Transarterial Chemoembolization of Advanced Liver Metastases of Neuroendocrine Tumors – A Retrospective Single-Center Analysis

Abstract

Background: In neuroendocrine tumors, metastases are a negative prognostic factor for survival and quality of life. Transcatheter arterial chemoembolization (TACE) is thought to be an effective symptomatic and antiproliferative treatment in patients with otherwise progressive disease. Methods: 62 chemoembolization procedures in 26 patients with progressive neuroendocrine tumors were reviewed. The underlying disease was carcinoid syndrome in 10, non-functional midgut tumor in 2, non-functional pancreatic tumor in 7, malignant insulinoma in 2 patients, non-functional tumor of the stomach in 1 and of unknown origin in 4 patients. Tumor burden of the liver was <25% in 3, 25–50% in 11, 50–75% in 6 and >75% in 6 patients. Results: TACE was technically successful in 57 cases. Four patients developed minor and 5 major complications. The 30-day mortality rate was 7.7%. According to WHO criteria, 14 patients had no change in tumor burden, 2 had regression and 5 progress after chemoembolization. Patients with a tumor burden >75% of the liver did not benefit from TACE due to the development of major complications, whereas patients with low (<50%) tumor burden and high (>50%) lipiodol uptake showed a trend towards longer survival. Five-year survival time after diagnosis was 48%. Patients treated with octreotide and/or α-interferon had no benefit from chemoembolization with regard to their carcinoid syndrome. Conclusions: In this retrospective study, patients with low (<50%) tumor burden and high (>50%) lipiodol uptake responded better to TACE than end-stage patients.

Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours

“…With a tumour response rate of 37% (CI 95%: 28 -49%), our results are in the range of previous studies regarding treatment's efficacy (Ruszniewski et al, 1993;Therasse et al, 1993;Diaco et al, 1995;Dominguez et al, 2000;Gupta et al, 2003;Kress et al, 2003;O'Toole et al, 2003;Roche et al, 2003). Recently, Roche et al (2004) reported a response rate of 74%, much higher than what we observed.…”

“…Post embolisation syndrome was reported only after 47% of procedures in our series, whereas its frequency is usually reported to be higher (Ruszniewski et al, 1993;Therasse et al, 1993;Diaco et al, 1995;Dominguez et al, 2000;Gupta et al, 2003;Kress et al, 2003;O'Toole et al, 2003;Roche et al, 2003Roche et al, , 2004. We can account for this discrepancy by assuming that as this side effect is extremely frequent it was probably not systematically reported, so that we recorded it only when considered significant, that is, responsible for an extension of hospital stay or the use of major analgesics.…”

“…Tumour response rate has widely varied between 9 and 60% (Ruszniewski et al, 1993;Therasse et al, 1993;Diaco et al, 1995;Dominguez et al, 2000;Gupta et al, 2003;Kress et al, 2003;O'Toole et al, 2003;Roche et al, 2003Roche et al, , 2004, partly explained by the limited case numbers (most studies involve less than 35 patients) and presumably by some factors related to the patients, their tumours, TACE protocol and previous treatments.…”

Regional Chemotherapy via Transarterial Chemoembolisation in Colorectal Liver Metastases

“…Patients with a tumour involvement of more than 75% of the liver may not benefit from TACE due to the development of major complications, whereas patients with a tumour burden of less than 50% and higher (>50%) lipiodol uptake show a trend towards longer survival. 11,12 Hence, significant liver toxicity can be a limiting factor that compromises the safety of such a procedure. 13 Extrahepatic metastases are a known limitation to the use of TACE.…”

Acute thrombocytopenia: An uncommon complication occurring following transarterial chemoembolization in a patient with neuroendocrine hepatic metastases

“…These tumors arise from the amine precursor uptake and decarboxylation system, and have been identified in the gastrointestinal tract (entrochromaffin cells), the lung (Kulchitsky's cells, bronchus) and the pancreas (islet cells) (1)(2)(3). NETs are slowly growing tumors with an indolent course.…”