The Role of Interventional Radiology for the Treatment of Hepatic Metastases from Neuroendocrine Tumor: An Updated Review

Abstract

Interventional radiology plays an important role in the management of patients with neuroendocrine tumor liver metastasis (NELM). Transarterial embolization (TAE), transarterial chemoembolization (TACE), and selective internal radiation therapy (SIRT) are intra-arterial therapies available for these patients in order to improve symptoms and overall survival. These treatment options are proposed in patients with NELM not responding to systemic therapies and without extrahepatic progression. Currently, available data suggest that TAE should be preferred to TACE in patients with NELM from extrapancreatic origin because of similar efficacy and better patient tolerance. TACE is more effective in patients with pancreatic NELM and SIRT has shown promising results along with good tolerance. However, large randomized controlled trials are still lacking in this setting. Available literature mainly consists in small sample size and retrospective studies with important technical heterogeneity. The purpose of this review is to provide an updated overview of the currently reported endovascular interventional radiology procedures that are used for the treatment of NELM.

Clinical Application of Trans-Arterial Radioembolization in Hepatic Malignancies in Europe: First Results from the Prospective Multicentre Observational Study CIRSE Registry for SIR-Spheres Therapy (CIRT)

“…For mCRC, studies have shown that good results can still be achieved in heavily pre-treated patients (see below) [ 38 – 40 ]. In NET, TARE can be considered for patients not responding to systemic therapies or have undergone prior peptide receptor radionuclide therapy (PRRT), TACE or bland embolization, which is reflected in the long median time from metastatic diagnosis to TARE (1242 days, Table 4 ) [ 35 , 41 , 42 ]. Due to the high OS generally found in NET patients, care should be taken in applying TARE in NET, as treatment-related deaths have been observed in this patient population [ 43 ].…”

Neuroendocrine Carcinomas of the Digestive Tract: What Is New?

“…Interventional radiology plays an important role in the therapeutic management of well-differentiated low-grade NEN, especially when liver burden is important or in the presence of a secretory syndrome [81][82][83]. Various types of liver-directed therapies are currently available, including intra-arterial therapies such as transarterial embolization (TAE), transarterial chemoembolization (TACE) and selective internal radiation therapy (SIRT), or radiofrequency ablation (RFA).…”

Liver-Directed Therapy for Neuroendocrine Metastases: From Interventional Radiology to Nuclear Medicine Procedures

“…TAE corresponds to catheterization of the hepatic artery and embolization using calibrated microparticles or ethiodized oil associated with gelfoam. TACE associates this procedure with the use of chemotherapeutic agents (usually doxorubicin, cisplatin, gemcitabine, or mitomycin C) based on the principle that ischemia of tumor cells increases sensitivity to chemotherapy [ 48 , 50 ]. TACE is performed either with an oily emulsion of chemotherapy (cTACE) or with drug-loaded beads (DEB-TACE).…”

“…In addition to general contraindications for vascular procedures (i.e., impaired hemostasis, allergy to iodinated contrast media), specific contraindications include portal vein thrombosis and bilio-enteric anastomosis. Patients with a tumoral burden greater than 75% of the liver parenchyma or who exhibit liver function impairment (bilirubin level ≥ 3 mg/dL, ascites) should be treated carefully, as they are at high risk of acute liver failure shortly after transarterial treatment [ 49 , 50 ]. Overall, 80–86% of patients will exhibit post-procedural symptoms, mostly in the form of a post-embolization syndrome (fever, nausea, vomiting, abdominal pain, and elevated liver enzymes) that should be anticipated and treated with analgesics, steroids, and hydration.…”