Neuroendocrine Hepatic Metastases Research Articles

3:09 PM Abstract No. 238 Bland versus Y90 embolization: a retrospective analysis of outcomes in hepatic neuroendocrine metastases

Both transarterial radioembolization (TARE) and bland transarterial embolization (TAE) have been shown in single-institution studies to have a substantial radiologic response for a variety of liver tumors, including neuroendocrine metastases. However, randomized controlled trials have not yet been published comparing these modalities. The purpose of this study was to compare outcomes between TARE and TAE when performed for neuroendocrine metastases. Retrospective review of our procedural database demonstrated that 132 unique patients had been treated with embolotherapy for neuroendocrine metastases to the liver between 2005 and 2019. Of these, 106 were treated exclusively with one of the two modalities; patients who underwent both treatments during the review period were excluded. Radiologic response was assessed at the 3-month follow-up imaging based on mRECIST criteria and compared with the chi square test. Time to (hepatic) progression (TTP), (hepatic) progression-free survival (PFS), and overall survival (OS) were analyzed using the Kaplan-Meier technique and compared with the log rank test. Baseline demographics and tumor characteristics such as WHO grade, presence of bilobar disease, and prior resection of the primary tumor were similar between groups. Radiologic response rate at three months was 70% in the bland group and 73% in the Y90 group (P = 0.9). The median TTP was significantly longer after TARE than TAE (18.4 vs. 10.2 months, P = 0.025). The median hepatic PFS from first embolotherapy was 9.1 months in the TAE group and 10.2 months in the TARE group (P = 0.52). The median OS was 30.2 months in the TAE and 33 months in the TARE group (P = 0.34). Of the baseline characteristics compared between groups, only WHO grade was an independent predictor of OS (59.1 vs. 32.1 vs. 10.3 months in grade 1, 2, and 3 disease respectively; P <0.001). TARE and TAE demonstrated similar PFS and OS, despite a significantly longer TTP with TARE. WHO grading was the only significant predictor of survival in these patients undergoing embolotherapy.

Early Prediction of Treatment Response of Neuroendocrine Hepatic Metastases after Peptide Receptor Radionuclide Therapy with 90Y-DOTATOC Using Diffusion Weighted and Dynamic Contrast-Enhanced MRI.

The purpose of this study was to determine if parameters derived from diffusion-weighted (DW-) and dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI) can help to assess early response to peptide receptor radionuclide therapy (PRRT) with 90Y-DOTATOC in neuroendocrine hepatic metastases (NET-HM). Twenty patients (10 male; 10 female; mean age: 59.2 years) with NET-HM were prospectively enrolled in this single-center imaging study. DW-MRI and DCE-MRI studies were performed just before and 48 hours after therapy with 90Y-DOTATOC. Abdominal SPECT/CT was performed 24 hours after therapy. This MRI imaging and therapy session was repeated after a mean interval of 10 weeks. Up to four lesions per patient were evaluated. Response to therapy was evaluated using metastasis sizes at the first and second therapy session as standard for comparison (regressive, stable, and progressive). DW-MRI analysis included the apparent diffusion coefficient (ADC) and parameters related to intravoxel incoherent motion (IVIM), namely, diffusion (D), perfusion fraction (f) and pseudo-diffusion (D∗). DCE-MRI analysis comprised Ktrans, ve and kep. For statistical analysis of group differences, one-way analysis of variance (ANOVA) and appropriate post hoc testing was performed. A total of 51 lesions were evaluated. Seven of 51 lesions (14%) showed size progression, 18/51 (35%) regression, and 26/51 (51%) remained stable. The lesion-to-spleen uptake ratio in SPECT showed a decrease between the two treatment sessions that was significantly stronger in regressive lesions compared with stable (p = 0.013) and progressive lesions (p = 0.021). ANOVA showed significant differences in mean ADC after 48 h (p = 0.026), with higher ADC values for regressive lesions. Regarding IVIM, highest values for D at baseline were seen in regressive lesions (p = 0.023). In DCE-MRI, a statistically significant increase in ve after 10 weeks (p = 0.046) was found in regressive lesions. No differences were observed for the transfer constants Ktrans and kep. Diffusion restriction quantified as ADC was able to differentiate regressive from progressive NET-HMs as early as 48 hours after PRRT. DW-MRI therefore may complement scintigraphy/SPECT for early assessment of response to PRRT. Assessment of perfusion parameters using IVIM and DCE-MRI did not show an additional benefit.

