancreatic neuroendocrine tumors (GEP‐NETs). Although GEP‐NETs are still uncommon, their incidence and prevalence have been steadily increasing over the past decades. The primary treatment for GEP‐NETs is surgery, which offers the best chance for a cure. However, because GEP‐NETs are often slow‐growing and do not cause symptoms until they have spread widely, curative surgery is not always an option. Significant advances have been made in systemic and locoregional treatment options in recent years, including peptide‐receptor radionuclide therapy with α and β emitters, somatostatin analogs, chemotherapy, and targeted molecular therapies.

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Stereotactic Ablative Radiotherapy for the Management of Liver Metastases from Neuroendocrine Neoplasms: A Preliminary Study

Cited by 14 publications

References 45 publications

Radiofrequency and microwave ablation controls hepatic oligoprogression of advanced gastroenteropancreatic neuroendocrine tumors

Radiofrequency and microwave ablation controls hepatic oligoprogression of advanced gastroenteropancreatic neuroendocrine tumors

Update in the management of gastroenteropancreatic neuroendocrine tumors

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