Skip to main content
Top
Published in: CardioVascular and Interventional Radiology 3/2011

01-06-2011 | Clinical Investigation

Hepatic Arterial Chemoembolization Using Drug-Eluting Beads in Gastrointestinal Neuroendocrine Tumor Metastatic to the Liver

Authors: Shantanu K. Gaur, Jeremy L. Friese, Cheryl A. Sadow, Rajasekhara Ayyagari, Christoph A. Binkert, Matthew P. Schenker, Matthew Kulke, Richard Baum

Published in: CardioVascular and Interventional Radiology | Issue 3/2011

Login to get access

Abstract

Purpose

This study was designed to evaluate short (<3 months) and intermediate-term (>3 months) follow-up in patients with metastatic neuroendocrine tumor to the liver who underwent hepatic arterial chemoembolization with drug-eluting beads at a single institution.

Methods

Institutional review board approval was obtained for this retrospective review. All patients who were treated with 100–300 or 300–500 μm drug-eluting LC Beads (Biocompatibles, UK) preloaded with doxorubicin (range, 50–100 mg) for GI neuroendocrine tumor metastatic to the liver from June 2004 to June 2009 were included. CT and MRI were evaluated for progression using Response Evaluation Criteria In Solid Tumors (RECIST) or European Association for the Study of the Liver (EASL) criteria. Short-term (<3 months) and intermediate-term (>3 months) imaging response was determined and Kaplan–Meier survival curves were plotted.

Results

Thirty-eight drug-eluting bead chemoembolization procedures were performed on 32 hepatic lobes, comprising 21 treatment cycles in 18 patients. All procedures were technically successful with two major complications (biliary injuries). At short-term follow-up (<3 months), 22 of 38 (58%) procedures and 10 of 21 (48%) treatment cycles produced an objective response (OR) with the remainder having stable disease (SD). At intermediate-term follow-up (mean, 445 days; range, 163–1247), 17 of 26 (65%) procedures and 8 of 14 (57%) treatment cycles produced an OR. Probability of progressing was approximately 52% at 1 year with a median time to progression of 419 days.