Modern sonographic imaging of abdominal neuroendocrine tumors

Radiological and nuclear medical diagnostics play an important role in the work-up of patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET). The sonographic examination, including contrast-enhanced examination, depicts an initial imaging modality to screen for NET. This report describes the sonomorphological behavior of ileal and pancreatic NET as well as hepatic metastases from NET. Sonographic evaluation of NET of the small intestine, pancreas and neuroendocrine hepatic metastases. Contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI), unenhanced ultrasonography. Contrast-enhanced ultrasound (CEUS). CEUS supports unenhanced ultrasound in the detection of NET and the differential diagnosis of unclear lesions, and is more sensitive for liver metastases (sensitivity according to the literature, 99% vs. 68%) PRACTICAL RECOMMENDATIONS: CEUS allows initial evaluation of NET and differentiation of benign vs. malignant lesions. Nevertheless, CEUS cannot replace more elaborate imaging modalities like CT or MRI for thorough staging examinations.

Phase I Trial of Dose-escalated Whole Liver Irradiation With Hepatic Arterial Fluorodeoxyuridine/Leucovorin and Streptozotocin Followed by Fluorodeoxyuridine/Leucovorin and Chemoembolization for Patients With Neuroendocrine Hepatic Metastases

We have previously shown that refractory neuroendocrine tumors can respond to moderate doses of chemoradiotherapy. We completed a dose-escalation phase I/II trial combining hepatic arterial (HA) chemotherapy, chemoembolization, and dose-escalated whole liver radiotherapy to determine the maximum safe dose of radiation that could be delivered and to make a preliminary assessment of response. From 2002 to 2009, 19 patients with symptomatic neuroendocrine liver metastases who failed somatostatin analog therapy were enrolled. HA fluorodeoxyuridine, leucovorin, and streptozotocin were delivered, as concurrent whole liver radiotherapy was dose escalated from 24 to 32 Gy in 2 Gy fractions, with a target rate of dose-limiting grade ≥3 radiation-induced liver disease of 10%. Eight weeks later, for patients without grade ≥3 liver or grade ≥4 any toxicity, a 72-hour infusion of HA fluorodeoxyuridine and leucovorin was given, followed by transarterial chemoembolization. Eleven patients completed the entire protocol and received 24 to 32 Gy. No patients developed radiation-induced liver disease; 7 had grade 3 to 4 transiently increased liver function tests, and 4 had other grade 4 toxicities. Three patients (14%) had partial response, 16 (84%) stable disease. Median freedom from local progression and overall survival were 35.3 and 54.6 months, respectively. Thirty-two in 2 Gy daily fractions can be delivered safely when combined with HA chemotherapy and subsequent transarterial chemoembolization. However, although objective responses were observed, this combination was not significantly better than our prior approaches. Further treatment intensification strategies, including individualized dose escalation for radiation-tolerant livers, and improved radiosensitization should be investigated, along with improved systemic therapy.

