Radioembolization for neuroendocrine liver metastases is safe and effective prior to major hepatic resection.

Published on Jun 1, 2020in Hepatobiliary surgery and nutrition7.293
· DOI :10.21037/HBSN.2019.07.11
Florian Bösch9
Estimated H-index: 9
(LMU: Ludwig Maximilian University of Munich),
Harun Ilhan21
Estimated H-index: 21
(LMU: Ludwig Maximilian University of Munich)
+ 11 AuthorsMartin K. Angele41
Estimated H-index: 41
Background: Radioembolization (RE) is well established in the treatment of neuroendocrine liver metastases. However surgery is rarely performed after RE, although liver resection is the gold standard in the treatment of localized neuroendocrine liver metastases. Therefore, aim of the present study was to evaluate the safety and feasibility of liver resection after RE in a homogenous cohort. Methods: From a prospective surgical (n=494) and nuclear medical (n=138) database patients with NELM who underwent liver resection and/or RE were evaluated. Between September 2011 and December 2017 eight patients could be identified who underwent liver resection after RE (mean therapeutic activity of 1,746 Mbq). Overall and progression free survival were evaluated as well as epidemiological and perioperative factors. The surgical specimens were analyzed for necrosis, fibrosis, inflammation, and steatosis. Results: The mean hepatic tumor load of patients, who had liver surgery after RE, was 31.4% with a mean Ki-67 proliferation index of 5.9%. The majority of these patients (7/8) received whole liver RE prior to liver resection, which did not increase morbidity and mortality compared to a surgical collective. Indications for RE were oncological (6/8) or carcinoid syndrome associated reasons (2/8). Mean overall survival was 25.1 months after RE and subsequent surgery. Tumor necrosis in radioembolized lesions was 29.4% without evidence of fibrosis and inflammation in hepatic tissue. Conclusions: This is the first study analyzing the multimodal therapeutic approach of liver resection following whole liver RE. This treatment algorithm is safe, does not lead to an increased morbidity and is associated with a favorable oncological outcome. Nonetheless, patient selection remains a key issue.
#1Arthur J. A. T. Braat (UU: Utrecht University)H-Index: 15
#2Srinivas Kappadath (University of Texas MD Anderson Cancer Center)H-Index: 6
Last. Marnix G.E.H. Lam (UU: Utrecht University)H-Index: 35
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Purpose Radioembolization of liver metastases of neuroendocrine neoplasms (NEN) has shown promising results; however, the current literature is of limited quality. A large international, multicentre retrospective study was designed to address several shortcomings of the current literature.
Background. Neuroendocrine tumors (NETs) are characterized by having behavior and prognosis that depend upon tumor histology, primary site, staging, and proliferative index. The symptoms associated with carcinoid syndrome and vasoactive intestinal peptide tumors are treated with octreotide acetate. The PROMID trial assesses the effect of octreotide LAR on the tumor growth in patients with well-differentiated metastatic midgut NETs. The CLARINET trial evaluates the effects of lanreotide in patien...
#1Florian Bösch (LMU: Ludwig Maximilian University of Munich)H-Index: 9
#2Katharina Hofmann (LMU: Ludwig Maximilian University of Munich)H-Index: 5
Last. Martin K. Angele (LMU: Ludwig Maximilian University of Munich)H-Index: 41
view all 10 authors...
BACKGROUND Neuroendocrine tumors of the pancreas (pNETs) are a rare disease. Grading according to the Ki67-index is the most validated risk factor. Nevertheless, controversies exist concerning other prognostic factors. The aim of this study was to evaluate published risk factors. METHODS Patients with pancreatic NETs who underwent surgery at our department from 2000 to 2014 were analyzed. The patient and tumor characteristics were evaluated. Kaplan-Meier analyses, univariate calculations as well...
#2John S. Werner (LMU: Ludwig Maximilian University of Munich)H-Index: 71
Neuroendokrine Tumoren (NET) sind seltene Neoplasien, die komplexe Herausforderungen an Diagnose und Behandlung stellen. Selbst im metastasierten Stadium gibt es wichtige Unterschiede in der Art dieser Tumoren im Vergleich zu gastrointestinalen und pankreatischen Adenokarzinomen. So unterscheiden sich die Krankheitsverlaufe ja nach Differenzierungsgrad erheblich. Auch im metastasierten Stadium liegt bei G1-Tumoren das 5‑Jahres-Uberleben bei bis zu 83 %. Ungefahr 20 % der Dunndarm-NET weisen zusa...