Conclusions

Drug-eluting bead chemoembolization is a reasonable alternative to hepatic arterial embolization and chemoembolization for the treatment of metastatic neuroendocrine tumor to the liver.
Literature
1.
go back to reference Brown KT, Koh BY, Brody LA et al (1999) Particle embolization of hepatic neuroendocrine metastases for control of pain and hormonal symptoms. J Vasc Interv Radiol 10(4):397–403PubMedCrossRef Brown KT, Koh BY, Brody LA et al (1999) Particle embolization of hepatic neuroendocrine metastases for control of pain and hormonal symptoms. J Vasc Interv Radiol 10(4):397–403PubMedCrossRef
2.
go back to reference Brown DB, Gould JE, Gervais DA et al (2007) Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria. J Vasc Interv Radiol 18(12):1469–1478PubMedCrossRef Brown DB, Gould JE, Gervais DA et al (2007) Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria. J Vasc Interv Radiol 18(12):1469–1478PubMedCrossRef
3.
go back to reference Caplin ME, Buscombe JR, Hilson AJ, Jones AL, Watkinson AF, Burroughs AK (1998) Carcinoid tumour. Lancet 352(9130):799–805PubMedCrossRef Caplin ME, Buscombe JR, Hilson AJ, Jones AL, Watkinson AF, Burroughs AK (1998) Carcinoid tumour. Lancet 352(9130):799–805PubMedCrossRef
4.
go back to reference Clouse ME, Perry L, Stuart K, Stokes KR (1994) Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Digestion 55:92–97PubMedCrossRef Clouse ME, Perry L, Stuart K, Stokes KR (1994) Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Digestion 55:92–97PubMedCrossRef
5.
go back to reference de Baere T, Deschamps F, Teriitheau C et al (2008) Transarterial chemoembolization of liver metastases from well-differentiated gastroenteropancreatic endocrine tumors with doxorubicin-eluting beads: preliminary results. J Vasc Interv Radiol 19(6):855–861PubMedCrossRef de Baere T, Deschamps F, Teriitheau C et al (2008) Transarterial chemoembolization of liver metastases from well-differentiated gastroenteropancreatic endocrine tumors with doxorubicin-eluting beads: preliminary results. J Vasc Interv Radiol 19(6):855–861PubMedCrossRef
6.
go back to reference Demeure MJ, Thompson NW, Hanto DW, Nagorney DM, Yao (2001) Indications and results of liver resection and hepatic chemoembolization for metastatic gastrointestinal neuroendocrine tumors. Surgery 130(4):682–685 (Discussion) Demeure MJ, Thompson NW, Hanto DW, Nagorney DM, Yao (2001) Indications and results of liver resection and hepatic chemoembolization for metastatic gastrointestinal neuroendocrine tumors. Surgery 130(4):682–685 (Discussion)
7.
go back to reference Diaco DS, Hajarizadeh H, Mueller CR, Fletcher WS, Pommier RF, Woltering EA (1995) Treatment of metastatic carcinoid-tumors using multimodality therapy of octreotide acetate intraarterial chemotherapy, and hepatic arterial chemoembolization. Am J Surg 169(5):523–528PubMedCrossRef Diaco DS, Hajarizadeh H, Mueller CR, Fletcher WS, Pommier RF, Woltering EA (1995) Treatment of metastatic carcinoid-tumors using multimodality therapy of octreotide acetate intraarterial chemotherapy, and hepatic arterial chemoembolization. Am J Surg 169(5):523–528PubMedCrossRef
8.
go back to reference Diamandidou E, Ajani JA, Yang DJ et al (1998) Two-phase study of hepatic artery vascular occlusion with microencapsulated cisplatin in patients with liver metastases from neuroendocrine tumors. AJR Am J Roentgenol 170(2):339–344PubMed Diamandidou E, Ajani JA, Yang DJ et al (1998) Two-phase study of hepatic artery vascular occlusion with microencapsulated cisplatin in patients with liver metastases from neuroendocrine tumors. AJR Am J Roentgenol 170(2):339–344PubMed
9.
go back to reference Dominguez S, Denys A, Menu Y, Ruszniewski P (1999) Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumours. Ital J Gastroenterol Hepatol 31:S213–S215PubMed Dominguez S, Denys A, Menu Y, Ruszniewski P (1999) Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumours. Ital J Gastroenterol Hepatol 31:S213–S215PubMed
10.
go back to reference Dominguez S, Denys A, Madeira I et al (2000) Hepatic arterial chemoembolization with streptozotocin in patients with metastatic digestive endocrine tumours. Eur J Gastroenterol Hepatol 12(2):151–157PubMedCrossRef Dominguez S, Denys A, Madeira I et al (2000) Hepatic arterial chemoembolization with streptozotocin in patients with metastatic digestive endocrine tumours. Eur J Gastroenterol Hepatol 12(2):151–157PubMedCrossRef
11.
go back to reference Drougas JG, Anthony LB, Blair TK et al (1998) Hepatic artery chemoembolization for management of patients with advanced metastatic carcinoid tumors. Am J Surg 175(5):408–412PubMedCrossRef Drougas JG, Anthony LB, Blair TK et al (1998) Hepatic artery chemoembolization for management of patients with advanced metastatic carcinoid tumors. Am J Surg 175(5):408–412PubMedCrossRef
12.
go back to reference Eriksson BK, Larsson EG, Skogseid BM, Lofberg AM, Lorelius LE, Oberg KE (1998) Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 83(11):2293–2301PubMedCrossRef Eriksson BK, Larsson EG, Skogseid BM, Lofberg AM, Lorelius LE, Oberg KE (1998) Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 83(11):2293–2301PubMedCrossRef
