Skip to main content
SpringerLink
Log in

Selective internal radiation therapy in patients with progressive neuroendocrine liver metastases

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the safety and efficacy of selective internal radiation therapy (SIRT) in patients with unresectable liver metastases from neuroendocrine tumours (NETLMs).

Methods

This retrospective study included 40 patients with progressive NETLMs (22 women, 18 men, mean age 61.6 years) who underwent SIRT with 90Y-labelled resin microspheres. Tumour response was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) on CT or MR images. Medical records were reviewed.

Results

In the 40 patients, 54 evaluable SIRT procedures were performed, 33 to the right liver lobe (mean activity 1.31 GBq), 13 to the left lobe (mean activity 0.85 GBq), and 8 to both lobes (mean activity 1.61 GBq). Late follow-up imaging (mean 20 months) was performed after 44 of the treatments. Objective tumour response and disease control rates were 54 % (29 of 54 treatments) and 94 % (51 treatments), respectively, at the early follow-up examination (mean 3 months) and 34 % (15 treatments) and 57 % (25 treatments), respectively at the late follow-up examination. Mean overall survival from the first SIRT was 34,8 months and survival rates at 1, 2, 3 and 5 years were 76 %, 59 %, 52 % and 35 % respectively. Adverse effects were generally mild and easily manageable, except in one patient who died from radiation-induced liver failure. Of the 45 patients, 18 (45 %) had received peptide receptor radionuclide therapy (PRRT) prior to SIRT.

Conclusion

SIRT with 90Y-labelled resin microspheres is a safe and effective treatment for patients with progressive NETLM, and also for those who have received prior PRRT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Veenendaal LM, Borel Rinkes IH, Lips CJ, van Hillegersberg R. Liver metastases of neuroendocrine tumours; early reduction of tumour load to improve life expectancy. World J Surg Oncol. 2006;4:35.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Eriksson BK, Larsson EG, Skogseid BM, Löfberg A-M, Lörelius L-E, Öberg KE. Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer. 1998;83:2293–301.

    Article  CAS  PubMed  Google Scholar 

  3. Granberg D, Eriksson L-G, Welin S, Kindmark H, Janson ET, Skogseid B, et al. Liver embolization with trisacryl gelatin microspheres (Embosphere) in patients with neuroendocrine tumors. Acta Radiol. 2007;48:180–5.

    Article  CAS  PubMed  Google Scholar 

  4. Roche A, Girish BV, de Baere T, Baudin E, Boige V, Elias D, et al. Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol. 2003;13:136–40.

    PubMed  Google Scholar 

  5. Ruszniewski P, Malka D. Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumors. Digestion. 2000;62 Suppl 1:79–83.

    Article  PubMed  Google Scholar 

  6. Jernigan SR, Osborne JA, Mirek CJ, Buckner G. Selective internal radiation therapy: quantifying distal penetration and distribution of resin and glass microspheres in a surrogate arterial model. J Vasc Interv Radiol. 2015;26:897–904.e2.

    Article  PubMed  Google Scholar 

  7. Kennedy AS, Nutting C, Coldwell D, Gaiser J, Drachenberg C. Pathologic response and microdosimetry of (90)Y microspheres in man: review of four explanted whole livers. Int J Radiat Oncol Biol Phys. 2004;60:1552–63.

    Article  CAS  PubMed  Google Scholar 

  8. Coldwell D, Sangro B, Salem R, Wasan H, Kennedy A. Radioembolization in the treatment of unresectable liver tumors: experience across a range of primary cancers. Am J Clin Oncol. 2012;35:167–77.

    Article  PubMed  Google Scholar 

  9. Kennedy AS, Dezarn WA, McNeillie P, Coldwell D, Nutting C, Carter D, et al. Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol. 2008;31:271–9.

    Article  PubMed  Google Scholar 

  10. Rhee TK, Lewandowski RJ, Liu DM, Mulcahy MF, Takahashi G, Hansen PD, et al. 90Y Radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg. 2008;247:1029–35.

    Article  PubMed  Google Scholar 

  11. Kennedy A, Nag S, Salem R, Murthy R, McEwan AJ, Nutting C, et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the Radioembolization Brachytherapy Oncology Consortium. Int J Radiat Oncol Biol Phys. 2007;68:13–23.

    Article  PubMed  Google Scholar 

  12. Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis. 2010;30:52–60.

    Article  CAS  PubMed  Google Scholar 

  13. Godwin 2nd JD. Carcinoid tumors. An analysis of 2,837 cases. Cancer. 1975;36:560–9.

    Article  PubMed  Google Scholar 

  14. Soreide O, Berstad T, Bakka A, Schrumpf E, Hanssen LE, Engh V, et al. Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors. Surgery. 1992;111:48–54.

    CAS  PubMed  Google Scholar 

  15. Musunuru S, Chen H, Rajpal S, Stephani N, McDermott JC, Holen K, et al. Metastatic neuroendocrine hepatic tumors: resection improves survival. Arch Surg. 2006;141:1000–4. Discussion 1005.

    Article  PubMed  Google Scholar 

  16. Chen H, Hardacre JM, Uzar A, Cameron JL, Choti MA. Isolated liver metastases from neuroendocrine tumors: does resection prolong survival? J Am Coll Surg. 1998;187:88–92. Discussion 92–3.

  17. de Baere T, Elias D, Dromain C, Din MG, Kuoch V, Ducreux M, et al. Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. AJR Am J Roentgenol. 2000;175:1619–25.

    Article  PubMed  Google Scholar 

  18. Gupta S, Johnson MM, Murthy R, Ahrar K, Wallace MJ, Madoff DC, et al. Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors. Cancer. 2005;104:1590–602.

