Role of Interventional Radiology in the Treatment of Patients with Neuroendocrine Metastases in the Liver

View More View Less
  • 1 H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida

Management of liver metastasis from neuroendocrine tumors routinely includes an interventional radiologist. Hepatic artery embolization, either bland (transarterial embolization) or with chemotherapy (transarterial chemoembolization), has been shown to improve response rates in neuroendocrine metastases to the liver. Radiofrequency ablation, cryotherapy, and percutaneous alcohol ablation are important adjuncts or alternative treatments to surgical debulking. In this article, the authors examine important techniques in the armamentarium of the interventional radiologist.

If the inline PDF is not rendering correctly, you can download the PDF file here.

Correspondence: Larry K. Kvols, MD, Neuroendocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612. E-mail: larry.kvols@moffitt.org
  • 1

    Moertel CG, Johnson CM, McKusick MA. The management of patients with advanced carcinoid tumors and islet cell carcinomas. Ann Intern Med 1994;120:302309.

    • Search Google Scholar
    • Export Citation
  • 2

    Carrasco CH, Charnsangavej C, Ajani J. The carcinoid syndrome: palliation by hepatic artery embolization. AJR Am J Roentgenol 1986;147:149154.

    • Search Google Scholar
    • Export Citation
  • 3

    Ajani JA, Carrasco CH, Charnsangavej C. Islet cell tumors metastatic to the liver: effective palliation by sequential hepatic artery embolization. Ann Intern Med 1988;108:340344.

    • Search Google Scholar
    • Export Citation
  • 4

    Clark OH, Ajani JA, Benson AB. NCCN Clinical Practice Guidelines in Oncology: Neuroendocrine Tumors. Version 1, 2008. Available at: www.nccn.org/professionals/physician_gls/PDF,neuroendocrine.pdf. Accessed January 3, 2009.

    • Search Google Scholar
    • Export Citation
  • 5

    Proye C. Natural history of liver metastasis of gastroenteropancreatic neuroendocrine tumors: place for chemoembolization. World J Surg 2001;25:685688.

    • Search Google Scholar
    • Export Citation
  • 6

    Blonski WC, Reddy KR, Shaked A. Liver transplantation for metastatic neuroendocrine tumor: a case report and review of the literature. World J Gastroenterol 2005;11:76767683.

    • Search Google Scholar
    • Export Citation
  • 7

    Sutcliffe R, Maguire D, Ramage J. Management of neuroendocrine liver metastases. Am J Surg 2004;187:3946.

  • 8

    Pichlmayr R, Weimann A, Oldhafer KJ. Appraisal of transplantation for malignant tumours of the liver with special reference to early stage hepatocellular carcinoma. Eur J Surg Oncol 1998;24:6067.

    • Search Google Scholar
    • Export Citation
  • 9

    Le Treut YP, Delpero JR, Dousset B. Results of liver transplantation in the treatment of metastatic neuroendocrine tumors. A 31-case French multicentric report. Ann Surg 1997;225:355364.

    • Search Google Scholar
    • Export Citation
  • 10

    Venook AP. Embolization and chemoembolization therapy for neuroendocrine tumors. Curr Opin Oncol 1999;11:3841.

  • 11

    Strosberg JR, Choi J, Cantor AB, Kvols LK. Selective hepatic artery embolization for treatment of patients with metastatic carcinoid and pancreatic endocrine tumors. Cancer Control 2006;13:7278.

    • Search Google Scholar
    • Export Citation
  • 12

    Ruszniewski P. Interventional radiology: less invasive or less effective? In: Irvin M, Modlin KO, eds. A Century of Aadvances in Neuroendocrine Tumor Biology and Treatment. Hanover, Germany: Felsenstein CCCP; 2007.

    • Search Google Scholar
    • Export Citation
  • 13

    Dominguez S, Denys A, Madeira I. Hepatic arterial chemoembolization with streptozotocin in patients with metastatic digestive endocrine tumours. Eur J Gastroenterol Hepatol 2000;12:151157.

    • Search Google Scholar
    • Export Citation
  • 14

    Casadei R, Tomassetti P, Rossi C. Treatment of metastatic glucagonoma to the liver: case report and literature review. Ital J Gastroenterol Hepatol 1999;31:308312.

    • Search Google Scholar
    • Export Citation
  • 15

    Lee SM, Forbes A, Williams R. Metastatic islet cell tumour with clinical manifestations of insulin and glucagon excess: successful treatment by hepatic artery embolization and chemotherapy. Eur J Surg Oncol 1988;14:265268.

    • Search Google Scholar
    • Export Citation
  • 16

    Ruszniewski P, Rougier P, Roche A. Hepatic arterial chemoembolization in patients with liver metastases of endocrine tumors. A prospective phase II study in 24 patients. Cancer 1993;71:26242630.

