Transarterial embolization (TAE) is equally effective and slightly safer than transarterial chemoembolization (TACE) to manage liver metastases in neuroendocrine tumors

Abstract

Liver metastases from neuroendocrine tumor (NET) can be treated by transarterial embolization (TAE) or transarterial chemoembolization (TACE). The goal of TAE and TACE is to reduce blood flow to the tumor resulting in tumor ischemia and necrosis. In this retrospective study, the effectiveness and safety of TAE-TACE in the treatment of liver metastases in patients with NET was compared. Thirty patients with a histologically confirmed gastro-entero-pancreatic NET with liver metastases were retrospectively investigated. Seventeen patients underwent TAE, while 13 patients underwent TACE. Tumor response, degree of devascularization in treated lesions, and progression free survival (PFS) were evaluated in the whole population and then separately in TAE and TACE subgroups. In all patients treated with TAE and TACE, there was a significant size reduction of lesions as compared to baseline. Per lesion reduction was 2.2 ± 1.4 versus 3.3 ± 1.5 cm for TAE (p < 0.001) and 2.2 ± 1.5 versus 3.4 ± 1.7 cm for TACE (p < 0.001). In the whole population, the median PFS for all patients was 36 months (16.2-55.7 CI), without significant difference between TAE and TACE. In no patient did adverse events grade 3 and 4 as well as TAE/TACE-related death occurred, while the post-embolization syndrome occurred in 41 % of patients treated with TAE and 61 % of those treated with TACE. TAE and TACE are both effective in NET patients with liver metastases. TAE should be preferred to TACE in light of its similar anti-tumor effects and slightly better toxicity profile.

Transarterial (Chemo)Embolization for Liver Metastases in Patients with Neuroendocrine Tumors

“…Thus, the results of this study suggest that TA(C)E might be effective and well tolerated in patients with NETs presenting with liver metastasis. There have been no reports of prognostic factors in patients with NETs treated with TA(C)E. There are some reports of the efficacy of TACE compared to that of TAE [16,18,[23][24][25][26] ; however, none of those studies was able to show a statistically significant difference in the median TTP/PFS between TACE and TAE. The current study also failed to show a significant difference in the median TTF between TACE and TAE (20.9 vs. 30.7 months, hazard ratio 1.16, p = 0.79) ( Table 4 ).…”

ENETS Consensus Guidelines Update for the Management of Distant Metastatic Disease of Intestinal, Pancreatic, Bronchial Neuroendocrine Neoplasms (NEN) and NEN of Unknown Primary Site

“…Locoregional therapies may be considered repetitively during the course of the disease. There is consensus that SIRT is still investigational, and that a comparative trial of SIRT to bland embolization is required, as well as more safety data on long-term tolerability of SIRT to establish this procedure for the management of NEN [14,15,16,17,18]. …”

Histologically-Proven Efficacy of Bland Embolization in a Patient with Net Liver Metastasis

“…Moreover, the presence of mild to moderate portal and lobular inflammation and intrahepatic cholestasis was not related to the LBE but rather to the presence of spaceoccupying lesion. These histological findings, together with evidence from other studies [9], would suggest that LBE is preferable to chemoembolization in the treatment of NET liver metastasis.…”