Treatment progression of rectal neuroendocrine neoplasms and hepatic metastasis

Gastroenteropancreatic neuroendocrine neoplasms are a group of heterogeneous tumors originated from the gastrointestinal peptidergic neurons and neuroendocrine cells. Rectum is one of the major sites of gastroenteropancreatic neuroendocrine neoplasms. Although the progression of rectal neuroendocine neoplasms (rNENs) is relatively slow, metastasis could occurs and liver is the major target organ invaded by distant metastatic rNENs. Surgical operation can be used as the preferred method for the treatment of rNENs and its metastasis at present. If the clinical situations of tumors are not eligible for the operation, interventional treatment can be considered as an alternative treatment. The chemotherapies and molecule-targeted drugs for rNENs are primarily in the light of therapeutic methods for pancreatic neuroendocrine neoplasms, it may help patients achieve partial response or stable disease, and prolong patients survival time. However, there has been few clinical researches directed toward rNENs and no an extensive consensus for treatment of rNENs up to now, and more evidences of evidence-based medicine should be necessitated. This paper has discussed and summarized treatment progression of rNENs and its metastasis. Key words: Neuroendocrine neoplasms, rectum; Therapy; Metastases

Abstract No. 375 - Bland vs. Y90 embolization: A retrospective analysis of outcomes in hepatic neuroendocrine metastases

Abstract No. 375 - Bland vs. Y90 embolization: A retrospective analysis of outcomes in hepatic neuroendocrine metastases

Ki67 score as a potential predictor in the selection of liver-directed therapies for metastatic neuroendocrine tumors: a single institutional experience.

Neuroendocrine tumors (NETs) metastatic to the liver are treated with transarterial radioembolization (TARE) using yttrium-90 (Y-90) microspheres or transarterial chemoembolization (TACE). However the criteria for patient selection are not well defined. We sought to determine if Ki67 score could help select patients for one therapy over the other in the management of hepatic neuroendocrine metastases. Single institution analysis of patients treated with Y-90 or TACE between 2001 and 2014. Pathologists blinded to clinical information performed Ki67 staining. Data were analyzed using multivariate association for survival outcomes. Amongst 72 patients (male: 39, female: 33, median age: 57 years) with metastatic NET, the most common site of origin was small bowel (n=35, 49%), while pancreas constituted 32% (n=23). Forty-four patients were treated with Y-90 (61%) and 28 patients received TACE (39%). Ki67 score was available in 28 patients (64%) treated with Y-90 and 16 patients (57%) with TACE. Within Y-90 group, there was greater use of Sandostatin (95% vs. 75%, P=0.02) and less number of total treatments completed (89% vs. 46%, P<0.001). There was no significant difference in overall survival (OS) between Y-90 and TACE when used without selection (median, 69 vs. 82 months, P=0.47). When adjusted for Ki67, patients with Ki67 score ≥3% had better OS with Y-90 compared to TACE (HR, 0.1; CI, 0.01-0.9), however for Ki67 <3%, OS was better when treated with TACE compared to Y-90 (HR, 13.5; CI, 1.22-148.87). There is significant interaction between Ki-67 score and liver-directed treatment benefit in patients with hepatic neuroendocrine metastases. Ki-67 score ≥3% predicts greater benefit with Y-90 and a Ki-67 score <3% predicts greater benefit with TACE.

Phase Ib study of pasireotide (P), everolimus (E), and selective internal radioembolization therapy (SIRT) for unresectable neuroendocrine hepatic metastases.

4092 Background: Pasireotide (P) is a somatostatin (SST) analogue active against receptors 1, 2, 3, and 5. Everolimus (E) is an mTOR inhibitor. mTOR and SST pathways activate angiogensis, survival ...

Acute thrombocytopenia: An uncommon complication occurring following transarterial chemoembolization in a patient with neuroendocrine hepatic metastases.

Neuroendocrine tumors are a group of carcinomas that secrete various polypeptides with hormonal activity. A significant percentage of patients already have hepatic metastases at the time of initial diagnosis, and 80-90% of these tumors are inoperable at the time of presentation. Transarterial chemoembolization (TACE) is the preferred approach for the management of neuroendocrine hepatic metastases. Although the technique is relatively safe, it is associated with several complications. The present study reported the case of a patient with neuroendocrine hepatic metastases who developed acute thrombocytopenia following TACE. To the best of our knowledge, acute thrombocytopenia occurring after TACE in a patient with neuroendocrine hepatic metastases has not been previously reported. In the present study, the hypothetical etiopathogenetic mechanisms were also discussed.

