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Transarterial Chemoembolization for Metastatic Neuroendocrine Tumors With Massive Hepatic Tumor Burden: Is the Benefit Worth the Risk?

  • Endocrine Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neuroendocrine tumors (NETs) have a propensity to metastasize to the liver, often resulting in massive tumor burden and hepatic dysfunction. While transarterial chemoembolization (TACE) is effective in treating patients with NET metastatic to the liver, there are limited data on its utility and benefit in patients with large hepatic involvement. The aim of our study was to determine the clinical benefit and complication rate of TACE in patients with massive hepatic tumor burden.

Methods

Medical records were reviewed in patients with grade 1 or 2 NETs with hepatic metastasis at our institution from January 2000 to September 2014 who underwent TACE. Of 201 total patients, 68 had massive hepatic tumor burden involving >75 % of liver parenchyma.

Results

Carcinoid syndrome was present in 40 (59 %) patients, and 57 (84 %) of the 68 patients were symptomatic from their disease. Complications beyond post-TACE syndrome occurred in 21.7 % of patients, with the most common complication being cardiac arrhythmias. The 30-day mortality rate was 7 %. Biochemical response was observed in 78 % of patients, while symptomatic relief and radiographic response was achieved in 85 and 82 % of patients, respectively. Median overall survival following TACE was 28 months, with 1-, 2-, and 5-year overall survival of 76, 54, and 26 %, respectively.

Conclusions

In spite of massive tumor burden, clinical and biochemical improvements were seen in the majority of patients. Morbidity was acceptable and reversible but with a fairly high mortality rate of 7 %. TACE should still be considered in selective patients with massive hepatic tumor burden from metastatic NET for symptom control and palliation.

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Disclosure

Mio Kitano, Gail W. Davidson, Lawrence A. Shirley, Carl R. Schmidt, Gregory E. Guy, Hooman Khabiri, Joshua D. Dowell, Manisha H. Shah, and Mark Bloomston have no disclosures to declare.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Mio Kitano MD, Gail W. Davidson MD, CNP, Lawrence A. Shirley MD, Carl R. Schmidt MD & Mark Bloomston MD

  2. Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Gregory E. Guy MD, Hooman Khabiri MD & Joshua D. Dowell MD, PhD

  3. Department of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA

    Manisha H. Shah MBBS

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  1. Mio Kitano MD
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  2. Gail W. Davidson MD, CNP
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Correspondence to Mio Kitano MD.

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Kitano, M., Davidson, G.W., Shirley, L.A. et al. Transarterial Chemoembolization for Metastatic Neuroendocrine Tumors With Massive Hepatic Tumor Burden: Is the Benefit Worth the Risk?. Ann Surg Oncol 23, 4008–4015 (2016). https://doi.org/10.1245/s10434-016-5333-x

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