European Radiology

, Volume 23, Issue 11, pp 3094–3103

Defining predictors for long progression-free survival after radioembolisation of hepatic metastases of neuroendocrine origin

Authors

    • Department of Clinical Radiology, University Hospitals-GrosshadernLudwig-Maximilians University
    • Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-GrosshadernLudwig-Maximilians University
    • Department of Clinical RadiologyUniversity of Munich
  • Felix Ceelen
    • Department of Clinical Radiology, University Hospitals-GrosshadernLudwig-Maximilians University
    • Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-GrosshadernLudwig-Maximilians University
  • Xabier García-Albéniz
    • Department of EpidemiologyHarvard School of Public Health
  • Philipp M. Paprottka
    • Department of Clinical Radiology, University Hospitals-GrosshadernLudwig-Maximilians University
    • Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-GrosshadernLudwig-Maximilians University
  • Christoph J. Auernhammer
    • Department of Internal Medicine II, University Hospitals-GrosshadernLudwig-Maximilians University
    • Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-GrosshadernLudwig-Maximilians University
  • Marco Armbruster
    • Department of Clinical Radiology, University Hospitals-GrosshadernLudwig-Maximilians University
    • Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-GrosshadernLudwig-Maximilians University
  • Konstantin Nikolaou
    • Department of Clinical Radiology, University Hospitals-GrosshadernLudwig-Maximilians University
    • Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-GrosshadernLudwig-Maximilians University
  • Alexander R. Haug
    • Department of Nuclear Medicine, University Hospitals-GrosshadernLudwig-Maximilians University
    • Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-GrosshadernLudwig-Maximilians University
  • Maximilian F. Reiser
    • Department of Clinical Radiology, University Hospitals-GrosshadernLudwig-Maximilians University
    • Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-GrosshadernLudwig-Maximilians University
  • Daniel Theisen
    • Department of Clinical Radiology, University Hospitals-GrosshadernLudwig-Maximilians University
    • Interdisciplinary Center of Neuroendocrine Tumours of the GastroEnteroPancreatic System (GEPNET-KUM), University Hospitals-GrosshadernLudwig-Maximilians University
Magnetic Resonance

DOI: 10.1007/s00330-013-2925-8

Cite this article as:
Sommer, W.H., Ceelen, F., García-Albéniz, X. et al. Eur Radiol (2013) 23: 3094. doi:10.1007/s00330-013-2925-8

Abstract

Objectives

To define predictive parameters of long progression-free survival (PFS) in patients undergoing radioembolisation of neuroendocrine liver metastases.

Methods

The following clinical and magnetic resonance imaging (MRI) parameters of 45 radioembolised patients (median age, 62 years; range, 43–75) were reviewed: age, gender, levels of chromogranin A and neuron-specific enolase (NSE), primary tumour site, Ki-67 proliferation index, hepatic tumour load, number of metastases, signal intensity characteristics, vascularisation, haemorrhagic and necrotic transformation and fluid–fluid levels. PFS was assessed according to RECIST 1.0. Statistical analysis included univariate Cox regression, Kaplan–Meier and multivariate regression.

Results

Median PFS was 727 days (95 % CI, 378–964). In the univariate regression analysis, hypovascular metastases progressed earlier (111 vs 727 days; P < 0.05). A Ki-67 ≤2 % was associated with a longer PFS than a Ki-67 of 3–20 % or >20 % (911 vs 727 vs 210 days, respectively; P < 0.05). Low NSE predicted longer PFS (911 vs 378 days; P < 0.05). In the adjusted multivariate analysis, vascularisation (hypervascularisation vs. no hypervascularisation; P = 0.0009) and NSE level (low vs high; P = 0.0119) had the strongest influence on PFS.

Conclusion

Response to radioembolisation in patients with neuroendocrine liver metastases can be predicted by the metastatic vascularisation pattern, the NSE level and the Ki-67.

Key Points

Radioembolisation is an effective treatment in hepatic metastases of neuroendocrine origin.

Pre-therapeutic vascularisation patterns of metastases on MRI can predict long progression-free survival.

Assessment of pre-therapeutic markers provides better therapy planning.

Keywords

RadioembolisationNeuroendocrine liver metastasesMagnetic resonanceVascularisationKi-67 proliferation index

Abbreviations

NET

Neuroendocrine tumour

GEP

Gastroenteropancreatic

NETLM

Neuroendocrine liver metastasis

PFS

Progression-free survival

SI

Signal intensity

TSE

Turbo spin echo

Fs

Fat saturation

3D GRE

Three-dimensional gradient recalled echo

NSE

Neuron-specific enolase

TAE

Trans-catheter arterial embolisation

TACE

Trans-catheter arterial chemoembolisation

RFA

Radiofrequency ablation

SIRT

Selective internal radiation therapy

PRRT

Peptide receptor targeted therapy

Copyright information

© European Society of Radiology 2013