TY - JOUR
TI - Hepatic intra-arterial therapies in metastatic neuroendocrine tumors: lessons from clinical practice
AU - Grozinsky-Glasberg, S.
AU - Kaltsas, G.
AU - Kaltsatou, M.
AU - Lev-Cohain, N.
AU - Klimov, A.
AU - Vergadis, V.
AU - Uri, I.
AU - Bloom, A.I.
AU - Gross, D.J.
JO - Endocrine Development
PY - 2018
VL - 60
TODO - 3
SP - 499-509
PB - Humana Press Inc.
SN - null
TODO - 10.1007/s12020-018-1537-0
TODO - doxorubicin;  mitomycin;  tumor marker, abdominal pain;  adult;  aged;  Article;  artificial embolization;  cancer grading;  cancer radiotherapy;  cancer surgery;  cancer survival;  cancer therapy;  chemoembolization;  clinical outcome;  clinical practice;  controlled study;  elevated blood pressure;  female;  fever;  follow up;  Greece;  human;  hypertransaminasemia;  Israel;  liver metastasis;  major clinical study;  male;  nausea and vomiting;  neuroendocrine tumor;  overall survival;  patient safety;  primary tumor;  priority journal;  retrospective study;  selective internal radiation therapy;  tertiary care center;  transarterial embolization;  treatment response;  tumor growth;  artificial embolization;  hepatic artery;  liver tumor;  middle aged;  neuroendocrine tumor;  pathology;  procedures;  prognosis;  secondary;  treatment outcome, Adult;  Aged;  Chemoembolization, Therapeutic;  Embolization, Therapeutic;  Female;  Hepatic Artery;  Humans;  Liver Neoplasms;  Male;  Middle Aged;  Neuroendocrine Tumors;  Prognosis;  Retrospective Studies;  Treatment Outcome
TODO - Background: Liver metastases are common in patients with neuroendocrine tumors (NETs), having a negative impact on disease prognosis. The options for selective therapy in patients with unresectable multiple liver metastases are limited to TACE (transarterial chemoembolization), TAE (transarterial embolization), or SIRT (selective internal radiation therapy). Aim: To explore the clinical outcome, survival and safety of these therapies in NETs patients. Methods: Retrospective case series of consecutive patients (mean age 56.6 years, 59% male) treated at two tertiary university medical centers from 2005 to 2015. Results: Fifty-seven patients with G1, G2, and low G3 NETs with liver metastases were investigated (pancreatic NET (pNET), 24; small bowel, 16; unknown origin (UKO), 9; rectal, 3; lung, 3; and gastric, 2). Fifty-three patients underwent TACE, three patients underwent TAE, and one patient underwent SIRT. Clinical improvement and tumor response were observed in 54/57 patients (95%), together with marked decreased in tumor markers. The median time to tumor progression following the first treatment was 14 ± 16 months. The median overall survival was 22 ± 18 months, more pronounced in the pNET, followed by small bowel and UKO subgroups. There was a trend for a better survival in patients with disease limited to the liver and in whom the primary tumor was resected. Conclusion: Hepatic intra-arterial therapies are well tolerated in the majority of patients with NETs and liver metastases and associated with both clinical improvement and tumor stabilization for prolonged periods. These therapies should be always considered, irrespective of the presence of extrahepatic metastasis. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
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