    • Search Google Scholar
    • Export Citation
  • 17

    Therasse E, Breittmayer F, Roche A. Transcatheter chemoembolization of progressive carcinoid liver metastasis. Radiology 1993;189:541547.

  • 18

    Roche A, Girish BV, de Baere T. Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol 2003;13:136140.

    • Search Google Scholar
    • Export Citation
  • 19

    Diaco DS, Hajarizadeh H, Mueller CR. Treatment of metastatic carcinoid tumors using multimodality therapy of octreotide acetate, intra-arterial chemotherapy, and hepatic arterial chemoembolization. Am J Surg 1995;169:523528.

    • Search Google Scholar
    • Export Citation
  • 20

    Clouse ME, Perry L, Stuart K, Stokes KR. Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Digestion 1994;55(Suppl 3):9297.

    • Search Google Scholar
    • Export Citation
  • 21

    Stokes KR, Stuart K, Clouse ME. Hepatic arterial chemoembolization for metastatic endocrine tumors. J Vasc Interv Radiol 1993;4:341345.

  • 22

    Perry LJ, Stuart K, Stokes KR, Clouse ME. Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Surgery 1994;116:11111116; discussion 1116–1117.

    • Search Google Scholar
    • Export Citation
  • 23

    Diamandidou E, Ajani JA, Yang DJ. Two-phase study of hepatic artery vascular occlusion with microencapsulated cisplatin in patients with liver metastases from neuroendocrine tumors. AJR Am J Roentgenol 1998;170:339344.

    • Search Google Scholar
    • Export Citation
  • 24

    Drougas JG, Anthony LB, Blair TK. Hepatic artery chemoembolization for management of patients with advanced metastatic carcinoid tumors. Am J Surg 1998;175:408412.

    • Search Google Scholar
    • Export Citation
  • 25

    Desai DC, O’Dorisio TM, Schirmer WJ. Serum pancreastatin levels predict response to hepatic artery chemoembolization and somatostatin analogue therapy in metastatic neuroendocrine tumors. Regul Pept 2001;96:113117.

    • Search Google Scholar
    • Export Citation
  • 26

    Ruszniewski P, Malka D. Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumors. Digestion 2000;62(Suppl 1):7983.

    • Search Google Scholar
    • Export Citation
  • 27

    Roche A, Girish BV, de Baere T. Prognostic factors for chemoembolization in liver metastasis from endocrine tumors. Hepatogastroenterology 2004;51:17511756.

    • Search Google Scholar
    • Export Citation
  • 28

    Touzios JG, Kiely JM, Pitt SC. Neuroendocrine hepatic metastases: does aggressive management improve survival? Ann Surg 2005;241:776783; discussion 783–775.

    • Search Google Scholar
    • Export Citation
  • 29

    Marrache F, Vullierme MP, Roy C. Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours. Br J Cancer 2007;96:4955.

    • Search Google Scholar
    • Export Citation
  • 30

    Ho AS, Picus J, Darcy MD. Long-term outcome after chemoembolization and embolization of hepatic metastatic lesions from neuroendocrine tumors. AJR Am J Roentgenol 2007;188:12011207.

    • Search Google Scholar
    • Export Citation
  • 31

    Hajarizadeh H, Ivancev K, Mueller CR. Effective palliative treatment of metastatic carcinoid tumors with intra-arterial chemotherapy/chemoembolization combined with octreotide acetate. Am J Surg 1992;163:479483.

    • Search Google Scholar
    • Export Citation
  • 32

    Kim YH, Ajani JA, Carrasco CH. Selective hepatic arterial chemoembolization for liver metastases in patients with carcinoid tumor or islet cell carcinoma. Cancer Invest 1999;17:474478.

    • Search Google Scholar
    • Export Citation
  • 33

    Gupta S, Yao JC, Ahrar K. Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience. Cancer J 2003;9:261267.

    • Search Google Scholar
    • Export Citation
  • 34

    Kress O, Wagner HJ, Wied M. Transarterial chemoembolization of advanced liver metastases of neuroendocrine tumors—a retrospective single-center analysis. Digestion 2003;68:94101.

    • Search Google Scholar
    • Export Citation
  • 35

    Fiorentini G, Rossi S, Bonechi F. Intra-arterial hepatic chemoembolization in liver metastases from neuroendocrine tumors: a phase II study. J Chemother 2004;16:293297.

    • Search Google Scholar
    • Export Citation
  • 36

    Artinyan A, Nelson R, Soriano P. Treatment response to transcatheter arterial embolization and chemoembolization in primary and metastatic tumors of the liver. HPB (Oxford) 2008;10:396404.

    • Search Google Scholar
    • Export Citation
  • 37

    Carrasco CH, Chuang VP, Wallace S. Apudomas metastatic to the liver: treatment by hepatic artery embolization. Radiology 1983;149:7983.

  • 38

    Mavligit GM, Pollock RE, Evans HL, Wallace S. Durable hepatic tumor regression after arterial chemoembolization-infusion in patients with islet cell carcinoma of the pancreas metastatic to the liver. Cancer 1993;72:375380.