Liver Transplantation for Unresectable Neuroendocrine Tumor Liver Metastases

Liver transplantation (LT) is performed in selected patients with neuroendocrine hepatic metastases. Survival benefit and the risk of tumor recurrence after LT, also exacerbated by immunosuppressive therapy, remain important clinical issues. Whether patients with particular types of neuroendocrine tumors (NET) benefit more than others is unclear. Bibliographical searches were performed in PubMed for the terms "liver transplantation and neuroendocrine tumors," "liver transplant and neuroendocrine tumors," "liver transplantation and immunosuppressive therapy," "tumor recurrence." Promising results have been reported for LT for NET metastases with 5-year survival of up to 90 % in patients with well-differentiated gastroenteropancreatic NETs, but only few patients are free of tumor 5 years after LT. Better outcomes have been reported for gastrointestinal tumors than for pancreatic NETs for both survival and risk or recurrence after LT. Selection criteria for LT are limited and include the 2007 Milan Criteria and the 2012 European Neuroendocrine Tumor Society guidelines, including: well-differentiated NET (Ki-67 <10 %), age <55 years, absence of extrahepatic disease, primary tumor removed before transplantation, stable disease for at least 6 months before LT, and <50 % liver involvement. LT might be considered in carefully selected patients. The risk of tumor recurrence remains a significant clinical problem after LT, but data focused on immunosuppression issue are lacking, and there are no currently approved strategies for prevention of recurrence or follow-up protocols. Further studies are needed to define universally accepted inclusion criteria, reliable predictors of better outcome, and optimal timing for LT.

Diffusion-weighted imaging with acquisition of three b-values for response evaluation of neuroendocrine liver metastases undergoing selective internal radiotherapy

To evaluate diffusion-weighted MRI with acquisition of three b-values and calculation of fractioned ADCs for response evaluation of neuroendocrine liver metastases undergoing selective internal radiotherapy (SIRT). Ten consecutive patients with neuroendocrine liver metastases underwent MRI before and following SIRT. Diffusion-weighted imaging included acquisition of the b-values 0, 50 and 800 s/mm(2) and calculation of ADC(50,800), ADC(0,50) and ADC(0,800) maps. According to therapy response, lesions were categorised into group A [≥20% reduction of the longest diameter (LD) in comparison to baseline MRI] and group B (<20% reduction of the LD). Twelve out of 31 metastases were categorised as group A and 19 out of 31 metastases were categorised as group B. Pretherapeutic values of ADC(0,800) and ADC(50,800) did not differ significantly between the two groups; however, ADC(0,50) was 32% lower in group A (P = 0.049). ADC(0,800) and ADC(50,800) increased significantly after therapy in both groups, however, group differences were not statistically significant. Conversely, the increase in ADC(0,50) was about a factor of 7 larger in group A than in group B (P = 0.023). Our study showed that the ADC(0,50) is a promising biomarker for response assessment of neuroendocrine liver metastases following SIRT. • Diffusion-weighted MRI offers new information about neuroendocrine hepatic metastases. • Evaluation of perfusion and diffusion components requires fractioned apparent diffusion coefficients (ADCs). • Perfusion effects represented by ADC (0.50) can be observed in neuroendocrine metastases. • Pretherapeutic ADC (0.50) was significantly lower in metastases with a response ≥20%. • Such biomarkers may help evaluate liver metastases in patients undergoing therapy.

Abstract No. 350 - Clinical and imaging response in neuroendocrine hepatic metastasis treated with Y-90 radioembolization