#1Yu Kai Su (NU: Northwestern University)H-Index: 2
#2Rosewell V. Mackey (NU: Northwestern University)H-Index: 1
Last. Robert J. Lewandowski (NU: Northwestern University)H-Index: 73
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Abstract Purpose To determine long-term hepatotoxicity of yttrium-90 ( 90 Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms. Materials and Methods Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90 Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whol...
#1Renate Galleberg (Haukeland University Hospital)H-Index: 3
#2Ulrich Knigge (UCPH: University of Copenhagen)H-Index: 52
Last. Halfdan Sorbye (University of Bergen)H-Index: 42
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Abstract Background Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce. The aim of this study was to evaluate the results of curatively intended resection/radiofrequency ablation (RFA) of liver metastases in patients with metastatic GEP-NEC. Methods 32 patients with...
#1Fernando Pardo (University of Navarra)H-Index: 34
#2Bruno Sangro (University of Navarra)H-Index: 80
Last. Michael SchoenH-Index: 1
view all 23 authors...
Background Reports show that selective internal radiation therapy (SIRT) may downsize inoperable liver tumors to resection or transplantation, or enable a bridge-to-transplant. A small-cohort study found that long-term survival in patients undergoing resection following SIRT appears possible but no robust studies on postsurgical safety outcomes exist. The Post-SIR-Spheres Surgery Study was an international, multicenter, retrospective study to assess safety outcomes of liver resection or transpla...
#1G. Paul Wright (University of Pittsburgh)H-Index: 4
#2J. Wallis Marsh (University of Pittsburgh)H-Index: 57
Last. Mathew H ChungH-Index: 10
view all 6 authors...
Background Treatment with yttrium-90 (Y90) microspheres has emerged as a viable liver-directed therapy for patients with unresectable tumors and those outside transplantation criteria. A select number of patients demonstrate a favorable response and become candidates for surgical resection.
#1Manon N.G.J.A. Braat (UU: Utrecht University)H-Index: 10
Last. Marnix G.E.H. LamH-Index: 35
view all 5 authors...
Radioembolization (RE) is a relatively novel treatment modality for primary and secondary hepatic malignancies. Microspheres embedded with a β-emitting radioisotope are injected into the hepatic artery, resulting in microsphere deposition in the tumor arterioles and normal portal triads. Microsphere deposition in nontumorous parenchyma can result in radiation-induced liver injury, with lethal RE-induced liver disease (REILD) at the outer end of the spectrum. The primary aim of this study was to ...
Purpose We investigated the prognostic role of 68Ga-DOTANOC in patients affected by hepatic metastases from neuroendocrine tumours (NET) undergoing 90Y radioembolization (90Y-RE).
Cited By3
#1Cathal O’Leary (HUP: Hospital of the University of Pennsylvania)H-Index: 1
#2Michael C. Soulen (HUP: Hospital of the University of Pennsylvania)H-Index: 69
Last. Susan Shamimi-Noori (HUP: Hospital of the University of Pennsylvania)H-Index: 7
view all 3 authors...
Metastatic liver disease is one of the major causes of cancer-related morbidity and mortality. Locoregional therapies offered by interventional oncologists alleviate cancer-related morbidity and in some cases improve survival. Locoregional therapies are often palliative in nature but occasionally can be used with curative intent. This review will discuss important factors to consider prior to palliative and curative intent treatment of metastatic liver disease with locoregional therapy. These fa...
#1Florian Bösch (LMU: Ludwig Maximilian University of Munich)H-Index: 9
#2Orlin BelyaevH-Index: 21
Last. Olga Radulova-Mauersberger (LMU: Ludwig Maximilian University of Munich)H-Index: 2
view all 10 authors...
Neuroendocrine neoplasms of the pancreas (pNEN) have an increasing incidence and prevalence. Thus, this entity is of increasing clinical significance. Patients with pNEN become clinically apparent due to different and unspecific symptoms. Some tumours secrete hormones and peptides and become clinically symptomatic. In general, these tumours can metastasise early and even small tumours lead to distant metastases. Nonetheless, primary tumour size and grading are important prognostic factors. On th...
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