Role of Interventional Radiology in the Treatment of Patients with Neuroendocrine Metastases in the Liver

Abstract

Management of liver metastasis from neuroendocrine tumors routinely includes an interventional radiologist. Hepatic artery embolization, either bland (transarterial embolization) or with chemotherapy (transarterial chemoembolization), has been shown to improve response rates in neuroendocrine metastases to the liver. Radiofrequency ablation, cryotherapy, and percutaneous alcohol ablation are important adjuncts or alternative treatments to surgical debulking. In this article, the authors examine important techniques in the armamentarium of the interventional radiologist.

Therapeutic strategies for advanced neuroendocrine carcinomas of jejunum/ileum and pancreatic origin

“…TAE and/or TACE of liver metastasis in NEC results in morphological response of the metastases with mostly partial tumour regression in approximately 50%, a biochemical response of 50–90%, and symptomatic response with a control of functional syndromes in 60–95% of cases, as has been extensively reviewed 66 71 73 74. Arterial phase enhancement is a positive predictive factor of tumour response 75.…”

“…TAE and TACE seem to be equally efficacious in the treatment of liver metastasis in NEC 66 73 76. While many different protocols have been reported in uncontrolled series for TAE and/or TACE,66 71 74 no single protocol shows confirmed superiority. Most centres recommend repeated sessions of TAE or TACE 66.…”

“…No controlled data on overall survival following RFA and comparison of RFA with other local ablative methods are currently available. Side-effects and complications of RFA include pain, bile leakage, liver abscess, intra-abdominal haemorrhage, pneumothorax and pleural effusion 69 71 72…”

“…A biochemical response measured by a reduction of urinary 5-hydroxy-indolic acetic acid (5-HIAA) and serum chromogranin A levels after TAE seems to correlate positively with prolonged survival in a recent series of 107 patients with liver metastasis of midgut carcinoid tumours 77. A common side-effect of TAE and/or TACE is a post-embolisation syndrome with abdominal pain, nausea, vomiting, fever and an increase in hepatic transaminases 71 74 75. Severe but rare complications are liver failure, cholecystitis, gastric ulcers and bleeding, liver abscess or carcinoid crisis 71 74 75.…”

“…A common side-effect of TAE and/or TACE is a post-embolisation syndrome with abdominal pain, nausea, vomiting, fever and an increase in hepatic transaminases 71 74 75. Severe but rare complications are liver failure, cholecystitis, gastric ulcers and bleeding, liver abscess or carcinoid crisis 71 74 75. The incidence of severe complications is minimised by superselective catheterisation, embolisation of a limited number of liver segments during a single intervention in cases with high tumour load of the liver and pretreatment with a somatostatin analogue in functionally active tumours 71 74 75.…”