Combined treatment of rapidly progressing neuroendocrine tumors by transcatheter arterial chemoembolisation of the liver and peptide-receptor radiotherapy is save and effective: Report of 30 consecutive patients.

Abstract

e14634 Background: Patients with rapidly progressing neuroendocrine tumors presenting with high tumor load and/or severe clinical syndromes are clinically challenging with limited life expectany. Peptide receptor radiotherapy (PRRT) and transcatheter arterial chemoembolisation (TACE) have demonstrated efficacy in the treatment of neuroendocrine tumors. However, there are no reports that both therapies have been applied in combination. Methods: We treated thirty consecutive patients (19 male and 11 female, mean age 55.2) years with rapidly progressing neuroendorine tumors with high tumor load or severe functional syndromes by sequential PRRT and TACE. The treatment was well tolerated by all patients except for one patient suffering from hepatic encephalopathy grade 3 for 12 hours after TACE. One patient showed hepatic failure attributed to progression. 28 of 30 patients could be discharged. Severe functional syndromes were present in 9 patients Sequential TACE and PRRT was performed in 29 patients. One patient intended to treat sequentially died after the first cycle of TACE due to progression and ectopic Cushing's syndrome. A mean of 2.8 cycles (1-10) of TACE was performed and a mean of 4.03 cycles of PRRT (1-7) with 90-Yttrium or 177- Lutetium. Results: In 7/9 patients functional syndromes could be controlled. Two of the nine patients died due to functional syndromes and progression. Response to combined treatment was evaluated after the last treatment, either TACE or PRRT. Stable disease was noted in 16/30 with a mean of 7 months, partial remission in 2/30 patients with a mean of 5 months (4-6) and progressive disease in 12/30 patients after a mean of 2.7 months (0.5-6). Nine deaths occurred, all in the progressive disease group. Conclusions: Initial experience with combined treatment of PRRT and TACE is safe and effective in controlling severe functional syndromes. A subgroup of patients responds with stable disease of partial remission although prognosis remains poor for most of the patients. No significant financial relationships to disclose.