Can imaging patterns of neuroendocrine hepatic metastases predict response yttruim-90 radioembolotherapy?

Abstract

To evaluate the response to treatment in patients with neuroendocrine tumor liver metastases following yttrium-90 ((90)Y) radioembolotherapy, as a function of image patterns at presentation for (90)Y radioembolotherapy. The study cohort consisted of patients with hepatic metastatic neuroendocrine tumors treated with (90)Y at our institution during a two-year time period. Hepatic metastases were evaluated on a pre-therapy study assessing relative arterial enhancement compared to liver, lesion size, necrosis of the lesion, and associated tumor burden in the liver. We used six response criteria: Response Evaluation Criteria in Solid Tumors (RECIST) size, World Health Organization (WHO) size, European Association for the Study of the Liver (EASL) necrosis guidelines, Choi size, Choi necrosis and combination of Choi size and necrosis. About 65 lesions in 17 patients met study criteria and formed the cohort. Statistically significant response was found for lesions < 5 cm vs those ≥ 5 cm with RECIST (P = 0.04), WHO (P = 0.002) and combined Choi criteria (P = 0.02). Hyperenhancing lesions demonstrated greater response only with the Choi size criteria (P = 0.04). Lesions with ≤ 50% necrosis on the pre-scan had statistically significant greater response with the Choi necrosis criteria (P = 0.01). There was no statistical significance for response comparing lesions < 2 cm vs ≥ 2 cm or in comparing the degrees of tumor burden. Based on our findings in this study, it is suggested that initial imaging findings, as listed above, are not a good predictor of response to (90)Y radioembolization.