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Radioembolization of Symptomatic, Unresectable Neuroendocrine Hepatic Metastases Using Yttrium-90 Microspheres

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Abstract

Purpose

To evaluate safety, efficacy, and symptom-control of radioembolization in patients with unresectable liver metastases from neuroendocrine tumors (NETLMs).

Materials and Methods

Forty-two patients (mean age of 62 years) with treatment-refractory NETLMs underwent radioembolization using yttrium-90 (90Y) resin microspheres. Posttreatment tumor response was assessed by cross-sectional imaging using the Response Evaluation Criteria in Solid Tumors (RECIST) and tumor-marker levels. Laboratory and clinical toxicities and clinical symptoms were monitored.

Results

The median activity delivered was 1.63 GBq (range 0.63–2.36). Imaging follow-up using RECIST at 3-month follow-up demonstrated partial response, stable disease, and progressive disease in 22.5, 75.0, and 2.5% of patients, respectively. In 97.5% of patients, the liver lesions appeared hypovascular or partially necrotic. The mean follow-up was 16.2 months with 40 patients (95.2%) remaining alive. The median decrease in tumor-marker levels at 3 months was 54.8% (chromogranin A) and 37.3% (serotonin), respectively. There were no acute or delayed toxicities greater than grade 2 according to Common Terminology Criteria for Adverse Events [CTCAE (v3.0)]. No radiation-induced liver disease was noted. Improvement of clinical symptoms 3 months after treatment was observed in 36 of 38 symptomatic patients.

Conclusion

Radioembolization with 90Y-microspheres is a safe and effective treatment option in patients with otherwise treatment-refractory NETLMs. Antitumoral effect is supported by good local tumor control, decreased tumor-marker levels, and improved clinical symptoms. Further investigation is warranted to define the role of radioembolization in the treatment paradigm for NETLMs.

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Authors and Affiliations

  1. Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, 81377, Munich, Germany

    Philipp M. Paprottka, Ralf-T. Hoffmann, Wieland H. Sommer, Franziska Raeßler, Christoph G. Trumm, Gerwin P. Schmidt, Nima Ashoori, Maximilian F. Reiser & Tobias F. Jakobs

  2. Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, 81377, Munich, Germany

    Alexander Haug

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  1. Philipp M. Paprottka
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  2. Ralf-T. Hoffmann
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Correspondence to Philipp M. Paprottka.

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Paprottka, P.M., Hoffmann, RT., Haug, A. et al. Radioembolization of Symptomatic, Unresectable Neuroendocrine Hepatic Metastases Using Yttrium-90 Microspheres. Cardiovasc Intervent Radiol 35, 334–342 (2012). https://doi.org/10.1007/s00270-011-0248-1

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