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Treatment of Neuroendocrine Tumors with Selective Internal Radiation Therapy

  • Douglas M. Coldwell
  • Martin Vyleta
  • Mahmood Samman
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

The pathophysiology of neuroendocrine tumors (NET) is discussed and the differences in types of tumors within this broad category are highlighted. While carcinoid is the most common of the NETs, the general principles of treatment can be extrapolated to the NETs in general. The chemotherapy treatments have not been historically very effective and the major treatment is surgery with removal of the primary as well as debulking metastases. This regimen only occurs in a small minority of patients since the disease has metastasized to the liver in 90 % of cases. Unresectable disease can be treated with modern chemotherapy for small cell cancer with reasonable results but loco-regional treatment of the liver disease is the primary treatment utilized. While ablative therapies can treat one lesion at a time, most patients benefit from having a regional approach to their treatment. Use of 90Yttrium beads has been demonstrated to not only be safe and effective but also to permit significant quality of life since the treatments are performed on an outpatient basis.

Keywords

Neuroendocrine Tumor Carcinoid Tumor Carcinoid Syndrome Selective Internal Radiation Therapy Midgut Carcinoid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Biku JJ, Davidson BR (2012) Treatment options for unresectable neuroendocrine lever metastases. Expert Rev Gastroenterol Hepatol 6:357–369CrossRefGoogle Scholar
  2. Chamberlain RS, Brown KT, Canes D et al (2000) Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 190:432–445PubMedCrossRefGoogle Scholar
  3. Dhand S, Gupta R (2011) Hepatic transcatheter arterial chemoembolization complicated by postembolization syndrome. Semin Intervent Radiol 28:207–2011PubMedCentralPubMedCrossRefGoogle Scholar
  4. Doherty G (2011) Neuroendocrine tumors and the Carcinoid syndrome. In: DeVita V, Lawrence T, Rosenberg S (eds) Cancer principles and practice of oncology, 9th edn. Lippincott, Williams and Wilkins, PhiladelphiaGoogle Scholar
  5. Gupta S, Johnson MM, Murthy R et al (2005) Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors. Cancer 104:1590–1602PubMedCrossRefGoogle Scholar
  6. Hassan MM, Yao JC (2011) Global epidemiology of neuroendocrine tumors. In: Yao JO, Hoff PM, Hoff AO (eds) Neuroendocrine tumors. Humana Press, Springer, New YorkGoogle Scholar
  7. Jones NB, Shah MH, Bloomston M (2012) Liver-Directed therapies in patients with advanced neuroendocrine tumors. J Natl Compr Canc Netw 10:765–774PubMedGoogle Scholar
  8. Kennedy AS, Nutting C, Coldwell DM et al (2004) Pathologic response and microdosimetry of 90Y-microspheres in man: review of four explanted whole livers. Int J Radiat Oncol Biol Phys 60:1552–1563PubMedCrossRefGoogle Scholar
  9. Kennedy AS, Dezarn WA, McNeillie P, Coldwell D et al (2008) Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol 31:271–279PubMedCrossRefGoogle Scholar
  10. Kennedy A, Coldwell D, Sangro B, Wasan H, Salem R (2011) Integrating radioembolization into the treatment paradigm for metastatic neuroendocrine tumors in the liver. Am J Clin Oncol (Epub ahead of print)Google Scholar
  11. King J, Quinn R, Glenn D et al (2008) Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer 113:921–929PubMedCrossRefGoogle Scholar
  12. Kolby L, Persson G, Franzen S et al (2003) Randomized clinical trial of the effect of interferon alpha on survival in patients with disseminated midgut carcinoid tumours. Br J Surg 90:687–693PubMedCrossRefGoogle Scholar
  13. Kulke M, Benson A, Bergsland E et al (2012) Neuroendocrine tumors. J Natl Compr Canc Netw 10:724–764PubMedGoogle Scholar
  14. Landry CS, Rich T, Jimenez C, Grubbs EG, Lee JE, Perrier ND (2011) Multiple endocrine Neoplasia. In: Yao JO, Hoff PM, Hoff AO (eds) Neuroendocrine tumors. Humana Press, New York, New YorkGoogle Scholar
  15. Laverman P, Sosabowski JK, Boerman OC, Oyen WJG (2012) Radiolabelled peptides for oncological diagnosis. Eur J Nucl Med Mol Imaging 39(Suppl 1):78–92PubMedCentralCrossRefGoogle Scholar
  16. Madoff D, Gupta S, Ahrar K et al (2006) Update on the management of neuroendocrine hepatic metastases. J Vasc Interv Radiol 17:1235–1250PubMedCrossRefGoogle Scholar
  17. Mitry E, Baudin E, Ducreux M et al (1999) Treatment of poorly differentiated neuroendocrine tumours with etoposide and cisplatin. Br J Cancer 81:1351–1355PubMedCentralPubMedCrossRefGoogle Scholar
  18. O’Toole D, Ruszniewski P (2005) Chemoembolization and other ablative therapies for liver metastases of gastrointestinal endocrine tumours. Best Pract Res Clin Gastroenterol 19:585–594PubMedCrossRefGoogle Scholar
  19. Robiolio PA, Rigolin VH, Wilson JS et al (1995) Carcinoid heart disease correlation of high serotonin levels with valvular abnormalities detected by cardiac catheterization and echocardiography. Circulation 92:790–795PubMedCrossRefGoogle Scholar
  20. Ruutiainen AT, Soulen MC, Tuite CM et al (2007) Chemoembolization and bland embolization of neuroendocrine tumor metastases to the liver. J Vasc Interv Radiol 18:847–855PubMedCrossRefGoogle Scholar
  21. Saxena A, Chua TC, Bester L et al (2010) Factors predicting response and survival after yttrium-90 radioembolization of unresectable neuroendocrine tumor liver metastases: a critical appraisal of 48 cases. Ann Surg 251:910–916PubMedCrossRefGoogle Scholar
  22. Singh S, Law C (2012) Chromogranin A: a sensitive biomarker for the detection and post-treatment monitoring of gastroenteropancreatic neuroendocrine tumors. Expert Rev Gastroenterol Hepatol 6:313–334PubMedCrossRefGoogle Scholar
  23. Soga J, Yakuwa Y, Osaka M (1999) Carcinoid syndrome: a statistical evaluation of 748 reported cases. J Exp Clin Cancer Res 18:133–141PubMedGoogle Scholar
  24. Vyleta M, Coldwell D (2011) Radioembolization in the treatment of neuroendocrine tumor metastases to the liver. Int J Hepatol 2011: 785315, Epub Dec 22Google Scholar
  25. Yao KA, Talamonti MS, Nemcek A et al (2001) Indications and results of liver resection and hepatic chemoembolization for metastatic gastrointestinal neuroendocrine tumors. Surgery 130:677–682PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Douglas M. Coldwell
    • 1
  • Martin Vyleta
    • 1
  • Mahmood Samman
    • 1
  1. 1.Department of RadiologyUniversity of LouisvilleLouisvilleUSA

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