The Efficacy of Hepatic ⁹⁰Y Resin Radioembolization for Metastatic Neuroendocrine Tumors: A Meta-Analysis

Abstract

90 Y resin radioembolization is an emerging treatment in patients with liver-dominant metastatic neuroendocrine tumors (mNETs), despite the absence of level I data. The aim of this study was to evaluate the efficacy of this modality in a meta-analysis of the published literature. Methods: A comprehensive review protocol screened all reports in the literature. Strict selection criteria were applied to ensure consistency among the selected studies: human subjects, complete response data with time interval, resin microspheres, more than 5 patients, not a duplicate cohort, English language, and separate and complete data for resin-based 90 Y treatment of mNET if the study included multiple tumor and microsphere types. Selected studies were critically appraised on 50 study criteria, in accordance with the research reporting standards for radioembolization. Response data (Response Evaluation Criteria in Solid Tumors) were extracted and analyzed using both fixed and random-effects meta-analyses. Results: One hundred fifty-six studies were screened; 12 were selected, totaling 435 procedures for response assessment. Funnel plots showed no evidence of publication bias (P 5 0.841). Critical appraisal revealed a median of 75% of desired criteria included in selected studies. Very high between-study heterogeneity ruled out a fixed-effects model. The random-effects weighted average objective response rate (complete and partial responses, CR and PR, respectively) was 50% (95% confidence interval, 38%-62%), and weighted average disease control rate (CR, PR, and stable disease) was 86% (95% confidence interval, 78%-92%). The percentage of patients with pancreatic mNET was marginally associated with poorer response (P 5 0.030), accounting for approximately 23% of the heterogeneity among studies. The percentage of CR and PR correlated with median survival (R 5 0.85; P 5 0.008). Conclusion: This meta-analysis confirms radioembolization to be an effective treatment option for patients with hepatic mNET. The pooled data demonstrated a high response rate and improved survival for patients responding to therapy.

Radioembolization with 490Y glass microspheres for the treatment of unresectable metastatic liver disease from chemotherapy-refractory gastrointestinal cancers: final report of a prospective pilot study

“…The radiographic responses (hepatic ORR of 73% and DCR of 100%) appear favorable in comparison to the previously reported rates for ORR (23-64%) and DCR (67-98%) (9)(10)(11)(12)(34)(35)(36). The radiographic responses reported in this study represent best observed responses.…”

“…Radioembolization involves transcatheter arterial delivery of 20-60 mm microspheres containing Yttrium-90 ( 90 Y) radioisotope into the tumor microvasculature (5). S t u d i e s d o c u m e n t i n g s a f e t y a n d e f f i c a c y o f radioembolization for hepatic metastases from colorectal (CRC) (6)(7)(8), neuroendocrine tumors (NET) (9)(10)(11)(12), and intrahepatic cholangiocarcinoma (13)(14)(15)(16)(17) largely represent retrospective case series. However, there has also been a growing number of prospective studies documenting the use of radioembolization for treatment of metastatic CRC (18)(19)(20) and describing the use of 90 Y glass microspheres for patients with hepatic metastases from a variety of tumor types (21,22).…”

90Y Hepatic Radioembolization: An Update on Current Practice and Recent Developments

“…Because of the hypervascular nature of hepatic metastases, neuroendocrine tumors are prime candidates for radioembolization. In a metaanalysis including 414 patients, the pooled objective response rate was 50%, disease control rate was 86%, and overall survival was 28.5 mo (Table 5) (77). Data reporting response rates based on the primary tumor origin and according to the World Health Organization histologic grading system are needed.…”

Safety of selective internal radiation therapy (SIRT) with yttrium-90 microspheres combined with systemic anticancer agents: expert consensus

“…Most frequently used for the management of hepatocellular carcinoma (HCC) (5) and liver metastasis of colorectal cancer (mCRC) (7), SIRT has also been used to treat the primary liver tumor intrahepatic cholangiocarcinoma (ICC) (8), and liver metastasis of many other tumor types including neuroendocrine tumors (NETs) (9), breast cancer (10,11) and uveal melanoma (12,13).…”