CardioVascular and Interventional Radiology

, Volume 34, Issue 3, pp 566–572 | Cite as

Hepatic Arterial Chemoembolization Using Drug-Eluting Beads in Gastrointestinal Neuroendocrine Tumor Metastatic to the Liver

  • Shantanu K. Gaur
  • Jeremy L. Friese
  • Cheryl A. Sadow
  • Rajasekhara Ayyagari
  • Christoph A. Binkert
  • Matthew P. Schenker
  • Matthew Kulke
  • Richard BaumEmail author
Clinical Investigation



This study was designed to evaluate short (<3 months) and intermediate-term (>3 months) follow-up in patients with metastatic neuroendocrine tumor to the liver who underwent hepatic arterial chemoembolization with drug-eluting beads at a single institution.


Institutional review board approval was obtained for this retrospective review. All patients who were treated with 100–300 or 300–500 μm drug-eluting LC Beads (Biocompatibles, UK) preloaded with doxorubicin (range, 50–100 mg) for GI neuroendocrine tumor metastatic to the liver from June 2004 to June 2009 were included. CT and MRI were evaluated for progression using Response Evaluation Criteria In Solid Tumors (RECIST) or European Association for the Study of the Liver (EASL) criteria. Short-term (<3 months) and intermediate-term (>3 months) imaging response was determined and Kaplan–Meier survival curves were plotted.


Thirty-eight drug-eluting bead chemoembolization procedures were performed on 32 hepatic lobes, comprising 21 treatment cycles in 18 patients. All procedures were technically successful with two major complications (biliary injuries). At short-term follow-up (<3 months), 22 of 38 (58%) procedures and 10 of 21 (48%) treatment cycles produced an objective response (OR) with the remainder having stable disease (SD). At intermediate-term follow-up (mean, 445 days; range, 163–1247), 17 of 26 (65%) procedures and 8 of 14 (57%) treatment cycles produced an OR. Probability of progressing was approximately 52% at 1 year with a median time to progression of 419 days.


Drug-eluting bead chemoembolization is a reasonable alternative to hepatic arterial embolization and chemoembolization for the treatment of metastatic neuroendocrine tumor to the liver.