13.
go back to reference Fiorentini G, Aliberti C, Turrisi G et al (2007) Intraarterial hepatic chemoembolization of liver metastases from colorectal cancer adopting irinotecan-eluting beads: results of a phase II clinical study. In Vivo 21(6):1085–1091PubMed Fiorentini G, Aliberti C, Turrisi G et al (2007) Intraarterial hepatic chemoembolization of liver metastases from colorectal cancer adopting irinotecan-eluting beads: results of a phase II clinical study. In Vivo 21(6):1085–1091PubMed
14.
go back to reference Gates J, Hartnell GG, Stuart KE, Clouse ME (1999) Chemoembolization of hepatic neoplasms: safety, complications, and when to worry. Radiographics 19(2):399–414PubMed Gates J, Hartnell GG, Stuart KE, Clouse ME (1999) Chemoembolization of hepatic neoplasms: safety, complications, and when to worry. Radiographics 19(2):399–414PubMed
15.
go back to reference Gupta S, Yao JC, Ahrar K et al (2003) Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the MD Anderson experience. Cancer J 9(4):261–267PubMedCrossRef Gupta S, Yao JC, Ahrar K et al (2003) Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the MD Anderson experience. Cancer J 9(4):261–267PubMedCrossRef
16.
go back to reference Hajarizadeh H, Ivancev K, Mueller CR, Fletcher WS, Woltering EA (1992) Effective palliative treatment of metastatic carcinoid-tumors with intraarterial chemotherapy chemoembolization combined with octreotide acetate. Am J Surg 163(5):479–483PubMedCrossRef Hajarizadeh H, Ivancev K, Mueller CR, Fletcher WS, Woltering EA (1992) Effective palliative treatment of metastatic carcinoid-tumors with intraarterial chemotherapy chemoembolization combined with octreotide acetate. Am J Surg 163(5):479–483PubMedCrossRef
17.
go back to reference Ho AS, Picus J, Darcy MD et al (2007) Long-term outcome after chemoembolization and embolization of hepatic metastatic lesions from neuroendocrine tumors. AJR Am J Roentgenol 188(5):1201–1207PubMedCrossRef Ho AS, Picus J, Darcy MD et al (2007) Long-term outcome after chemoembolization and embolization of hepatic metastatic lesions from neuroendocrine tumors. AJR Am J Roentgenol 188(5):1201–1207PubMedCrossRef
18.
go back to reference Kadivar F, Soulen MC (2010) Enhancing ablation: synergies with regional and systemic therapies. J Vasc Interv Radiol 21(8 Suppl):S251–S256PubMedCrossRef Kadivar F, Soulen MC (2010) Enhancing ablation: synergies with regional and systemic therapies. J Vasc Interv Radiol 21(8 Suppl):S251–S256PubMedCrossRef
19.
go back to reference Kim YH, Ajani JA, Carrasco CH et al (1999) Selective hepatic arterial chemoembolization for liver metastases in patients with carcinoid tumor or islet cell carcinoma. Cancer Invest 17(7):474–478PubMedCrossRef Kim YH, Ajani JA, Carrasco CH et al (1999) Selective hepatic arterial chemoembolization for liver metastases in patients with carcinoid tumor or islet cell carcinoma. Cancer Invest 17(7):474–478PubMedCrossRef
20.
go back to reference Kulke M (2005) Advances in the treatment of neuroendocrine tumors. Curr Treat Options Oncol 6(5):397–409PubMedCrossRef Kulke M (2005) Advances in the treatment of neuroendocrine tumors. Curr Treat Options Oncol 6(5):397–409PubMedCrossRef
22.
go back to reference Lammer J, Malagari K, Vogl T et al (2009) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33(1):41–52PubMedCrossRef Lammer J, Malagari K, Vogl T et al (2009) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33(1):41–52PubMedCrossRef
23.
go back to reference Lewis AL, Taylor RR, Hall B, Gonzalez MV, Willis SL, Stratford PW (2006) Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol 17(8):1335–1343PubMedCrossRef Lewis AL, Taylor RR, Hall B, Gonzalez MV, Willis SL, Stratford PW (2006) Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol 17(8):1335–1343PubMedCrossRef
24.
go back to reference Loewe C, Schindl M, Cejna M, Niederle B, Lammer J, Thurnher S (2003) Permanent transarterial embolization of neuroendocrine metastases of the liver using cyanoacrylate and lipiodol: assessment of mid- and long-term results. AJR Am J Roentgenol 180(5):1379–1384PubMed Loewe C, Schindl M, Cejna M, Niederle B, Lammer J, Thurnher S (2003) Permanent transarterial embolization of neuroendocrine metastases of the liver using cyanoacrylate and lipiodol: assessment of mid- and long-term results. AJR Am J Roentgenol 180(5):1379–1384PubMed
25.
go back to reference Marlink RG, Lokich JJ, Robins JR, Clouse ME (1990) Hepatic arterial embolization for metastatic hormone-secreting tumors: technique, effectiveness, and complications. Cancer 65(10):2227–2232PubMedCrossRef Marlink RG, Lokich JJ, Robins JR, Clouse ME (1990) Hepatic arterial embolization for metastatic hormone-secreting tumors: technique, effectiveness, and complications. Cancer 65(10):2227–2232PubMedCrossRef
27.
28.
go back to reference Moertel CG, Lefkopoulo M, Lipsitz S, Hahn RG, Klaassen D (1992) Streptozocin doxorubicin, streptozocin fluorouracil, or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 326(8):519–523PubMedCrossRef Moertel CG, Lefkopoulo M, Lipsitz S, Hahn RG, Klaassen D (1992) Streptozocin doxorubicin, streptozocin fluorouracil, or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 326(8):519–523PubMedCrossRef
