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Defining predictors for long progression-free survival after radioembolisation of hepatic metastases of neuroendocrine origin

  • Magnetic Resonance
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Abstract

Objectives

To define predictive parameters of long progression-free survival (PFS) in patients undergoing radioembolisation of neuroendocrine liver metastases.

Methods

The following clinical and magnetic resonance imaging (MRI) parameters of 45 radioembolised patients (median age, 62 years; range, 43–75) were reviewed: age, gender, levels of chromogranin A and neuron-specific enolase (NSE), primary tumour site, Ki-67 proliferation index, hepatic tumour load, number of metastases, signal intensity characteristics, vascularisation, haemorrhagic and necrotic transformation and fluid–fluid levels. PFS was assessed according to RECIST 1.0. Statistical analysis included univariate Cox regression, Kaplan–Meier and multivariate regression.

Results

Median PFS was 727 days (95 % CI, 378–964). In the univariate regression analysis, hypovascular metastases progressed earlier (111 vs 727 days; P < 0.05). A Ki-67 ≤2 % was associated with a longer PFS than a Ki-67 of 3–20 % or >20 % (911 vs 727 vs 210 days, respectively; P < 0.05). Low NSE predicted longer PFS (911 vs 378 days; P < 0.05). In the adjusted multivariate analysis, vascularisation (hypervascularisation vs. no hypervascularisation; P = 0.0009) and NSE level (low vs high; P = 0.0119) had the strongest influence on PFS.

Conclusion

Response to radioembolisation in patients with neuroendocrine liver metastases can be predicted by the metastatic vascularisation pattern, the NSE level and the Ki-67.

Key Points

• Radioembolisation is an effective treatment in hepatic metastases of neuroendocrine origin.

• Pre-therapeutic vascularisation patterns of metastases on MRI can predict long progression-free survival.

• Assessment of pre-therapeutic markers provides better therapy planning.

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Abbreviations

NET:

Neuroendocrine tumour

GEP:

Gastroenteropancreatic

NETLM:

Neuroendocrine liver metastasis

PFS:

Progression-free survival

SI:

Signal intensity

TSE:

Turbo spin echo

Fs:

Fat saturation

3D GRE:

Three-dimensional gradient recalled echo

NSE:

Neuron-specific enolase

TAE:

Trans-catheter arterial embolisation

TACE:

Trans-catheter arterial chemoembolisation

RFA:

Radiofrequency ablation

SIRT:

Selective internal radiation therapy

PRRT:

Peptide receptor targeted therapy

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Acknowledgments

None of the authors has any financial or other kinds of interests that might pose a conflict of interest in connection with the submitted article.

A subset of this patient cohort has been previously published by Paprottka et al. [21]

Author information

Authors and Affiliations

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

    Wieland H. Sommer, Felix Ceelen, Philipp M. Paprottka, Marco Armbruster, Konstantin Nikolaou, Maximilian F. Reiser & Daniel Theisen

  2. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Xabier García-Albéniz

  3. Department of Internal Medicine II, University Hospitals-Grosshadern, Ludwig-Maximilians University, Munich, Germany

    Christoph J. Auernhammer

  4. Department of Nuclear Medicine, University Hospitals-Grosshadern, Ludwig-Maximilians University, Munich, Germany

    Alexander R. Haug

  5. Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-Grosshadern, Ludwig-Maximilians University, Munich, Germany

    Wieland H. Sommer, Felix Ceelen, Philipp M. Paprottka, Christoph J. Auernhammer, Marco Armbruster, Konstantin Nikolaou, Alexander R. Haug, Maximilian F. Reiser & Daniel Theisen

  6. Department of Clinical Radiology, University of Munich, Grosshadern Campus, Marchioninistr 15, 81377, Munich, Germany

    Wieland H. Sommer

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  1. Wieland H. Sommer
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Correspondence to Wieland H. Sommer.

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Sommer, W.H., Ceelen, F., García-Albéniz, X. et al. Defining predictors for long progression-free survival after radioembolisation of hepatic metastases of neuroendocrine origin. Eur Radiol 23, 3094–3103 (2013). https://doi.org/10.1007/s00330-013-2925-8

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  • DOI: https://doi.org/10.1007/s00330-013-2925-8

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