    • Search Google Scholar
    • Export Citation
  • 39

    Hanssen LE, Schrumpf E, Kolbenstvedt AN. Recombinant alpha-2 interferon with or without hepatic artery embolization in the treatment of midgut carcinoid tumours. A preliminary report. Acta Oncol 1989;28:439443.

    • Search Google Scholar
    • Export Citation
  • 40

    Wangberg B, Westberg G, Tylen U. Survival of patients with disseminated midgut carcinoid tumors after aggressive tumor reduction. World J Surg 1996;20:892899; discussion 899.

    • Search Google Scholar
    • Export Citation
  • 41

    Eriksson BK, Larsson EG, Skogseid BM. Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 1998;83:22932301.

    • Search Google Scholar
    • Export Citation
  • 42

    Loewe C, Schindl M, Cejna M. Permanent transarterial embolization of neuroendocrine metastases of the liver using cyanoacrylate and lipiodol: assessment of mid- and long-term results. AJR Am J Roentgenol 2003;180:13791384.

    • Search Google Scholar
    • Export Citation
  • 43

    Ruutiainen AT, Soulen MC, Tuite CM. Chemoembolization and bland embolization of neuroendocrine tumor metastases to the liver. J Vasc Interv Radiol 2007;18:847855.

    • Search Google Scholar
    • Export Citation
  • 44

    Christante D, Pommier S, Givi B, Pommier R. Hepatic artery chemoinfusion with chemoembolization for neuroendocrine cancer with progressive hepatic metastases despite octreotide therapy. Surgery 2008;144:885893; discussion 893–884.

    • Search Google Scholar
    • Export Citation
  • 45

    McStay MK, Maudgil D, Williams M. Large-volume liver metastases from neuroendocrine tumors: hepatic intraarterial 90Y-DOTA-lanreotide as effective palliative therapy. Radiology 2005;237:718726.

    • Search Google Scholar
    • Export Citation
  • 46

    King J, Quinn R, Glenn DM. Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer 2008;113:921929.

    • Search Google Scholar
    • Export Citation
  • 47

    Kennedy AS, Dezarn WA, McNeillie P. Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol 2008;31:271279.

    • Search Google Scholar
    • Export Citation
  • 48

    Murthy R, Kamat P, Nunez R. Yttrium-90 microsphere radioembolotherapy of hepatic metastatic neuroendocrine carcinomas after hepatic arterial embolization. J Vasc Interv Radiol 2008;19:145151.

    • Search Google Scholar
    • Export Citation
  • 49

    Rhee TK, Lewandowski RJ, Liu DM. 90Y Radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg 2008;247:10291035.

    • Search Google Scholar
    • Export Citation
  • 50

    Hellman P, Ladjevardi S, Skogseid B. Radiofrequency tissue ablation using cooled tip for liver metastases of endocrine tumors. World J Surg 2002;26:10521056.

    • Search Google Scholar
    • Export Citation
  • 51

    Giovannini M. Percutaneous alcohol ablation for liver metastasis. Semin Oncol 2002;29:192195.

  • 52

    Livraghi T, Goldberg SN, Lazzaroni S. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 1999;210:655661.

    • Search Google Scholar
    • Export Citation
  • 53

    Lencioni RA, Allgaier HP, Cioni D. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 2003;228:235240.

    • Search Google Scholar
    • Export Citation
  • 54

    Atwell TD, Charboneau JW, Que FG. Treatment of neuroendocrine cancer metastatic to the liver: the role of ablative techniques. Cardiovasc Intervent Radiol 2005;28:409421.

    • Search Google Scholar
    • Export Citation
  • 55

    Shafir M, Shapiro R, Sung M. Cryoablation of unresectable malignant liver tumors. Am J Surg 1996;171:2731.

  • 56

    Cozzi PJ, Englund R, Morris DL. Cryotherapy treatment of patients with hepatic metastases from neuroendocrine tumors. Cancer 1995;76:501509.

    • Search Google Scholar
    • Export Citation
  • 57

    Sheen AJ, Poston GJ, Sherlock DJ. Cryotherapeutic ablation of liver tumours. Br J Surg 2002;89:13961401.

  • 58

    Duperier T, Ali A, Pereira S. Laparoscopic cryoablation of a metastatic carcinoid tumor. J Laparoendosc Adv Surg Tech A 2001;11:105109.

  • 59

    Shapiro RS, Shafir M, Sung M. Cryotherapy of metastatic carcinoid tumors. Abdom Imaging 1998;23:314317.

  • 60

    Vogl TJ, Naguib NN, Zangos S. Liver metastases of neuroendocrine carcinomas: interventional treatment via transarterial embolization, chemoembolization and thermal ablation. Eur J Radiol 2009; in press.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 202 115 7
PDF Downloads 99 64 4
EPUB Downloads 0 0 0