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Percutaneous Laser Ablation of Liver Metastases from Neuroendocrine Neoplasm. A Retrospective Study for Safety and Effectiveness

  • Sergio SartoriEmail author
  • Paola Tombesi
  • Francesca Di Vece
  • Lara Bianchi
  • Rosaria Ambrosio
Clinical Investigation Interventional Oncology
  • 1 Downloads
Part of the following topical collections:
  1. Interventional Oncology

Abstract

Purpose

To retrospectively assess safety and efficacy of laser ablation (LA) of multiple liver metastases (LM) from neuroendocrine neoplasms (NEN).

Methods

Twenty-one patients with NEN and at least 3 LM ≤ 4 cm in diameter underwent ultrasonography-guided LA. Up to seven LM were ablated in a single session; if the number of LM exceeded seven, the remaining LM were ablated in further LA sessions with a time interval of 3–4 weeks. LA was performed according to the multifiber technique. The patients underwent contrast-enhanced CT 1 month after LA, and were subsequently monitored every 3 months for the first 2 years and then every 6 months.

Results

In total, 189 LM were treated in 21 patients (mean 9 ± 8.2, median 6) in 41 LA sessions (range 1–5). The diameter of LM ranged from 5 to 35 mm (median 19 mm, mean 17.9 ± 6.4 mm). One grade 4 complication occurred (0.53%): a bowel perforation managed by surgery. Technical efficacy was 100%, primary efficacy rate 94.7%, and secondary efficacy rate 100%. Complete relief of hormone-related symptoms was obtained in all the 13 symptomatic patients. Median follow-up was 39 months (range 12–99). 1-, 2-, 3-, and 5-year survival rates were 95%, 86%, 66%, and 40%, respectively. Overall survival resulted higher for patients with Ki-67 expression ≤ 7% than for those with Ki-67 > 7% (p = 0.0347).

Conclusions

LA is a promising and safe technique to treat LM from NEN. A longer follow-up should provide definitive information on the long-term efficacy of this liver-directed therapy.

Level of Evidence

Retrospective study, local non-random sample, level 3.

Keywords

Neuroendocrine tumors Liver neoplasms Ablation techniques Laser therapy 

Notes

Funding

This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standards

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.

Informed Consent

This study has obtained institutional review board approval from the IRB of St. Anna Hospital, and the need for informed consent was waived.