    Article  PubMed  Google Scholar 

  19. Strosberg JR, Choi J, Cantor AB, Kvols LK. Selective hepatic artery embolization for treatment of patients with metastatic carcinoid and pancreatic endocrine tumors. Cancer Control. 2006;13:72–8.

    PubMed  Google Scholar 

  20. Bloomston M, Al-Saif O, Klemanski D, Pinzone JJ, Martin EW, Palmer B, et al. Hepatic artery chemoembolization in 122 patients with metastatic carcinoid tumor: lessons learned. J Gastrointest Surg. 2007;11:264–71.

    Article  PubMed  Google Scholar 

  21. Christante D, Pommier S, Givi B, Pommier RF. Hepatic artery chemoinfusion with chemoembolization for neuroendocrine cancer with progressive hepatic metastases despite octreotide therapy. Surgery. 2008;144:885–93. Discussion 893–894.

    Article  PubMed  Google Scholar 

  22. Dong XD, Carr BI. Hepatic artery chemoembolization for the treatment of liver metastases from neuroendocrine tumors: a long-term follow-up in 123 patients. Med Oncol. 2011;28 Suppl 1:S286–90.

    Article  PubMed  Google Scholar 

  23. Vogl TJ, Gruber T, Naguib NN, Hammerstingl R, Nour-Eldin NE. Liver metastases of neuroendocrine tumors: treatment with hepatic transarterial chemotherapy using two therapeutic protocols. AJR Am J Roentgenol. 2009;193:941–7.

    Article  PubMed  Google Scholar 

  24. Arrese D, McNally ME, Chokshi R, Feria-Arias E, Schmidt C, Klemanski D, et al. Extrahepatic disease should not preclude transarterial chemoembolization for metastatic neuroendocrine carcinoma. Ann Surg Oncol. 2013;20:1114–20.

    Article  PubMed  Google Scholar 

  25. Cao CQ, Yan TD, Bester L, Liauw W, Morris DL. Radioembolization with yttrium microspheres for neuroendocrine tumour liver metastases. Br J Surg. 2010;97:537–43.

    Article  CAS  PubMed  Google Scholar 

  26. King J, Quinn R, Glenn DM, Janssen J, Tong D, Liaw W, et al. Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer. 2008;113:921–9.

    Article  PubMed  Google Scholar 

  27. Memon K, Lewandowski RJ, Mulcahy MF, Riaz A, Ryu RK, Sato KT, et al. Radioembolization for neuroendocrine liver metastases: safety, imaging, and long-term outcomes. Int J Radiat Oncol Biol Phys. 2012;83:887–94.

    Article  PubMed  Google Scholar 

  28. Paprottka PM, Hoffmann RT, Haug A, Sommer WH, Raessler F, Trumm CG, et al. Radioembolization of symptomatic, unresectable neuroendocrine hepatic metastases using yttrium-90 microspheres. Cardiovasc Intervent Radiol. 2012;35:334–42.

    Article  PubMed  Google Scholar 

  29. Saxena A, Chua TC, Bester L, Kokandi A, Morris DL. Factors predicting response and survival after yttrium-90 radioembolization of unresectable neuroendocrine tumor liver metastases: a critical appraisal of 48 cases. Ann Surg. 2010;251:910–6.

    Article  PubMed  Google Scholar 

  30. Benson 3rd AB, Geschwind JF, Mulcahy MF, Rilling W, Siskin G, Wiseman G, et al. Radioembolisation for liver metastases: results from a prospective 151 patient multi-institutional phase II study. Eur J Cancer. 2013;49:3122–30.

    Article  PubMed  Google Scholar 

  31. Ozao-Choy J, Friedman ML, Kim AS, Wachsman A, Wolin EM, Yu R, et al. Radioembolization for treatment of liver metastases from neuroendocrine tumors: correlation with imaging and biomarkers. Pancreas. 2013;42:358–60.

    Article  PubMed  Google Scholar 

  32. Kennedy A, Bester L, Salem R, Sharma RA, Parks RW, Ruszniewski P. Role of hepatic intra-arterial therapies in metastatic neuroendocrine tumours (NET): guidelines from the NET-Liver-Metastases Consensus Conference. HPB (Oxford). 2015;17:29–37.

    Article  Google Scholar 

  33. Kolligs FT, Bilbao JI, Jakobs T, Iñarrairaegui M, Nagel JM, Rodriguez M, et al. Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma. Liver Int. 2015;35:1715–21.

    Article  PubMed  Google Scholar 

  34. Theysohn JM, Ertle J, Muller S, Schlaak JF, Nensa F, Sipilae S, et al. Hepatic volume changes after lobar selective internal radiation therapy (SIRT) of hepatocellular carcinoma. Clin Radiol. 2014;69:172–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden

    Charlotte Ebeling Barbier & Rickard Nyman

  2. Department of Surgical Sciences, Section of Nuclear Medicine and PET, Uppsala University Hospital, Uppsala, Sweden

    Ulrike Garske-Román & Mattias Sandström

  3. Department of Medical Sciences, Division of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden

    Dan Granberg

Authors
  1. Charlotte Ebeling Barbier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulrike Garske-Román
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mattias Sandström
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rickard Nyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dan Granberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charlotte Ebeling Barbier.

Ethics declarations

Conflicts of Interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barbier, C.E., Garske-Román, U., Sandström, M. et al. Selective internal radiation therapy in patients with progressive neuroendocrine liver metastases. Eur J Nucl Med Mol Imaging 43, 1425–1431 (2016). https://doi.org/10.1007/s00259-015-3264-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-015-3264-6

Keywords

Search

Navigation