Chemoembolization and Bland Embolization of Neuroendocrine Tumor Metastases to the Liver

Ruutiainen, Alexander T.; Soulen, Michael C.; Tuite, Catherine M.; Clark, Timothy W.I.; Mondschein, Jeffrey I.; Stavropoulos, S. William; Trerotola, Scott O.

doi:10.1016/j.jvir.2007.04.018

Cited by 129 publications

(86 citation statements)

References 19 publications

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“…[11][12][13] Of late, studies have demonstrated successful application to a variety of secondary hepatic malignancies, including metastasis from neuroendocrine neoplasm, breast cancer, or sarcoma. [14][15][16][17] To our knowledge, the use of TACE for the treatment of hepatic recurrence after curative surgery for pancreatic adenocarcinoma has yet to be reported. Therefore, the aim of the current study was to evaluate the clinical effectiveness of TACE in patients with hepatic recurrence after curative resection for pancreatic adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Arterial Chemoembolization for Hepatic Recurrence after Curative Resection of Pancreatic Adenocarcinoma

Kim¹,

Choi²,

Yoon³

et al. 2010

Gut Liver

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Background/Aims: Despite curative resection, hepatic recurrences cause a significant reduction in survival in patients with primary pancreatic adenocarcinoma. Transcatheter arterial chemoembolization (TACE) has recently been used successfully to treat primary and secondary hepatic malignancy. Methods: Between 2003 and 2008, 15 patients underwent TACE because of hepatic recurrence after curative resection of a pancreatic adenocarcinoma. The tumor response was evaluated based on computed tomography scans after TACE. The overall duration of patient survival was measured. Results: After TACE, a radiographically evident response occurred in six patients whose tumors demonstrated a tumor blush on angiography. Four patients demonstrated stabilization of a hypovascular mass. The remaining five patients demonstrated continued progression of hypovascular hepatic lesions. The median survival periods from the time of diagnosis and from the time of initial TACE were 9.6 and 7.5 months, respectively. Conclusions: TACE may represent a viable therapeutic modality in patients with hepatic recurrence after curative resection of pancreatic adenocarcinoma. (Gut Liver 2010;4: 384-388)

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Section: Introductionmentioning

confidence: 99%

Transcatheter Arterial Chemoembolization for Hepatic Recurrence after Curative Resection of Pancreatic Adenocarcinoma

Kim¹,

Choi²,

Yoon³

et al. 2010

Gut Liver

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“…Duration of symptom response was 15 months for TACE and 7.5 months for TAE. OS values at 1, 3, and 5 years were 86, 67, and 50% for TACE and 68, 46, and 33% for TAE respectively (43). In the same study, toxicities of grade 3 or worse occurred after 25% of TACE and 22% of TAE.…”

Section: Chemoembolization and Embolizationmentioning

confidence: 66%

“…However, from retrospective series, tumor grade has been reported to have an impact on TTP after TAE with 54.5 months, OS for patients with low-grade tumors and 24 months for patients with high-grade tumors (34). npNETs have significant better outcomes after TACE with a response rate of 66.7% and progression free survival (PFS) of 22.7 months, vs 35.2% response rate and 16.1 months PFS for pNETs (43), higher rate of symptoms control (7), and improved median survival (80 months vs 20 months) (44). A tumor burden below 30% (7), arterial phase enhancement on abdominal CT, and high BMI are among other reported predictors of TACE efficacy including response and TTP (25).…”

