Comparison of Transarterial Liver-Directed Therapies for Low-Grade Metastatic Neuroendocrine Tumors in a Single Institution

Abstract

Objectives We compared the clinical outcomes of patients with metastatic neuroendocrine tumors (mNET) treated with hepatic artery embolization (HAE), chemoembolization (HACE) and selective internal radiation therapy (SIRT) at our institution over the last ten years. Methods Medical records of 42 mNET patients with hepatic metastases treated with HAE, HACE or SIRT at the University of Iowa from 2001 to 2011 were analyzed. Results 13 patients had HAE, 17 had HACE and 12 had SIRT as their initial procedure. TTP was similar between SIRT (15.1 months) and HACE/HAE groups (19.6 months) (p= 0.968). There was a trend towards increased TTP in patients receiving HACE (33.4 months), compared to HAE (12.1 months) or SIRT (15.1 months), although not statistically significant (p = 0.512). The overall survival for all patients from the first intervention was 41.9 months. There was no difference between HACE/HAE and SIRT in post-therapy change of CgA (p=0.233) and PcSt (p=0.158) levels. TTP did not correlate with the change in the post-therapy CgA (p=0.299) or PcSt (p=0.208) levels. Conclusion There was no significant difference in TTP in patients treated with SIRT compared to patients treated with HAE or HACE. Baseline and post-therapy marker changes were not predictive of TTP.

Use of PERCIST for Prediction of Progression-Free and Overall Survival After Radioembolization for Liver Metastases from Pancreatic Cancer

“…Surprisingly, we saw no correlation between baseline SUV peak or TLG 5 and any endpoint (Tables 2 and 3). Although baseline SUV max is presumed to be an indicator of tumor vitality and thus aggressiveness in many types of cancer (29,30), and given that a high baseline SUV max has been described as an independent prognostic factor for progression of pancreatic cancer (13), we did not find baseline SUV peak or TLG 5 to be of value in predicting survival in our series of pancreatic cancer patients with liver metastases. Though the baseline level of CA19-9 demonstrated prognostic value in our previous study (5), response by CA19-9 and CEA failed to show a significant association with outcome in the present investigation.…”

Management Options for Advanced Low or Intermediate Grade Gastroenteropancreatic Neuroendocrine Tumors: Review of Recent Literature

“…Due to the insidious behavior of NETs and indolent course of the disease, many patients will present with liver metastases, which is associated with a poor prognosis [ 52 ]. In contrast to normal hepatic parenchyma that depends largely on portal venous circulation, the hypervascular liver NETs metastases rely primarily on hepatic artery blood supply.…”

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]. …”