18F-FDOPA PET/CT-Guided Radiofrequency Ablation of Liver Metastases from Neuroendocrine Tumours: Technical Note on a Preliminary Experience

Cazzato, Roberto Luigi; Garnon, Julien; Ramamurthy, Nitin; Tsoumakidou, Georgia; Impériale, Alessio; Namer, Izzie Jacques; Bachellier, Philippe; Caudrelier, Jean; Rao, Pramod; Koch, Guillaume; Gangi, Afshin

doi:10.1007/s00270-016-1334-1

Cited by 27 publications

(24 citation statements)

References 23 publications

(28 reference statements)

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“…TAE has most often been compared to TACE, but no statistically significant differences have been drawn[29,45]. The TACE-DEB outcomes seem promising but serious complications, such as bilomas and abscess formation, have been reported[66] and they led to the premature discontinuation of a phase-II trial as serious adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…Radiofrequency ablation (RFA) and microwave ablation are the most favored techniques to address neuroendocrine liver metastases and 5-year OS rates of up to 53% have been reported[44]. Radiofrequency ablation and microwave ablation may be performed either percutaneously or laparoscopically as part of a multi-modality treatment (in association of surgery) or as alternative, for patients who are not eligible for major surgical procedure[45]. Ablative techniques are most effective in patients with a low tumor volume (lesions between 1 and 5 cm) and best indicated for a limited number of metastases (< 5-6 lesions)[8].…”

Section: Locoregional Treatmentsmentioning

confidence: 99%

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Is there still a role for the hepatic locoregional treatment of metastatic neuroendocrine tumors in the era of systemic targeted therapies?

Cavalcoli

Rausa

Conte

et al. 2017

WJG

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Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) frequently present with distant metastases at the time of diagnosis and the liver is the most frequent site of spreading. The early identification of metastatic disease represents a major prognostic factor for GEP-NENs patients. Radical surgical resection, which is feasible for a minority of patients, is considered the only curative option, while the best management for patients with unresectable liver metastases is still being debated. In the last few years, a number of locoregional and systemic treatments has become available for GEP-NEN patients metastatic to the liver. However, to date only a few prospective studies have compared those therapies and the optimal management option is based on clinical judgement. Additionally, locoregional treatments appear feasible and safe for disease control for patients with limited liver involvement and effective in symptoms control for patients with diffuse liver metastases. Considering the lack of randomized controlled trials comparing the locoregional treatments of liver metastatic NEN patients, clinical judgment remains key to set the most appropriate therapeutic pathway. Prospective data may ultimately lead to more personalized and optimized treatments. The present review analyzes all the locoregional therapy modalities (i.e., surgery, ablative treatments and transarterial approach) and aims to provide clinicians with a useful algorithm to best treat GEP-NEN patients metastatic to the liver.

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Section: Discussionmentioning

confidence: 99%

Section: Locoregional Treatmentsmentioning

confidence: 99%

Is there still a role for the hepatic locoregional treatment of metastatic neuroendocrine tumors in the era of systemic targeted therapies?

Cavalcoli

Rausa

Conte

et al. 2017

WJG

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“…Both studies and case reports have reported the successful use in patients with carcinoid syndrome of the control of the symptoms of the hormone-excess state by using: everolimus[•38]; PRRT[•56, 57, 66, 95, •96, •148]; liver-directed therapies including TACE/TAE[70, 72, •73, 77, 95, 98, 149]; radioembolization[70, 150, 151]; RFA[80, 81, 83, 95, 152]; by increasing the dosage of octreotide/Lanreotide in refractory cases[94, 97, 153–155]; use of cytoreductive surgery[23, 95, 156–160]; use of 131 I-MIBG[95, 105, 106, 108, 110, •161, 162–164]; with the use of the tryptophan hydroxylase inhibitor, Telotristat[108, 113, 114, ••116, •117, 118, 119] and with pasireotide in octreotide resistant cases[•122]. …”