Embolization Chemoembolization Carcinoid Liver Neuroendocrine tumor 



SKG was supported by the Society for Interventional Radiology Foundation Student Research Grant and the Paul & Daisy Soros Fellowship.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Brown KT, Koh BY, Brody LA et al (1999) Particle embolization of hepatic neuroendocrine metastases for control of pain and hormonal symptoms. J Vasc Interv Radiol 10(4):397–403PubMedCrossRefGoogle Scholar
  2. 2.
    Brown DB, Gould JE, Gervais DA et al (2007) Transcatheter therapy for hepatic malignancy: standardization of terminology and reporting criteria. J Vasc Interv Radiol 18(12):1469–1478PubMedCrossRefGoogle Scholar
  3. 3.
    Caplin ME, Buscombe JR, Hilson AJ, Jones AL, Watkinson AF, Burroughs AK (1998) Carcinoid tumour. Lancet 352(9130):799–805PubMedCrossRefGoogle Scholar
  4. 4.
    Clouse ME, Perry L, Stuart K, Stokes KR (1994) Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Digestion 55:92–97PubMedCrossRefGoogle Scholar
  5. 5.
    de Baere T, Deschamps F, Teriitheau C et al (2008) Transarterial chemoembolization of liver metastases from well-differentiated gastroenteropancreatic endocrine tumors with doxorubicin-eluting beads: preliminary results. J Vasc Interv Radiol 19(6):855–861PubMedCrossRefGoogle Scholar
  6. 6.
    Demeure MJ, Thompson NW, Hanto DW, Nagorney DM, Yao (2001) Indications and results of liver resection and hepatic chemoembolization for metastatic gastrointestinal neuroendocrine tumors. Surgery 130(4):682–685 (Discussion)Google Scholar
  7. 7.
    Diaco DS, Hajarizadeh H, Mueller CR, Fletcher WS, Pommier RF, Woltering EA (1995) Treatment of metastatic carcinoid-tumors using multimodality therapy of octreotide acetate intraarterial chemotherapy, and hepatic arterial chemoembolization. Am J Surg 169(5):523–528PubMedCrossRefGoogle Scholar
  8. 8.
    Diamandidou E, Ajani JA, Yang DJ et al (1998) Two-phase study of hepatic artery vascular occlusion with microencapsulated cisplatin in patients with liver metastases from neuroendocrine tumors. AJR Am J Roentgenol 170(2):339–344PubMedGoogle Scholar
  9. 9.
    Dominguez S, Denys A, Menu Y, Ruszniewski P (1999) Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumours. Ital J Gastroenterol Hepatol 31:S213–S215PubMedGoogle Scholar
  10. 10.
    Dominguez S, Denys A, Madeira I et al (2000) Hepatic arterial chemoembolization with streptozotocin in patients with metastatic digestive endocrine tumours. Eur J Gastroenterol Hepatol 12(2):151–157PubMedCrossRefGoogle Scholar
  11. 11.
    Drougas JG, Anthony LB, Blair TK et al (1998) Hepatic artery chemoembolization for management of patients with advanced metastatic carcinoid tumors. Am J Surg 175(5):408–412PubMedCrossRefGoogle Scholar
  12. 12.
    Eriksson BK, Larsson EG, Skogseid BM, Lofberg AM, Lorelius LE, Oberg KE (1998) Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 83(11):2293–2301PubMedCrossRefGoogle Scholar
  13. 13.
    Fiorentini G, Aliberti C, Turrisi G et al (2007) Intraarterial hepatic chemoembolization of liver metastases from colorectal cancer adopting irinotecan-eluting beads: results of a phase II clinical study. In Vivo 21(6):1085–1091PubMedGoogle Scholar
  14. 14.
    Gates J, Hartnell GG, Stuart KE, Clouse ME (1999) Chemoembolization of hepatic neoplasms: safety, complications, and when to worry. Radiographics 19(2):399–414PubMedGoogle Scholar
  15. 15.
    Gupta S, Yao JC, Ahrar K et al (2003) Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the MD Anderson experience. Cancer J 9(4):261–267PubMedCrossRefGoogle Scholar
  16. 16.
    Hajarizadeh H, Ivancev K, Mueller CR, Fletcher WS, Woltering EA (1992) Effective palliative treatment of metastatic carcinoid-tumors with intraarterial chemotherapy chemoembolization combined with octreotide acetate. Am J Surg 163(5):479–483PubMedCrossRefGoogle Scholar
  17. 17.
    Ho AS, Picus J, Darcy MD et al (2007) Long-term outcome after chemoembolization and embolization of hepatic metastatic lesions from neuroendocrine tumors. AJR Am J Roentgenol 188(5):1201–1207PubMedCrossRefGoogle Scholar
  18. 18.
    Kadivar F, Soulen MC (2010) Enhancing ablation: synergies with regional and systemic therapies. J Vasc Interv Radiol 21(8 Suppl):S251–S256PubMedCrossRefGoogle Scholar
  19. 19.
    Kim YH, Ajani JA, Carrasco CH et al (1999) Selective hepatic arterial chemoembolization for liver metastases in patients with carcinoid tumor or islet cell carcinoma. Cancer Invest 17(7):474–478PubMedCrossRefGoogle Scholar
  20. 20.
    Kulke M (2005) Advances in the treatment of neuroendocrine tumors. Curr Treat Options Oncol 6(5):397–409PubMedCrossRefGoogle Scholar
