scholarly journals Non-Pharmacological Therapeutic Options for Liver Metastases in Advanced Neuroendocrine Tumors

2019 ◽  
Vol 8 (11) ◽  
pp. 1907 ◽  
Author(s):  
Solène Dermine ◽  
Lola-Jade Palmieri ◽  
Julie Lavolé ◽  
Amélie Barré ◽  
Antony Dohan ◽  
...  
Keyword(s):  
Liver Metastasis ◽  
Neuroendocrine Tumors ◽  
Tumor Burden ◽  
Tumor Surgery ◽  
Therapeutic Approaches ◽  
Hepatic Artery Embolization ◽  
Artery Embolization ◽  
Ablative Techniques ◽  
Resectable Liver Metastasis

The incidence of liver metastasis in digestive neuroendocrine tumors is high. Their presence appears as an important prognostic factor in terms of quality of life and survival. These tumors may be symptomatic because of the tumor burden itself and/or the hormonal hyper-secretion induced by the tumor. Surgery is the treatment of choice for resectable tumors and metastasis. Nevertheless, surgery is only possible in a small number of cases. The management of non-resectable liver metastasis is a challenge. The literature is rich but consists predominantly in small retrospective series with a low level of proof. Thus, the choice of one technique over another could be difficult. Local ablative techniques (radiofrequency) or trans-catheter intra-arterial liver-directed treatments (hepatic artery embolization, chemo-embolization, and radio-embolization) are frequently considered for liver metastasis. In the present review, we focus on these different therapeutic approaches in advanced neuroendocrine tumors, results (clinical and radiological), and overall efficacy, and summarize recommendations to help physicians in their clinical practice.

Hospitalization after hepatic artery embolization (HAE) for neuroendocrine tumors (NET).

2011 ◽  
Vol 29 (15_suppl) ◽  
pp. e14553-e14553
Author(s):  
S. Jaramillo ◽  
M. Lewis ◽  
L. R. Roberts ◽  
J. Rubin ◽  
A. Grothey
Keyword(s):  
Hepatic Artery ◽  
Neuroendocrine Tumors ◽  
Hepatic Artery Embolization ◽  
Artery Embolization

Hepatic artery embolization in advanced neuroendocrine tumors: Efficacy and long-term outcomes

2015 ◽  
Vol 12 (1) ◽  
pp. 61-69 ◽  
Author(s):  
Marinos Pericleous ◽  
Martyn E Caplin ◽  
Emmanuel Tsochatzis ◽  
Dominic Yu ◽  
Luke Morgan-Rowe ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Neuroendocrine Tumors ◽  
Hepatic Artery Embolization ◽  
Long Term Outcomes ◽  
Artery Embolization

Medical Treatment of Neuroendocrine Tumors

1993 ◽  
Vol 79 (6) ◽  
pp. 380-388 ◽  
Author(s):  
Emilio Bajetta ◽  
Maria Di Bartolomeo ◽  
Nicoletta Zilembo ◽  
Anna Maria Bochicchio
Keyword(s):  
Medical Treatment ◽  
Neuroendocrine Tumors ◽  
Specific Treatment ◽  
Tumor Burden ◽  
Somatostatin Analogue ◽  
Clear Definition ◽  
Therapeutic Approaches ◽  
Inhibition Of Tumor Growth ◽  
Definition Of ◽  
Precise Role

Background Tumors of the neuroendocrine system are characterized by amine precursor uptake and decarboxylation, and they represent a heterogeneous group of carcinomas including carcinoids, islet cell carcinomas of the pancreas, medullary thyroid carcinomas and Merkel cell carcinomas. Their similar cytochemical and ultrastructural properties sustain the hypothesis of a common embryologic origin within the neural crest. Many of these tumors grow slowly, and reducing tumor burden represents the treatment of choice. However, when surgery is not feasible, medical treatment has to be considered. Therapeutic approaches in metastatic disease often do not consider the different biologic behaviors of these neoplasms. Moreover, efficacy of the treatment is associated with lack of a clear definition of the type of response: objective, symptomatic or biochemical. Methods In this review we have analyzed the different medical approaches used in the treatment of neuroendocrine tumors in an attempt to define their precise role in the different neoplasms. Results In carcinoid tumors, immunotherapy and the somatostatin analogue can be efficaciously used for the control of carcinoid syndrome. For inhibition of tumor growth, chemotherapy should be used only in patients with rapidly progressive disease, and the results are still unsatisfactory. Conclusions Although all these tumors appear to have similar cytochemical properties, the responsiveness of the various neoplasms is very different. In the future, a specific treatment modality and a clear definition of the type of response (objective, symptomatic or biochemical) need to be defined for each type of neuroendocrine tumor.

scholarly journals Hepatic Artery Embolization for Neuroendocrine Tumors: Postprocedural Management and Complications

2012 ◽  
Vol 17 (5) ◽  
pp. 725-731 ◽  
Author(s):  
Mark A. Lewis ◽  
Sylvia Jaramillo ◽  
Lewis Roberts ◽  
Chad J. Fleming ◽  
Joseph Rubin ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Neuroendocrine Tumors ◽  
Hepatic Artery Embolization ◽  
Artery Embolization

