This retrospective analysis concentrates on our institutional experience with transarterial radioembolization (TARE) for the treatment of liver metastasis from neuroendocrine cancer.
Anabel Miguelez, Lorraine Portelance, MD; University of Miami
Purpose: Many publications can be found on the use of yttrium-90 (Y-90) transarterial radioembolization (TARE) for the treatment of primary liver cancer or liver metastasis from colorectal adenocarcinoma. It is important to study the results that could be achieved when TARE is being used to treat liver metastasis of other origin. This retrospective analysis concentrates on our institutional experience with TARE for the treatment of liver metastasis from neuroendocrine cancer.
Materials and Methods: Our institutional review board (IRB)-approved Y-90 databank was reviewed to identify patients with neuroendocrine cancer who received Y-90 TARE for liver metastasis from February 2011 to September 2013. Information on patient demographics, performance status, disease-related characteristics (liver panel, complete blood count [CBC], chromogranin A, and gross tumor volume [GTV] measured in cc on the most recent study pre-TARE), treatment-related parameters (Y-90 dose delivered), and treatment outcome (treatment toxicity, overall survival [OS]) were captured for this analysis.
Results: Between February 2011 and September 2013, a total of 16 patients with metastatic neuroendocrine (liver-predominant disease) received Y-90 TARE in our institution. Eight of these patients received treatment to both liver lobes, for a total of 24 procedures. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status between 0 and 2 prior to treatment. In addition, all patients had a bilirubin level below 2.0 and an albumin level above 3.0 prior to treatment. The median GTV per lobe was 299 cc (range: 27–670 cc). With a median follow-up of 16.5 months (range: 2–26 mo), the 1-year OS was 75%. There was no relationship between OS and GTV volume. Two patients with severe endocrine disorders that required repeated hospitalization (one patient with severe hypoglycemia and a second patient with hypertensive crisis) responded well to TARE, with marked improvement in their medical condition and no need for further admission postprocedure. In terms of treatment toxicity, one patient was diagnosed with a radiation-induced liver disease and died 13 months post-treatment. One patient developed a pancytopenia that was potentially related to treatment.
Conclusion: The use of Y-90 TARE for patients with liver metastasis from neuroendocrine carcinoma is a treatment option that should be assessed in a prospective multicentric study. In this series, Y-90 TARE was associated with a high 1-year survival rate. However, patients need to be monitored closely postprocedure, since serious treatment-related toxicity could develop.