29.
go back to reference Musunuru S, Chen H, Rajpal S et al (2006) Metastatic neuroendocrine hepatic tumors: resection improves survival. Arch Surg 141(10):1000–1004PubMedCrossRef Musunuru S, Chen H, Rajpal S et al (2006) Metastatic neuroendocrine hepatic tumors: resection improves survival. Arch Surg 141(10):1000–1004PubMedCrossRef
30.
go back to reference Ollivier S, Fonck M, Becouarn Y, Brunet R (1998) Dacarbazine, fluorouracil, and leucovorin in patients with advanced neuroendocrine tumors: a phase II trial. Am J Clin Oncol Cancer Clinical Trials 21(3):237–240 Ollivier S, Fonck M, Becouarn Y, Brunet R (1998) Dacarbazine, fluorouracil, and leucovorin in patients with advanced neuroendocrine tumors: a phase II trial. Am J Clin Oncol Cancer Clinical Trials 21(3):237–240
31.
go back to reference Osborne DA, Zervos EE, Strosberg J et al (2006) Improved outcome with cytoreduction versus embolization for symptomatic hepatic metastases of carcinoid and neuroendocrine tumors. Ann Surg Oncol 13(4):572–581PubMedCrossRef Osborne DA, Zervos EE, Strosberg J et al (2006) Improved outcome with cytoreduction versus embolization for symptomatic hepatic metastases of carcinoid and neuroendocrine tumors. Ann Surg Oncol 13(4):572–581PubMedCrossRef
32.
go back to reference Rhee TK, Lewandowski RJ, Liu DM et al (2008) Y-90 radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg 247(6):1029–1035PubMedCrossRef Rhee TK, Lewandowski RJ, Liu DM et al (2008) Y-90 radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg 247(6):1029–1035PubMedCrossRef
33.
go back to reference Rinke A, Muller HH, Schade-Brittinger C et al (2009) Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol 27(28):4656–4663PubMedCrossRef Rinke A, Muller HH, Schade-Brittinger C et al (2009) Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol 27(28):4656–4663PubMedCrossRef
34.
go back to reference Rougier P, Mitry E (2000) Chemotherapy in the treatment of neuroendocrine malignant tumors. Digestion 62:73–78PubMedCrossRef Rougier P, Mitry E (2000) Chemotherapy in the treatment of neuroendocrine malignant tumors. Digestion 62:73–78PubMedCrossRef
35.
go back to reference Ruszniewski P, Malka D (2000) Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumors. Digestion 62:79–83PubMedCrossRef Ruszniewski P, Malka D (2000) Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumors. Digestion 62:79–83PubMedCrossRef
36.
go back to reference Ruutiainen AT, Soulen MC, Tuite CM et al (2007) Chemoembolization and bland embolization of neuroendocrine tumor metastases to the liver. J Vasc Interv Radiol 18(7):847–855PubMedCrossRef Ruutiainen AT, Soulen MC, Tuite CM et al (2007) Chemoembolization and bland embolization of neuroendocrine tumor metastases to the liver. J Vasc Interv Radiol 18(7):847–855PubMedCrossRef
37.
go back to reference Schnirer II, Yao JC, Ajani JA (2003) Carcinoid: a comprehensive review. Acta Oncologica 42(7):672–692PubMedCrossRef Schnirer II, Yao JC, Ajani JA (2003) Carcinoid: a comprehensive review. Acta Oncologica 42(7):672–692PubMedCrossRef
38.
go back to reference Therasse E, Breittmayer F, Roche A et al (1993) Transcatheter chemoembolization of progressive carcinoid liver metastasis. Radiology 189(2):541–547PubMed Therasse E, Breittmayer F, Roche A et al (1993) Transcatheter chemoembolization of progressive carcinoid liver metastasis. Radiology 189(2):541–547PubMed
39.
go back to reference van der Lely AJ, de Herder WW (2005) Carcinoid syndrome: diagnosis and medical management. Arq Bras Endocrinol Metabol 49(5):850–860PubMedCrossRef van der Lely AJ, de Herder WW (2005) Carcinoid syndrome: diagnosis and medical management. Arq Bras Endocrinol Metabol 49(5):850–860PubMedCrossRef
40.
go back to reference Varela M, Real MI, Burrel M et al (2007) Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 46(3):474–481PubMedCrossRef Varela M, Real MI, Burrel M et al (2007) Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 46(3):474–481PubMedCrossRef
41.
go back to reference Venook AP (1999) Embolization and chemoembolization therapy for neuroendocrine tumors. Curr Opin Oncol 11(1):38–41PubMedCrossRef Venook AP (1999) Embolization and chemoembolization therapy for neuroendocrine tumors. Curr Opin Oncol 11(1):38–41PubMedCrossRef
42.
go back to reference Yao JC, Hassan M, Phan A et al (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26(18):3063–3072PubMedCrossRef Yao JC, Hassan M, Phan A et al (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26(18):3063–3072PubMedCrossRef
Metadata
Title
Hepatic Arterial Chemoembolization Using Drug-Eluting Beads in Gastrointestinal Neuroendocrine Tumor Metastatic to the Liver
Authors
Shantanu K. Gaur
Jeremy L. Friese
Cheryl A. Sadow
Rajasekhara Ayyagari
Christoph A. Binkert
Matthew P. Schenker
Matthew Kulke
Richard Baum
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
CardioVascular and Interventional Radiology / Issue 3/2011
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-011-0122-1

Other articles of this Issue 3/2011

CardioVascular and Interventional Radiology 3/2011 Go to the issue