Objective To compare efficacy, survival outcome and prognostic factors of conventional transarterial chemoembolization (cTACE), drug-eluting beads TACE (DEB-TACE) and 90Yttrium-radioembolization (Y90) for the treatment of liver metastases from gastro-entero-pancreatic (GEP) neuroendocrine tumors (NELM). Methods This retrospective analysis included 192 patients (58.6years mean age, 56%men) with NELM treated with cTACE(N=122), DEB-TACE(N=26), or Y90(N=44) between 2000 and 2014. Radiologic response to therapy was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) and World Health Organization (WHO) using peri-procedural MR imaging. Survival analysis included Propensity score analysis (PSA), median overall survival (MOS), hepatic progression-free survival, Kaplan-Meier using log-rank test and the uni-and multivariate Cox proportional hazards model (MVA). Results MOS of the entire study population was 28.8months. As for cTACE, DEB-TACE and Y90, MOS was 33.8months, 21.7months and 23.6months, respectively. According to the MVA, cTACE demonstrated a significantly longer MOS as compared to DEB-TACE(p=.04) or Y90(p=.032). The five-year survival rate after initial cTACE, DEB-TACE and Y90 was 28.2%, 10.3% and 18.5%, respectively. Conclusions Upon PSA, our study suggests significant survival benefits for patients treated with cTACE as compared to DEB-TACE and Y90. This data supports the therapeutic decision for cTACE as the primary intra-arterial therapy option in patients with unresectable NELM until proven otherwise.

Although radiofrequency (RF) ablation has been accepted as a curative treatment modality for solid organ tumors, intraductal RF ablation for malignant biliary obstruction has not been widely described.The aim of this study was to evaluate the feasibility, safety, and efficacy (in terms of stent patency and survival) of intraductal RF ablation combined with biliary stent placement for nonresectable malignant biliary obstruction.A search of the nonresectable malignant extrahepatic biliary obstruction database (179 patients) identified 18 consecutive patients who were treated with biliary intraluminal RF ablation during percutaneous transhepatic cholangiodrainage and inner stent placement (RF ablation group) and 18 patients who underwent inner stent placement without biliary intraluminal RF ablation (control group). The patients were matched for tumor type, location of obstruction, tumor stage, and Child–Pugh class status. Primary endpoints included safety, stent patency time, and survival rates. The secondary endpoint was effectiveness of the technique.The RF ablation and control groups were closely matched in terms of age, diagnosis, presence of metastases, presence of locally advanced tumor, American Society of Anesthesiologists (ASA) grade, and chemotherapy regimen (all P > .05). The technical success rate for both groups was 100%. The median time of stent patency in the RF ablation and control groups were 5.8 (2.8–11.5) months and 4.5 (2.4–8.0) months, respectively (Kaplan–Meier analysis: P = .03). The median survival times in the RF ablation and control groups were 6.1 (4.8–15.2) months and 5.8 (4.2–16.5) months, with no significant difference according to Kaplan–Meier analysis (P = .45). In univariate and multivariate analyses, poorer overall survival was associated with advanced age and presence of metastases (P < .05).Intraductal RF ablation combined with biliary stent placement for nonresectable malignant biliary obstruction is safe and feasible and effectively increases stent patency time. However, it does not improve patient survival.