Section: Summary Of Recent Advances In Management Of Specific Hormmentioning

confidence: 99%

Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

Ito¹,

Lee²,

Jensen³

2016

Expert Opinion on Pharmacotherapy

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Introduction Neuroendocrine tumors(NETs), once thought rare, are increasing in frequency in most countries and receiving increasing-attention. NETs present two-treatment problems. A proportion is functional, hormone-excess-state(F-NET), each of which must be treated. Recently, there are many advances, well-covered in reviews/consensus papers on imaging-NETs;new, novel anti-tumor treatments and understanding their pathogenesis. However, little attention has been paid to advances in the treatment of the hormone-excess-state. These advances are usually reported in case-series, and case-reports with few large studies. In this paper these advances are reviewed. Areas covered Advances in the last 5-years are concentrated on, but a review up to 10-years was performed. PubMed and other databases(Cochrane, etc) were searched for F-NET-syndromes including carcinoid-syndrome, as well as meeting-abstracts on NETs. All advances that controlled hormone-excess-states or facilitated-control were covered. These include new medical-therapies[serotonin-synthesis inhibitors(telotristat), Pasireotide, new agents for treating ACTHomas], increased dosing with conventional therapies(octreotide-LAR, Lanreotide-Autogel), mTor inhibitors(everolimus), Tyrosine-kinase inhibitors(sunitinib), cytoreductive surgery, liver-directed therapies(embolization, chemoembolization, radioembolization, RFA), peptide radio-receptor-therapy(PRRT) and 131I-MIBG, ablation of primary F-NETs. Expert Opinion Although many of the newer therapies controlling the hormone-excess-states in F-NETs are reported in relatively few patients, all the approaches show promise. Their description also generates some controversies/unresolved areas, such as the order of these new treatments, their longterm-efficacy, and effectiveness of combinations which may require large, controlled studies.

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“…PET/CT imaging is generally indicated to guide in biopsies of bony or visceral lesions, as these lesions will have intense activity metabolically, which can be easily visualized on PET/CT, but poorly on other modalities like ultrasound, MRI, and CT. On the other hand, ultrasound, MRI, CT, and similar imaging modalities are usually used in the guidance of superficial or percutaneous biopsies. 2 PET/CT imaging modalities can also be used to guide biopsies of lesions that had been previously biopsied with other techniques (ultrasound or CT) and reached inconclusive results with high clinical suspicion. These lesions must, however, have high metabolic activity for this technique to work.…”

Section: Indications Of Pet/ct Guided Proce-duresmentioning

confidence: 99%

“…Therefore, allowing the opening of routes to directly performing procedures with PET/CT guidance. 2 This last technique is not as widely available as the previous ones, and it usually can only be done in specialized PET/CT interventional suites. 3 In this review, we will thoroughly discuss the indications, uses, and advantages of guiding biopsies with PET/CT techniques, with main focus on the field of oncology.…”

Section: Introductionmentioning

confidence: 99%

Imaging for biopsies

Almeshal

2018

Int J Community Med Public Health

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Positron emission tomography/computed tomography (PET/CT) imaging technique is considered to be an advanced technique that emerged recently and has been successfully used to guide several procedures like obtaining biopsies and ablating tumors. In this review, we will thoroughly discuss the indications, uses, and advantages of guiding biopsies with PET/CT techniques, with main focus on the field of oncology. PET/CT techniques are considered to be emerging imaging modalities that have significantly improved diagnostic accuracy of biopsies. The most important advantage of using PET/CT imaging to guide biopsies is its ability to provide accurate visualization of the lesion, with immediate assessment of the procedure following its end. On the other hand, this technique still has some limitations. Most importantly, the significant exposure to radiation to both the patient and the physician.

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18F-FDOPA PET/CT-Guided Radiofrequency Ablation of Liver Metastases from Neuroendocrine Tumours: Technical Note on a Preliminary Experience

Abstract: 18F-FDOPA PET/CT-guided RFA appears technically feasible, safe, and effective in patients with GEP-NETs and low-burden hepatic metastases. Further prospective studies are required to elucidate its precise role in tailored multimodality management of GEP-NET liver metastases.

Cited by 27 publications

References 23 publications

Is there still a role for the hepatic locoregional treatment of metastatic neuroendocrine tumors in the era of systemic targeted therapies?

Is there still a role for the hepatic locoregional treatment of metastatic neuroendocrine tumors in the era of systemic targeted therapies?

Treatment of symptomatic neuroendocrine tumor syndromes: recent advances and controversies

Imaging for biopsies

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