Purpose To evaluate both the clinical and imaging response of unresectable hepatic neuroendocrine metastasis after treatment with Y-90 microsphere radioembolization. Materials and Methods This is a single institution retrospective review of 26 patients with neuroendocrine hepatic metastasis treated with Y-90 microsphere radioembolization. Clinical symptoms, biochemical markers and imaging at regular intervals of 1, 3, 6, 12 and 18 months post-procedure were reviewed. The patient's clinical and imaging response were evaluated. Other medical and interventional therapies were recorded. The two largest hepatic lesions were measured and tumor response was determined by RECIST 1.1 criteria. Results There were equal numbers of males and females. The mean patient age was 60, with a range of 26 to 88. Primary neuroendocrine sites were the small bowel (10), pancreas (6), colon and rectum (4), other (4) and unknown (2). Six patients (23%) underwent prior open radiofrequency ablation therapy. Twenty-one patients (81%) also received transarterial chemoembolizations. Most patients (77%) had a single Y-90 treatment. All patients had been treated with octreotide. Partial response was seen in 11 patients (42%), stable disease in 13 patients (50%) and progressive disease in 2 patients (8%). Biochemical marker response was evenly split, half increasing and half decreasing after therapy. Symptomatic improvement was noted in 18 patients (69%). Both patients with progressive disease had symptomatic improvement. Conclusion It has been shown that Y-90 microsphere radioembolization is a safe and effective therapy for hepatic neuroendocrine metastasis. Our data shows that this therapy also improves clinical symptoms. While further evaluation is needed, radioembolization may be able to play a larger role in the management of clinical symptoms.

Phase II Study of Chemoembolization With Drug-Eluting Beads in Patients With Hepatic Neuroendocrine Metastases: High Incidence of Biliary Injury

To evaluate safety in an interim analysis of transarterial chemoembolization (TACE) with doxorubicin-eluting beads (DEB) in 13 patients with hepatic metastases from neuroendocrine tumors (NETs) as part of a phase II trial. Institutional Review Board approval and informed consent were obtained. Thirteen patients completed preliminary safety analysis. Their mean age was 65 years, Eastern Cooperative Oncology Group status was 0/1, tumor burden range was 4-75 %, and mean targeted tumor size was 5.9 cm. Up to four DEB-TACE sessions (100-300 μm beads loaded with ≤100 mg doxorubicin) within 6 months were allowed. Tumor response was assessed by magnetic resonance imaging 1 month after treatment using contrast-enhancement [European Association for the Study of the Liver (EASL) and size Response Evaluation Criteria in Solid Tumors (RECIST)] criteria. Safety was assessed by National Cancer Institute Common Terminology Criteria. DEB-TACE was successfully performed in all 13 patients. At 1 month follow-up, there was a mean 12 % decrease in tumor size (p < 0.0003) and a 56 % decrease in tumor enhancement (p < 0.0001). By EASL criteria, the targeted lesion objective response rate was 78 %. Grade 3 to 4 toxicities were fatigue (23 %), increased alanine amino transferase (15 %), hyperglycemia (15 %), and abdominal pain (8 %). Seven patients developed bilomas (54 %); all of these patients had multiple small (<4 cm) lesions. Subsequently, four underwent percutaneous drainage, three for abscess formation and one for symptoms related to mass effect. Although biloma and liver abscess are known risks after TACE, the high incidence in our study population was unexpected and forced interruption of the trial. Although this occurred in a small group of patients, we have changed our technique and patient selection as a result of these findings, thus allowing resumption of the trial.

Phase I trial of dose escalated whole liver irradiation (WLRT) with hepatic arterial (HA) fluorodeoxyuridine (FUDR)/leucovorin (LV)/streptozotocin (STZ) chemotherapy followed by chemoembolization with mitomycin C (MMC) for patients with neuroendocrine hepatic metastases.

