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Liver transarterial embolizations in metastatic neuroendocrine tumors

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Abstract

The management of patients with well-differentiated neuroendocrine tumors (NET) and non-resectable liver metastases is challenging. Liver-directed transarterial embolization (TAE), transarterial chemo-embolization (TACE) and selective internal radiation therapy (SIRT) have a place of choice among other treatment modalities. However, their utilization relies on a low level of proof, due to the lack of prospective data, the absence of comparative studies and considerable heterogeneity between local practices. TAE and TACE generally achieve average symptomatic, biological and radiological responses of 75%, 56% and 50%, with progression-free survival of 12–18 months, with acceptable tolerance. Although not clearly demonstrated, TACE may be more effective than TAE in pancreatic NET, but not in small-intestine NET. SIRT has been developed more recently and may achieve similar results, with improved tolerance, but decreased cost-effectiveness, although no prospective comparison has been published to date. There is currently no strong argument to choose between TAE, TACE and SIRT, and they have not been compared to other treatment modalities. The evaluation of their efficacy has mostly relied on criteria based on size variations, which do not take into account tumor viability and metabolism, and thus may not be relevant. These techniques may be especially effective when performed as first-line therapies, in patients with non-major liver involvement (<75%) and with hypervascular metastases. Finally, studies exploring their combination with systemic therapies are ongoing.

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Abbreviations

NELM:

Neuroendocrine liver metastasi(e)s

NET:

Neuroendocrine tumor(s)

OS:

Overall survival

PFS:

Progression-free survival

TACE:

Transarterial chemo-embolization

TAE:

Transarterial embolization

SIRT:

Selective internal radiation therapy

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Authors and Affiliations

  1. Department of Gastroenterology and Pancreatology, DHU UNITY, ENETS Center of Excellence, Beaujon Hospital (APHP), Paris-Diderot University, 100 boulevard du Général Leclerc, 92110, Clichy, France

    Louis de Mestier, Olivia Hentic & Philippe Ruszniewski

  2. Department of Radiology, DHU UNITY, ENETS Center of Excellence, Beaujon Hospital (APHP), Paris-Diderot University, Clichy, France

    Magaly Zappa & Valérie Vilgrain

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  1. Louis de Mestier
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  2. Magaly Zappa
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  3. Olivia Hentic
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  4. Valérie Vilgrain
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  5. Philippe Ruszniewski
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Correspondence to Louis de Mestier.

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Conflicts of interest

LM: Pfizer, Novartis, Ipsen.

MZ: Pfizer.

OH: Pfizer, Novartis, Ipsen, Keocyt.

VV: none.

PR: Pfizer, Novartis, Ipsen.

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de Mestier, L., Zappa, M., Hentic, O. et al. Liver transarterial embolizations in metastatic neuroendocrine tumors. Rev Endocr Metab Disord 18, 459–471 (2017). https://doi.org/10.1007/s11154-017-9431-2

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