Radioembolization with 90Y Resin Microspheres of Neuroendocrine Liver Metastases: International Multicenter Study on Efficacy and Toxicity

Abstract

Purpose

Radioembolization of liver metastases of neuroendocrine neoplasms (NEN) has shown promising results; however, the current literature is of limited quality. A large international, multicentre retrospective study was designed to address several shortcomings of the current literature.

Materials

244 NEN patients with different NEN grades were included.

Methods

Primary outcome parameters were radiologic response 3 and 6 months after treatment according to RECIST 1.1 and mRECIST. Secondary outcome parameters included clinical response, clinical and biochemical toxicities.

Results

Radioembolization resulted in CR in 2%, PR in 14%, SD in 75% and PD 9% according to RECIST 1.1 and in CR in 8%, PR in 35%, SD in 48% and PD in 9% according to mRECIST. Objective response rates improved over time in 20% and 26% according to RECIST 1.1. and mRECIST, respectively. Most common new grade 3–4 biochemical toxicity was lymphocytopenia (6.7%). No unexpected clinical toxicities occurred. Radioembolization-specific complications occurred in < 4%. In symptomatic patients, improvement and resolution of symptoms occurred in 44% and 34%, respectively. Median overall survival from first radioembolization was 3.7, 2.7 and 0.7 years for G1, G2 and G3, respectively. Objective response is independent of NEN grade or primary tumour origin. Significant prognostic factors for survival were NEN grade/Ki67 index, ≥ 75% intrahepatic tumour load, the presence of extrahepatic disease and disease control rate according to RECIST 1.1.

Conclusion

Safety and efficacy of radioembolization in NEN patients was confirmed with a high disease control rate of 91% in progressive patients and alleviation of NEN-related symptoms in 79% of symptomatic patients.

Level of evidence

4.

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Funding

Travel expenses and accommodations of AJATB were partially covered by Sirtex Medical Europe, producer of SIR-spheres. Remaining travel expenses were granted by the Girard de Mielet van Coehoorn Foundation (Grant of the Board of Directors UMC Utrecht, the Netherlands). Both parties have no access to the data and have not been involved in data analysis or in the writing of the manuscript.

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Correspondence to A. J. A. T. Braat.

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Conflict of interest

C.M.D. has acted as a consultant for Sirtex, Bayer Healthcare and Ipsen. A.F. receives research funding from Ipsen, Novartis and Sirtex Medical. D.B.B is a consultant for BTG, receives research funding from Sirtex and has served on a speaker’s bureau for Boston Scientific. D.Y.S. has acted as consultant for BTG, Boston Scientific, Amgen, EmbolX and Viralytics. M.G.E.H.L. has acted as a consultant for BTG, Sirtex, Mirada and Bayer Healthcare. All other authors have no conflicts of interest to declare.

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Braat, A.J.A.T., Kappadath, S.C., Ahmadzadehfar, H. et al. Radioembolization with 90Y Resin Microspheres of Neuroendocrine Liver Metastases: International Multicenter Study on Efficacy and Toxicity. Cardiovasc Intervent Radiol 42, 413–425 (2019). https://doi.org/10.1007/s00270-018-2148-0

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Keywords

  • Radioembolization
  • SIRT
  • NEN
  • NET
  • Neuroendocrine tumor