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Chemoembolization of Neuroendocrine Liver Metastases Using Streptozocin and Tris-acryl Microspheres: Embozar (EMBOsphere + ZAnosaR) Study

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An Erratum to this article was published on 18 January 2017

Abstract

Purpose

The purpose of this prospective observational study was to evaluate the efficacy and tolerability of transarterial chemoembolization (TACE) for neuroendocrine liver metastases using a combination of streptozocin, Lipiodol, and tris-acryl microspheres.

Patients and Methods

A total of 16 men and 9 women aged 59.6 ± 11.3 years, all with predominant liver disease, underwent 54 courses of TACE using an emulsion of 1.5 g of streptozocin and 10 ml of Lipiodol. Additional embolization was performed using 300–500 µm tris-acryl microspheres. Morphological response was evaluated using the RECIST criteria on multi-detector computed tomography or MRI. Clinical efficacy was evaluated particularly in patients with carcinoid syndrome.

Results

The primary tumor was located in the small bowel or pancreas in 21 (84%) patients. Eleven (44%) patients presented with a carcinoid syndrome. Nineteen (76%) patients presented with more than 10 liver nodules. One delayed case of ischemic cholecystitis was treated conservatively. After a median follow-up of 36.1 months, 1 (4%) patient had a complete response, 12 (48%) patients had a partial response, and 7 (28%) patients had a stable disease corresponding to a disease control rate of 80%. All patients with carcinoid syndrome had significant improvement. Median time to progression was 18.8 months and overall survival was 100, 100, and 92% at 1, 2, and 3 years, respectively. Seven patients presented with extrahepatic progression with abdominal lymphadenopathies or metastases to the brain, ovary, adrenal gland, or lung.

Conclusion

Optimized TACE using a combination of streptozocin, Lipiodol, and tris-acryl microspheres is effective and well tolerated.

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Authors and Affiliations

  1. Department of Diagnostic Imaging and Interventional Radiology, Caen University and Medical Center, Avenue Cote de Nacre, 14033, Caen Cedex 9, France

    Jean-Pierre Pelage & Audrey Fohlen

  2. CERVOxy, CEA, CNRS, ISTCT - Imagerie et Stratégie Thérapeutiques des Pathologies Cérébrales et Tumorales (M Bernaudin), Université de Basse-Normandie UNICAEN, Caen, France

    Jean-Pierre Pelage & Audrey Fohlen

  3. Department of Hepatogastroenterology and Oncology, Hopital Ambroise Pare, 9, Avenue Charles de Gaulle, 92104, Boulogne Cedex, France

    Emmanuel Mitry & Philippe Rougier

  4. Department of Radiology, Hopital Ambroise Pare, 9, Avenue Charles de Gaulle, 92104, Boulogne Cedex, France

    Christine Lagrange

  5. Department of Biostatistics and Public Health, Hopital Ambroise Pare, 9, Avenue Charles de Gaulle, 92104, Boulogne Cedex, France

    Alain Beauchet

Authors
  1. Jean-Pierre Pelage
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  2. Audrey Fohlen
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  4. Christine Lagrange
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  6. Philippe Rougier
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Corresponding author

Correspondence to Jean-Pierre Pelage.

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Conflict of interest

Jean-Pierre Pelage Research grants and consultant: Merit Medical, Terumo, ALN. Consultant: Boston Scientific, Cook, Keocyt, Guerbet. Audrey Fohlen Research grants and consultant: Guerbet. Consultant: Cook. Emmanuel Mitry Consultant: Keocyt. Philippe Rougier Consultant: Keocyt. The other authors have no conflict of interest to disclose.

Ethical Standards

The study was in accordance with the ethical standards of the institutional committee and was approved by the Institutional Review Board.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00270-017-1573-9.

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Pelage, JP., Fohlen, A., Mitry, E. et al. Chemoembolization of Neuroendocrine Liver Metastases Using Streptozocin and Tris-acryl Microspheres: Embozar (EMBOsphere + ZAnosaR) Study. Cardiovasc Intervent Radiol 40, 394–400 (2017). https://doi.org/10.1007/s00270-016-1535-7

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  • DOI: https://doi.org/10.1007/s00270-016-1535-7

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