Predictors of survival following hepatic artery embolization for the treatment of melanoma liver metastasis

2014 ◽  
Vol 25 (3) ◽  
pp. S74
Author(s):  
H. Takaki ◽  
T. Litchman ◽  
J.P. Erinjeri ◽  
R.H. Siegelbaum ◽  
R.P. Shah ◽  
...  
Keyword(s):  
Liver Metastasis ◽  
Hepatic Artery ◽  
Hepatic Artery Embolization ◽  
Artery Embolization

Phase II study of sunitinib malate following hepatic artery embolization for metastatic neuroendocrine tumors.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 244-244 ◽  
Author(s):  
J. R. Strosberg ◽  
A. Cheema ◽  
T. Campos ◽  
T. Valone ◽  
L. K. Kvols
Keyword(s):  
Overall Survival ◽  
Hepatic Artery ◽  
Neuroendocrine Tumors ◽  
Progression Free Survival ◽  
Hepatic Artery Embolization ◽  
Artery Embolization ◽  
Free Survival ◽  
Radiographic Response ◽  
Starting Dose ◽  
Dose Reductions

244 Background: Neuroendocrine tumors (NETs) frequently metastasize to the liver. Hepatic arterial embolization is an important therapeutic modality in treating patients with liver-predominant metastases. NETs are highly vascular and are known to express both VEGF and VEGFR. We hypothesize that administration of sunitinib, a VEGFR inhibitor, following hepatic artery embolization will delay tumor revascularization and extend progression-free survival. Methods: Patients with metastatic neuroendocrine tumors to the liver underwent a series of selective arterial embolizations followed by sunitinib (one week after each embolization, and continued until disease progression or up to a maximum of 8 cycles). Radiographic response rates were assessed by RECIST criteria. PFS and OS were calculated using Kaplan-Meier methodology. Results: 39 patients with metastatic NETs were enrolled. Primary tumor sites included the small intestine (26), pancreas (10), rectum (2), and lung (1). The initial starting dose of sunitinib was 50 mg; however, all five patients enrolled at this dose required dose reductions, and the starting dose was subsequently lowered to 37.5 mg. The majority of patients required further dose reductions to 25 mg. Twenty-eight patients (72%) experienced a partial radiographic response (PR), eight patients (20%) had stable disease, and three patients (8%) had progressive disease as their best response. Median PFS was 18 months and the rate of 1-year PFS was 72%. The rates of overall survival (OS) at 1 year and 2 years were 94% and 78%. Serum VEGF levels increased by an average of 51 pg/ml (34%) after embolization. Conclusions: Hepatic artery embolization is a highly active treatment option for patients with metastatic neuroendocrine tumors to the liver. Embolization stimulates release of VEGF into the circulation. Sunitinib can be administered following hepatic artery embolization. The high rates of progression-free survival and overall survival associated with this sequence of therapies are encouraging. [Table: see text]

Comparison of hepatic artery embolization and selective internal radiation therapy for metastatic neuroendocrine tumors.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 332-332
Author(s):  
Eric Steven Engelman ◽  
Roberto Leon-Ferre ◽  
Boris Naraev ◽  
Nancy Sharma ◽  
Shiliang Sun ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Hepatic Artery ◽  
Neuroendocrine Tumors ◽  
Hepatic Metastases ◽  
Selective Internal Radiation Therapy ◽  
Hepatic Artery Embolization ◽  
Internal Radiation ◽  
Artery Embolization ◽  
Selective Internal Radiation

332 Background: Liver-directed therapies can be beneficial in reducing morbidity and mortality in patients with metastatic neuroendocrine tumors (mNETs). We compared the clinical outcomes of patients treated with hepatic artery embolization/chemoembolization (HA(C)E) or selective internal radiation therapy (SIRT) with SIR-Spheres at our institution over the last ten years. Methods: Medical records of 42 mNET patients with hepatic metastases treated with either bland hepatic artery embolization (HAE), chemoembolization (HACE), or SIRT at the University of Iowa from 2001 to 2011 were analyzed. Chi-square and Wilcoxon rank-sum tests were performed to compare the groups. Time to progression (TTP) and overall survival (OS) were calculated using Kaplain-Meier analysis. Results: The tumors were located in the small bowel in 21 patients (50%), pancreas in 8 (19%), lung in 2 (5%), and other locations in 11 patients (26%). Ten patients (24%) had extra-hepatic metastases. 13 patients had HAE, 17 patients had HACE and 12 patients had SIRT. 20 of these patients had a second procedure with 6 receiving SIRT, 9 HAE and 5 HACE. TTP was similar between SIRT (15.1 months) and HAE or HACE (19.6 months) (p= 0.968). There was a trend towards an increased TTP in patients receiving HACE (33.4 months), compared to HAE (12.1 months) or SIRT (15.1 months) (p = 0.512). The overall survival for all patients from the first intervention was 41.9 months. Conclusions: There appears to be no significant difference in TTP in patients treated with SIRT compared to patients treated with HAE or HACE in this cohort; however, there may be a trend towards a longer time to disease progression in patients treated with chemoembolization compared to the other two modalities. Patients tend to have a prolonged survival after all three liver-directed therapies.

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