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04.07.2017 | Vascular-Interventional

Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model

verfasst von: Duc Do Minh, Julius Chapiro, Boris Gorodetski, Qiang Huang, Cuihong Liu, Susanne Smolka, Lynn Jeanette Savic, David Wainstejn, MingDe Lin, Todd Schlachter, Bernhard Gebauer, Jean-François Geschwind

Erschienen in: European Radiology | Ausgabe 12/2017

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Abstract

Objectives

To compare efficacy, survival outcome and prognostic factors of conventional transarterial chemoembolisation (cTACE), drug-eluting beads TACE (DEB-TACE) and yttrium-90 radioembolisation (Y90) for the treatment of liver metastases from gastroenteropancreatic (GEP) neuroendocrine tumours (NELM).

Methods

This retrospective analysis included 192 patients (58.6 years mean age, 56% men) with NELM treated with cTACE (N = 122), DEB-TACE (N = 26) or Y90 (N = 44) between 2000 and 2014. Radiologic response to therapy was assessed according to Response Evaluation Criteria in Solid Tumours (RECIST) and World Health Organization (WHO) criteria using periprocedural MR imaging. Survival analysis included propensity score analysis (PSA), median overall survival (MOS), hepatic progression-free survival, Kaplan–Meier using log-rank test and the uni- and multivariate Cox proportional hazards model (MVA).

Results

MOS of the entire study population was 28.8 months. As for cTACE, DEB-TACE and Y90, MOS was 33.8 months, 21.7 months and 23.6 months, respectively. According to the MVA, cTACE demonstrated a significantly longer MOS as compared to DEB-TACE (p <.01) or Y90 (p = .02). The 5-year survival rate after initial cTACE, DEB-TACE and Y90 was 28.2%, 10.3% and 18.5%, respectively.

Conclusions

Upon PSA, our study suggests significant survival benefits for patients treated with cTACE as compared to DEB-TACE and Y90. This data supports the therapeutic decision for cTACE as the primary intra-arterial therapy option in patients with unresectable NELM until proven otherwise.

Key Points

• cTACE achieved a significantly longer overall survival in patients with unresectable NELM.

• Patients treated with cTACE showed a prolonged hepatic progression-free survival.

• cTACE, DEB-TACE and Y90 radioembolisation demonstrated comparable safety and toxicity profiles.

• Age >70 years, extrahepatic metastases and tumour burden >50% were identified as negative predictors.

• Propensity score analysis suggests the superiority of cTACE over DEB-TACE and Y90.

Nur mit Berechtigung zugänglich

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Titel: Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model
verfasst von: Duc Do Minh
Julius Chapiro
Boris Gorodetski
Qiang Huang
Cuihong Liu
Susanne Smolka
Lynn Jeanette Savic
David Wainstejn
MingDe Lin
Todd Schlachter
Bernhard Gebauer
Jean-François Geschwind
Publikationsdatum: 04.07.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 12/2017
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4856-2

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Intra-arterial therapy of neuroendocrine tumour liver metastases: comparing conventional TACE, drug-eluting beads TACE and yttrium-90 radioembolisation as treatment options using a propensity score analysis model