e14603 Background: Phase I trial combining HA chemotherapy, chemoembolization and dose-escalated WLRT was conducted to determine if the maximum safe dose of 32 Gy in 2 Gy fractions could be delivered to patients (pts) with neuroendocrine (NE) hepatic metastases. Methods: Pts with symptomatic liver metastases from NE tumors who failed somatostatin analog therapy were eligible. HA FUDR (3 mg/m2/d) and LV (300 mg/m2/d) were given for 12 days; STZ (500 mg/m2/d) was given on days 5,8,10. Concurrent WLRT was prescribed in 2 Gy/day with doses escalated from 24 Gy to 32 Gy using the time-to-event continual reassessment method for dose allocation with a target rate of dose-limiting grade ≥3 radiation-induced liver disease (RILD) of 10%. 8 weeks later, for patients without RILD and other grade ≥4 toxicities, 72-h infusion with HA FUDR (3 mg/m2/d) and LV (300 mg/m2/d) was given, followed by chemoembolization with mitomycin C (20 mg) and polyvinyl alcohol. Results: 19 pts were enrolled in the trial, 11 pts completed the entire protocol. 7 pts received 24 Gy, 2 - 26 Gy, 1 - 28 Gy, 2 - 30 Gy and 6 - 32 Gy. One pt stopped at 14 Gy because of STZ-induced grade 4 renal failure. No pts developed RILD at any dose level; 4 - had grade 3-4 increased liver function tests, 4 - had other grade 4 toxicities during or after the first part of the treatment; 1 - had other grade 4 toxicity during the second part. Posterior estimates of probabilities of RILD were all &lt;10% (table). Three pts (14%) had partial response, 16 (84%) - stable disease. Median freedom from local progression for all pts was 35.3 (9.3-58.9) months. Conclusions: The study showed that chemotherapy can be safely combined with a full dose of WLRT and subsequent chemoembolization without producing RILD. [Table: see text]

Abstract No. 349: Tumor response in neuroendocrine hepatic metastasis with radioembolization treatment

To evaluate the outcome of transarterial radioembolization using Y-90 glass microspheres (Theraspheres) in patients with metastatic neuroendocrine tumors to the liver based on serial cross-sectional imaging.

An Overview of the Surgical Management of Hepatic Neuroendocrine Metastases

Neuroendocrine tumours (NET) frequently metastasise to the liver (NLM) and are associated with significant morbidity and mortality. Numerous treatment options have been implemented both for cure, and to implement disease control. Surgical treatment includes curative resection, palliative cytoreductive resection and transplantation. Complete surgical resection is only possible in a subset of people with NLMs due to excessive metastatic burden and anatomical location. Ablative therapies may be used either as an adjunct to surgery or as a primary treatment. The purpose of the following article is to summarise surgical treatment strategies in the management of patients with hepatic neuroendocrine metastases, based on the available literature.

Treatment of neuroendocrine tumor liver metastases.

In the care of patients with hepatic neuroendocrine metastases, medical oncologists should work in multidisciplinary fashion with surgeons, interventional radiologists, and radiation oncologists to assess the potential utility of liver-directed and systemic therapies. This paper addresses the various roles and evidence basis for cytoreductive surgery, thermal ablation (radiofrequency, microwave, and cryoablation), and embolization (bland embolization (HAE), chemoembolization (HACE), and radioembolization) as liver-directed therapies. Somatostatin analogues, cytotoxic chemotherapy, and the newer agents everolimus and suntinib are discussed as a means for controlling intra- and extrahepatic disease, along with peptide receptor radiotherapy (PRRT). Finally, the experience with orthotopic liver transplant for neuroendocrine tumors is described.

6517 POSTER Sunitinib and Transarterial Chemoembolization (TACE) for Advanced Hepatocellular Carcinoma (HCC)- Final Results of a Phase 2 Trial

