Outcomes After Transarterial Embolization of Neuroendocrine Tumor Liver Metastases Using Spherical Particles of Different Sizes

  • Rebecca Zener
  • Hyukjun Yoon
  • Etay Ziv
  • Anne Covey
  • Karen T. Brown
  • Constantinos T. Sofocleous
  • Raymond H. Thornton
  • F. Edward Boas
Clinical Investigation Interventional Oncology
Part of the following topical collections:
  1. Interventional Oncology
  2. Interventional Oncology



To evaluate initial response and overall survival of neuroendocrine tumor (NET) liver metastases initially treated with transarterial embolization (TAE) using spherical particles of different sizes.


A single-institution retrospective review was performed of 160 patients with NET liver metastases initially treated with TAE using < 100 µm (n = 77) or only ≥ 100 µm (n = 83) spherical particles. For each patient, we evaluated: initial response by mRECIST, time to progression, overall survival, complications, primary site, tumor grade and degree of differentiation, volume of liver disease, extrahepatic disease, NET-related symptoms, comorbidities, Child–Pugh score, performance status, lobar versus selective embolization, and arteriovenous shunting.


Initial response was higher for TAE using particles < 100 versus TAE using only particles ≥ 100 μm (64 vs 42%, p = 0.007). Multivariate logistic regression showed that use of particles < 100 μm and liver < 50% replaced with tumor were independent predictors of a better initial response rate. There was no difference in major or minor complications between the two particle size groups. Median overall survival after TAE was 55 months for well- to moderately differentiated NET and 13 months for poorly differentiated or undifferentiated NET. There was no significant difference in survival between TAE patients treated with < 100 versus only ≥ 100-μm particles.


NET patients treated with TAE using particles < 100 μm had better initial response, but the same overall survival, compared to TAE using only particles ≥ 100 μm.


Neuroendocrine tumor Carcinoid Transarterial embolization Particle size 



This research was funded in part through an NIH/NCI Cancer Center Support Grant (P30 CA008748).


This research was funded in part through an NIH/NCI Cancer Center Support Grant (P30 CA008748). The funding source played no role in study design, data collection, data analysis, or writing the manuscript.

Compliance with Ethical Standards

Conflict of interest

FEB is a co-founder of Claripacs, LLC. He received research funding (investigator-initiated) and support for research meetings from Guerbet. He received research support (investigator-initiated) from GE. He received research supplies (investigator-initiated) from Bayer. He received a research grant and speaker fees from Society of Interventional Oncology, which were sponsored by Guerbet. He is an investor in Labdoor, Qventus, CloudMedx, and Notable Labs. AC is on the advisory board for Accurate Medical and is a stockholder in Amgen. EZ received an investigator-initiated industry research grant from Johnson & Johnson and has a pending investigator-initiated research grant from AAA-Novartis.

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 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This HIPAA-compliant retrospective study was approved by the IRB.

Informed Consent

For this type of study, informed consent is not required. This study has obtained IRB approval from Memorial Sloan Kettering Cancer Center, and the need for informed consent was waived.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Interventional Radiology Service, Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA

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