  21. 21.
    Kulke MH, Mayer RJ (1999) Carcinoid tumors. N Engl J Med 340(11):858–868PubMedCrossRefGoogle Scholar
  22. 22.
    Lammer J, Malagari K, Vogl T et al (2009) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33(1):41–52PubMedCrossRefGoogle Scholar
  23. 23.
    Lewis AL, Taylor RR, Hall B, Gonzalez MV, Willis SL, Stratford PW (2006) Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol 17(8):1335–1343PubMedCrossRefGoogle Scholar
  24. 24.
    Loewe C, Schindl M, Cejna M, Niederle B, Lammer J, Thurnher S (2003) Permanent transarterial embolization of neuroendocrine metastases of the liver using cyanoacrylate and lipiodol: assessment of mid- and long-term results. AJR Am J Roentgenol 180(5):1379–1384PubMedGoogle Scholar
  25. 25.
    Marlink RG, Lokich JJ, Robins JR, Clouse ME (1990) Hepatic arterial embolization for metastatic hormone-secreting tumors: technique, effectiveness, and complications. Cancer 65(10):2227–2232PubMedCrossRefGoogle Scholar
  26. 26.
    Maton PN (1988) The carcinoid syndrome. JAMA 260(11):1602–1605PubMedCrossRefGoogle Scholar
  27. 27.
    Modlin IM, Sandor A (1997) An analysis of 8305 cases of carcinoid tumors. Cancer 79(4):813–829PubMedCrossRefGoogle Scholar
  28. 28.
    Moertel CG, Lefkopoulo M, Lipsitz S, Hahn RG, Klaassen D (1992) Streptozocin doxorubicin, streptozocin fluorouracil, or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 326(8):519–523PubMedCrossRefGoogle Scholar
  29. 29.
    Musunuru S, Chen H, Rajpal S et al (2006) Metastatic neuroendocrine hepatic tumors: resection improves survival. Arch Surg 141(10):1000–1004PubMedCrossRefGoogle Scholar
  30. 30.
    Ollivier S, Fonck M, Becouarn Y, Brunet R (1998) Dacarbazine, fluorouracil, and leucovorin in patients with advanced neuroendocrine tumors: a phase II trial. Am J Clin Oncol Cancer Clinical Trials 21(3):237–240Google Scholar
  31. 31.
    Osborne DA, Zervos EE, Strosberg J et al (2006) Improved outcome with cytoreduction versus embolization for symptomatic hepatic metastases of carcinoid and neuroendocrine tumors. Ann Surg Oncol 13(4):572–581PubMedCrossRefGoogle Scholar
  32. 32.
    Rhee TK, Lewandowski RJ, Liu DM et al (2008) Y-90 radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg 247(6):1029–1035PubMedCrossRefGoogle Scholar
  33. 33.
    Rinke A, Muller HH, Schade-Brittinger C et al (2009) Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol 27(28):4656–4663PubMedCrossRefGoogle Scholar
  34. 34.
    Rougier P, Mitry E (2000) Chemotherapy in the treatment of neuroendocrine malignant tumors. Digestion 62:73–78PubMedCrossRefGoogle Scholar
  35. 35.
    Ruszniewski P, Malka D (2000) Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumors. Digestion 62:79–83PubMedCrossRefGoogle Scholar
  36. 36.
    Ruutiainen AT, Soulen MC, Tuite CM et al (2007) Chemoembolization and bland embolization of neuroendocrine tumor metastases to the liver. J Vasc Interv Radiol 18(7):847–855PubMedCrossRefGoogle Scholar
  37. 37.
    Schnirer II, Yao JC, Ajani JA (2003) Carcinoid: a comprehensive review. Acta Oncologica 42(7):672–692PubMedCrossRefGoogle Scholar
  38. 38.
    Therasse E, Breittmayer F, Roche A et al (1993) Transcatheter chemoembolization of progressive carcinoid liver metastasis. Radiology 189(2):541–547PubMedGoogle Scholar
  39. 39.
    van der Lely AJ, de Herder WW (2005) Carcinoid syndrome: diagnosis and medical management. Arq Bras Endocrinol Metabol 49(5):850–860PubMedCrossRefGoogle Scholar
  40. 40.
    Varela M, Real MI, Burrel M et al (2007) Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 46(3):474–481PubMedCrossRefGoogle Scholar
  41. 41.
    Venook AP (1999) Embolization and chemoembolization therapy for neuroendocrine tumors. Curr Opin Oncol 11(1):38–41PubMedCrossRefGoogle Scholar
  42. 42.
    Yao JC, Hassan M, Phan A et al (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26(18):3063–3072PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011

Authors and Affiliations

  • Shantanu K. Gaur
    • 1
  • Jeremy L. Friese
    • 1
  • Cheryl A. Sadow
    • 2
  • Rajasekhara Ayyagari
    • 1
  • Christoph A. Binkert
    • 3
  • Matthew P. Schenker
    • 1
  • Matthew Kulke
    • 4
  • Richard Baum
    • 1
    Email author
  1. 1.Brigham & Women’s Hospital, Angiography and Interventional RadiologyBostonUSA
  2. 2.Department of RadiologyBrigham & Women’s HospitalBostonUSA
  3. 3.Department of RadiologyKantonsspital WinterthurWinterthurSwitzerland
  4. 4.Department of Adult OncologyDana-Farber Cancer InstituteBostonUSA

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