Defining predictors for long progression-free survival after radioembolisation of hepatic metastases of neuroendocrine origin
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To define predictive parameters of long progression-free survival (PFS) in patients undergoing radioembolisation of neuroendocrine liver metastases.
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.
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.
Response to radioembolisation in patients with neuroendocrine liver metastases can be predicted by the metastatic vascularisation pattern, the NSE level and the Ki-67.
• 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.
KeywordsRadioembolisation Neuroendocrine liver metastases Magnetic resonance Vascularisation Ki-67 proliferation index
Neuroendocrine liver metastasis
Turbo spin echo
- 3D GRE
Three-dimensional gradient recalled echo
Trans-catheter arterial embolisation
Trans-catheter arterial chemoembolisation
Selective internal radiation therapy
Peptide receptor targeted therapy