References

  1. 1.
    Kolbec KJ, Farsad K. Catheter-based treatments for hepatic metastases from neuroendocrine tumors. Am J Roentgenol. 2014;203:717–24.CrossRefGoogle Scholar
  2. 2.
    Ho AS, Picus J, Darcy MD, et al. Long-term outcome after chemoembolization and embolization of hepatic metastatic lesions from neuroendocrine tumors. Am J Roentgenol. 2007;188:1201–7.CrossRefGoogle Scholar
  3. 3.
    Elias D, Goerè D, Leroux G, et al. Combined liver surgery and RFA for patients with gastroenteropancreatic endocrine tumors presenting with more than 15 metastases to the liver. Eur J Surg Oncol. 2009;35:1092–7.CrossRefGoogle Scholar
  4. 4.
    Gillams A, Cassoni A, Conway G, Lees W. Radiofrequency ablation of neuroendocrine liver metastases: the Middlesex experience. Abdom Imaging. 2005;30:435–41.CrossRefGoogle Scholar
  5. 5.
    Fairweather M, Swanson R, Wang J, et al. Management of neuroendocrine tumor liver metastases: long-term outcomes and prognostic factors from a large prospective database. Ann Surg Oncol. 2017;24:2319–25.CrossRefGoogle Scholar
  6. 6.
    Cavalcoli F, Rausa E, Conte D, Nicolini AF, Massironi S. Is there still a role for the hepatic locoregional treatment of metastatic neuroendocrine tumors in the era of systemic targeted terapies? World J Gastroenterol. 2017;23(15):2640–50.CrossRefGoogle Scholar
  7. 7.
    Howe JR, Cardona K, Fraker DL, et al. The surgical management of small bowel neuroendocrine tumors. Consensus guidelines of the North American Neuroendocrine Tumor Society. Pancreas. 2017;46(6):715–31.CrossRefGoogle Scholar
  8. 8.
    Öberg K, Knigge U, Kwekkeboom D, Perren A, ESMO Guidelines Working Group. Neuroendocrine gastro-entero-pancreatic tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(Suppl 7):124–30.Google Scholar
  9. 9.
    Kunz PL, Reidy-Lagunes D, Anthony LB, North American Neuroendocrine Tumor Society, et al. Consensus guidelines for the management and treatment of neuroendocrine tumors. Pancreas. 2013;42(4):557–77.CrossRefGoogle Scholar
  10. 10.
    Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM, Que FG. Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg. 2003;197(1):29–37.CrossRefGoogle Scholar
  11. 11.
    Mayo SC, de Jong MC, Pulitano C, et al. Surgical management of hepatic neuroendocrine tumor metastasis: results from an international multi-institutional analysis. Ann Surg Oncol. 2010;17(12):3129–36.CrossRefGoogle Scholar
  12. 12.
    Tombesi P, Di Vece F, Sartori S. Radiofrequency, microwave, and laser ablation of liver tumors: time to move toward a tailored ablation technique? Hepatoma Res. 2015;1:52–7.CrossRefGoogle Scholar
  13. 13.
    Sartori S, Di Vece F, Ermili F, Tombesi P. Laser ablation of liver tumors: an ancillary technique, or an alternative to radiofrequency and microwave? World J Radiol. 2017;9:91–6.CrossRefGoogle Scholar
  14. 14.
    Qian GJ, Wang N, Shen Q, et al. Efficacy of microwave versus radiofrequency ablation for treatment of small hepatocellular carcinoma: experimental and clinical studies. Eur Radiol. 2012;22:1983–90.CrossRefGoogle Scholar
  15. 15.
    Di Vece F, Tombesi P, Ermili F, Maraldi C, Sartori S. Coagulation areas produced by cool-tip radiofrequency ablation and microwave ablation using a device to decrease back-heating effects: a prospective pilot study. Cardiovasc Intervent Radiol. 2014;37:723–9.Google Scholar
  16. 16.
    Ferrari FS, Megliola A, Scorzelli A, et al. Treatment of small HCC through radiofrequency ablation and laser ablation. Comparison of techniques and long-term results. Radiol Med. 2007;112:377–93.CrossRefGoogle Scholar
  17. 17.
    Di Costanzo GG, Tortora R, D’Adamo G, et al. Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: a randomized trial. J Gastroenterol Hepatol. 2015;30:559–65.CrossRefGoogle Scholar
  18. 18.
    Pacella CM, Bizzarri G, Magnolfi F, et al. Laser thermal ablation in the treatment of small hepatocellular carcinoma: results in 74 patients. Radiology. 2001;221:712–20.CrossRefGoogle Scholar
  19. 19.
    Di Costanzo GG, D’Adamo G, Tortora R, et al. A novel needle guide system to perform percutaneous laser ablation of liver tumors using the multifiber technique. Acta Radiol. 2013;54:876–81.CrossRefGoogle Scholar
  20. 20.
    Akyildiz HY, Mitchell J, Milas M, Siperstein A, Berber E. Laparoscopic radiofrequency thermal ablation of neuroendocrine hepatic metastases: long-term follow-up. Surgery. 2010;148:1288–93.CrossRefGoogle Scholar
  21. 21.
    Wessels FJ, Schell SR. Radiofrequency ablation treatment of refractory carcinoid hepatic metastases. J Surg Res. 2001;95:8–12.CrossRefGoogle Scholar
  22. 22.
    Taner T, Atwell TD, Zhang L, et al. Adjunctive radiofrequency ablation of metastatic neuroendocrine cancer to the liver complements surgical resection. HPB (Oxford). 2013;15:190–5.CrossRefGoogle Scholar
