Single-institution experience of radioembolization with yttrium-90 microspheres for unresectable metastatic neuroendocrine liver tumors.

Abstract

The aim of this study was to assess the effectiveness of yttrium-90 (90 Y) microspheres for the treatment of unresectable metastatic liver neuroendocrine tumors (NET). From February 2006 to September 2015, 36 patients (19 male and 17 female, age 63.6±9.4years) who underwent 90 Y therapy for unresectable liver metastases of NET were included and analyzed retrospectively. All patients received a variety of treatments before 90 Y therapy. The radiological response, symptoms improvement of carcinoid syndrome, tumor marker changes, complications, side effects/toxicity, survival, and factors related to survival were evaluated and analyzed. Of the 36 patients, the mean delivered dose of 90 Y was 1.8±0.7GBq with a total of 40 treatments. Overall disease control rate was 88.9% (32/36) at 3months following therapy. In 16 patients with carcinoid syndrome, 15 (93.8%) patients had symptomatic improvement. Tumor marker response (5-hydroxyindoleacetic acid [n=7] and chromogranin A [n=13]) at 3months after treatment were as follows: none (n=0, 4), partial (n=6, 7), and complete (n=1, 2). Radiation-induced gastrointestinal ulcers (n=2, 5.6%) were identified. Side effects included fatigue (n=31, 86.1%), anorexia (n=26, 72.2%), nausea (n=15, 41.7%), vomiting (n=14, 38.9%), abdominal pain (n=10, 27.8%), and fever (n=8, 22.2%). The mean follow-up was 27.0±16.4months, with a median survival of 41.0months. Child-Pugh classification (P=0.008) and lymph node metastases (P=0.045) had statistically significant influence on overall survival. Yttrium-90 radioembolization can be effective in the treatment of unresectable liver metastases of NET who failed to respond to other treatments.