Médecine Nucléaire et Radiothérapie

Neuroendocrine Hepatic Tumors: Summary of Patient Selection, Response and Toxicity of Radioembolization in 281 Patients

Abstract

Lowell Anthony

Debulking neuroendocrine hepatic metastases is commonplace as both symptoms and disease are better controlled. The challenge in clinical decision making includes patient selection, timing and procedure. Extirpation, radiofrequency ablation, hepatic artery chemoembolization, bland embolization and radioembolization are techniques widely available in the U.S. For patients undergoing intrahepatic therapies, procedure selection is based not only on disease bulk but also on disease location. From 8 published studies, the outcomes of 281 patients who underwent radioembolization were reviewed. Symptomatic improvement occurs within 3 months in approximately half the patients. Partial biochemical responses (>50% reduction from baseline) using chromogranin A occur in two thirds of subjects as 2 centers have observed. Disease control (complete + partial + stable responses) is reported in 50-100% of patients. The median time to progression is 11.1 months in one report. Six centers report a median survival ranging from 14 to 70 months. One, 2 and 3 year survival ranges from 2 reports are 86-100%, 57-58% and 47-57%, respectively As more choices become available in controlling neuroendocrine disease, optimally combining debulking procedures such as radioembolization with systemic therapy is challenging. Using infusional 5-FU with radioembolization can be done safely but added benefit remains uncertain. Prior hepatic artery chemoembolization may not be a contraindication to radioembolization. Future trials are needed to guide the practitioner in using radiation sensitizers with radioembolization.