  23. 23.
    Henn AR, Levine EA, McNulty W, Zagoria RJ. Percutaneous radiofrequency ablation of hepatic metastases for symptomatic relief of neuroendocrine syndromes. Am J Roentgenol. 2003;181:1005–10.CrossRefGoogle Scholar
  24. 24.
    Mazzaglia PJ, Berber E, Milas M, Siperstein AE. Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival. Surgery. 2007;142:10–9.CrossRefGoogle Scholar
  25. 25.
    Berber E, Flesher N, Siperstein AE. Laparoscopic radiofrequency ablation of neuroendocrine liver metastases. World J Surg. 2002;26:985–90.CrossRefGoogle Scholar
  26. 26.
    Hellman P, Ladjevardi S, Skogseid B, Akerstrom G, Elvin A. Radiofrequency tissue ablation using cooled tip for liver metastases of endocrine tumors. World J Surg. 2002;26:1052–6.CrossRefGoogle Scholar
  27. 27.
    Elvin A, Skogseid B, Hellman P. Radiofrequency ablation of neuroendocrine liver metastases. Abdom Imaging. 2005;30:427–34.CrossRefGoogle Scholar
  28. 28.
    Wang W, Seeruttun SR, Fang C, Zhou Z. Comprehensive treatment of a functional pancreatic neuroendocrine tumor with multifocal liver metastases. Chin J Cancer Res. 2014;26(4):501–6.Google Scholar
  29. 29.
    Perälä J, Klemola R, Kallio R, et al. MRI-guided laser ablation of neuroendocrine tumor hepatic metastases. Acta Radiol Short Rep. 2014;3(1):2047981613499753.Google Scholar
  30. 30.
    Tombesi P, Di Vece F, Sartori S. Laser ablation for hepatic metastases from neuroendocrine tumors. AJR Am J Roentgenol. 2015;204(6):W732.CrossRefGoogle Scholar
  31. 31.
    Ahmed M, Solbiati L, Brace CL, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. J Vasc Interv Radiol. 2014;25:1691–705.CrossRefGoogle Scholar
  32. 32.
    Filippiadis DK, Binkert C, Pellerin O, et al. CIRSE quality assurance document and standards for classification of complications: the CIRSE classification system. Cardiovasc Intervent Radiol. 2017;40:1141–6.CrossRefGoogle Scholar
  33. 33.
    Oberg K, Astrup L, Eriksson B, Nordic NE Tumour Group, et al. Guidelines for management of gastropancreatic neuroendocrine tumours. Acta Oncol. 2004;43:617–25.CrossRefGoogle Scholar
  34. 34.
    Ramage JK, Davies AH, Ardill J, UKNET Work for Neuroendocrine Tumours, et al. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut. 2005;54(suppl 4):iv1–16.Google Scholar
  35. 35.
    Maxwell JE, Sherman SK, O’Dorisio TM, et al. Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy? Surgery. 2016;159:320–33.CrossRefGoogle Scholar
  36. 36.
    Chambers AJ, Pasieka JL, Dixon E, et al. The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors. Surgery. 2008;144:645–51.CrossRefGoogle Scholar
  37. 37.
    Graff-Baker AN, Sauer DA, Pommier SJ, et al. Expanded criteria for carcinoid liver debulking: maintaining survival and increasing the number of eligible patients. Surgery. 2014;156:1369–76.CrossRefGoogle Scholar
  38. 38.
    Braat AJAT, Kappadath SC, Ahmadzadehfar H, et al. Radioembolization with 90Y resin microspheres of neuroendocrine liver metastases: international multicenter study on efficacy and toxicity. Cardiovasc Intervent Radiol. 2019;42(3):413–25.CrossRefGoogle Scholar
  39. 39.
    Mohan H, Nicholson P, Winter DC, et al. Radiofrequency ablation for neuroendocrine liver metastases: a systematic review. J Vasc Interv Radiol. 2015;26:935–42.CrossRefGoogle Scholar
  40. 40.
    Pacella CM, Francica G, Di Lascio FM, et al. Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. J Clin Oncol. 2009;27:2615–21.CrossRefGoogle Scholar
  41. 41.
    Puls R, Langner S, Rosenberg C, et al. Laser ablation of liver metastases from colorectal cancer with MR thermometry: 5-year survival. J Vasc Interv Radiol. 2009;20:225–34.CrossRefGoogle Scholar
  42. 42.
    Vogl TJ, Dommermuth A, Heinle B, et al. Colorectal cancer liver metastases: long-term survival and progression-free survival after thermal ablation using magnetic resonance-guided laser-induced interstitial thermotherapy in 594 patients: analysis of prognostic factors. Invest Radiol. 2014;49:48–56.CrossRefGoogle Scholar
  43. 43.
    Genc CG, Falconi M, Partelli S, et al. Recurrence of pancreatic neuroendocrine tumors and survival predicted by Ki67. Ann Surg Oncol. 2018.  https://doi.org/10.1245/s10434-018-6518-2.Google Scholar
  44. 44.
    Milione M, Maisonneuve P, Pellegrinelli A, et al. Ki67 proliferative index of the neuroendocrine component drives MANEC prognosis. Endocr Relat Cancer. 2018;25(5):583–93.CrossRefGoogle Scholar

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.Section of Interventional UltrasoundSt. Anna HospitalFerraraItaly
  2. 2.Endocrinology UnitSt. Anna HospitalFerraraItaly

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