assess whether surgical intent (curative or cytoreductive) has an impact on long-term outcome, and assess cost-effectiveness of surgery for the symptomatic management of hepatic neuroendocrine metastases. Methods: A retrospective review of a prospectively maintained database of all patients referred to a neuroendocrine multidisciplinary team meeting between January 1996 and December 2008. Result: 340 patients were referred during the study period, of whom 190 (55.8%) had disease stage 1−3. Of the remaining 150 patients with stage 4 disease, 117 (78%) were treated non-surgically (6 RFA, 15 MIBG, 51 octreotide, 23 lantreotide, 2 dotate, 2 chemoembolisation) whilst 33 patients (22%) were treated by surgical resection. Thirteen underwent surgery with curative intent, whilst 19 underwent cytoreductive resection. At median follow-up of 66 months, 8 of the 13 patients (62%) who underwent curative resection had hepatic recurrence. Overall 1, 3, and 5-year survival rates were 94%, 64% and 46% for stage 4 medically medically managed patients, 100%, 100% and 82% for patients undergoing cytoreductive surgery and 100%, 100%, 100% for patients undergoing curative resection. (p = 0.049). Curative resection gave a median duration of symptom control of 67.5 months (IQR 36.5−81) compared to 24 months (IQR 19–45.5) for cytoreductive surgery. Cost per QALY for the treatment of hepatic neuroendocrine metastases was €1,438 for curative surgery and €3,121 for cytoreductive surgery, compared to €14,450 for non-surgical management. Conclusions: Hepatic resection improves survival in patients with neuroendocrine metastases. Although recurrence rates are high, curative surgery is associated with more durable symptom control than cytoreduction. Resection for symptom control is considerably more cost-effective than medical management.

Prospective phase II study of chemoembolization with drug-eluting beads for hepatic neuroendocrine metastases: Interim analysis.

331 Background: To evaluate safety and efficacy of transarterial chemoembolization with doxorubicin eluting beads (DEB-TACE) in 30 patients with hepatic neuroendocrine metastases (NET) in a prospective phase II study. We report the interim analysis on 10 patients. Methods: Patients who met inclusion criteria (NET liver-dominant metastases, ECOG 0-1, treatment naïve) underwent up to 4 DEB-TACE sessions (100-300 micron beads loaded with up to 100mg of doxorubicin) within a 6-month period. Statistical plan included interim analysis of initial 10 patients to assess therapeutic efficacy (defined as objective response≥50%). Tumor response was assessed by MR imaging 1 month after treatment using contrast-enhancement (EASL) and tumor size (RECIST). Safety was assessed by NCI Common Terminology Criteria. Results: DEB-TACE was successfully performed in 10 patients (22 targeted lesions). Patient characteristics included mean age 65 yrs; ECOG 0/1 (6/4); carcinoid syndrome (n=2); tumor burden range (4-75%), and mean targeted tumor size 4.8 cm (range 1.2-10.2). At one month follow-up (n=9), Grade 3 toxicities consisted of hyperglycemia (n=3), abdominal pain (n=3), fatigue (n=1), biloma (n=1) and elevated ALT (n=1). Note that four patients had Grade 2 bilomas, which occurred in the setting of small lesions (&lt;2cm), diffuse disease with very low tumor burden (near military pattern), and single lesion ≥ 5cm. Tumor response using MR imaging at 1 month-follow-up revealed a mean treated tumor decrease in size of 7% (p=0.03), and a mean decrease in contrast-enhancement of 59% (p&lt;0.0001). Using RECIST, partial response was achieved in 1 patient (11%), whereas 8 patients (89%) had stable disease. Using EASL criteria, 7 patients (78%) had objective tumor response and 2 (12%) had stable disease. Conclusions: Interim analysis shows therapeutic efficacy of DEB-TACE in liver-dominant NET metastases. Early recommendation suggests DEB-TACE may be best suited for NET patients with multifocal disease or diffuse disease with large tumor burden. [Table: see text] No significant financial relationships to disclose.

Thermal Ablative Therapies for Secondary Hepatic Malignancies

Hepatic metastatic disease affects more than half of the patients with colorectal cancer and neuroendocrine cancer. Hepatic resection remains the gold standard for liver metastasis from colorectal and neuroendocrine primaries. Thermal ablative technologies, however, are increasingly being used either alone or in combination with resection to treat this group of patients. Radiofrequency ablation is the most common modality used in the United States, whereas microwave ablation has been more widely used in the East. In addition to being adjuncts to hepatic resection, ablation has gained an increased popularity in the management of patients who are not operative candidates or have unresectable colorectal or neuroendocrine hepatic metastasis. Although radiofrequency ablation seems to have a higher local recurrence than resection, ablation remains an important therapeutic option for many patients with hepatic metastasis.