Section: Chemoembolization and Embolizationmentioning

confidence: 99%

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

Baère

Deschamps

Tselikas

et al. 2015

European Journal of Endocrinology

112

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Neuroendocrine tumors from gastro-pancreatic origin (GEP-NET) can be responsible for liver metastases. Such metastases can be the dominant part of the disease as well due to the tumor burden itself or the symptoms related to such liver metastases. Intra-arterial therapies are commonly used in liver only or liver-dominant disease and encompass trans-arterial chemoembolization (TACE), trans-arterial embolization (TAE), and radioembolization (RE). TACE performed with drug emulsified in Lipiodol has been used for the past 20 years with reported overall survival in the range of 3-4 years, with objective response up to 75%. Response to TACE is higher when treatment is used as a first-line therapy and degree of liver involvement is lower. Benefit of TACE over TAE is unproven in randomized study, but reported in retrospective studies namely in pancreatic NETs. RE provides early interesting results that need to be further evaluated in terms of benefit and toxicity. Radiofrequency ablation allows control of small size and numbered liver metastases, with low invasiveness. Ideal metastases to target are one metastasis !5 cm, or three metastases !3 cm, or a sum of diameter of all metastases below 8 cm. Ablation therapies can be applied in the lung or in the bones when needed, and more invasive surgery should be probably saved for large-size metastases. Even if the indication of image-guided therapy in the treatment of GEP-NET liver metastases needs to be refined, such therapies allow for manageable invasive set of treatments able to address oligometastatic patients in liver, lung, and bones. These treatments applied locally will save the benefit and the toxicity of systemic therapy for more advanced stage of the disease.

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“…14 Nevertheless, most patients with widespread metastatic PNET disease ultimately succumb to the disease despite the availability of multiple palliative interventions. 1,2,[15][16][17][18][19][20][21][22] Somatostatin analog therapy is usually the first non-surgical therapy used in patients with slowly progressive disease because it is generally well tolerated. Octreotide has not been studied in PNET patients specifically but the PROMID trial in widely metastatic small bowel carcinoid tumors was the first to show tumor stabilization in a randomized clinical setting and this has become the de facto first line treatment for many patients.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,[17][18][19][20][21][22] There clearly is an unmet need for more effective, well-tolerated anti-tumor therapy in patients with metastatic PNET tumors.…”

Section: Discussionmentioning

confidence: 99%

PTCH 1 staining of pancreatic neuroendocrine tumor (PNET) samples from patients with and without multiple endocrine neoplasia (MEN-1) syndrome reveals a potential therapeutic target

Gurung

Hua

Runske

et al. 2014

Cancer Biology & Therapy

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Pancreatic neuroendocrine tumors (PNETs) are rare, indolent tumors that may occur sporadically or develop in association with well-recognized hereditary syndromes, particularly multiple endocrine neoplasia type 1 (MEN-1). We previously demonstrated that the hedgehog (HH) signaling pathway was aberrantly up-regulated in a mouse model that phenocopies the human MEN-1 syndrome, Men1l/l;RipCre, and that inhibition of this pathway suppresses MEN-1 tumor cell proliferation. We hypothesized that the HH signaling pathway is similarly upregulated in human PNETs. We performed immunohistochemical (IHC) staining for PTCH1 in human fresh and archival PNET specimens to examine whether human sporadic and MEN-1-associated PNETs revealed similar abnormalities as in our mouse model and correlated the results with clinical and demographic factors of the study cohort. PTCH1 staining was positive in 12 of 22 PNET patients (55%). Four of 5 MEN-1 patients stained for PTCH1 (p D 0.32 as compared with sporadic disease patients). Nine of 16 patients with metastatic disease stained for PTCH1 as compared with zero of 3 with localized disease only (p D 0.21). No demographic or clinical features appeared to be predictive of PTCH 1 positivity and PTCH 1 positivity per se was not predictive of clinical outcome. PTCH1, a marker of HH pathway up regulation, is detectable in both primary and metastatic tumors in more than 50% of PNET patients. Although no clinical or demographic factors predict PTCH1 positivity and PTCH1 positivity does not predict clinical outcome, the frequency of expression alone indicates that perturbation of this pathway with agents such as Vismodegib, an inhibitor of Smoothened (SMO), should be examined in future clinical trials.

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Chemoembolization and Bland Embolization of Neuroendocrine Tumor Metastases to the Liver

Cited by 129 publications

References 19 publications

Transcatheter Arterial Chemoembolization for Hepatic Recurrence after Curative Resection of Pancreatic Adenocarcinoma

Transcatheter Arterial Chemoembolization for Hepatic Recurrence after Curative Resection of Pancreatic Adenocarcinoma

GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs

PTCH 1 staining of pancreatic neuroendocrine tumor (PNET) samples from patients with and without multiple endocrine neoplasia (MEN-1) syndrome reveals a potential therapeutic target

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