Open AccessRadioembolization Versus Bland Embolization for Hepatic Metastases from Small Intestinal Neuroendocrine Tumors: Short‐Term Results of a Randomized Clinical Trial
Author(s) -
Elf AnnaKarin,
Andersson Mats,
Henrikson Olof,
Jalnefjord Oscar,
Ljungberg Maria,
Svensson Johanna,
Wängberg Bo,
Johanson Viktor
Publication year - 2018
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-017-4324-9
Subject(s) - medicine , response evaluation criteria in solid tumors , neuroendocrine tumors , randomized controlled trial , radiology , embolization , nuclear medicine , clinical trial , phases of clinical research
Background Radioembolization (RE) with intra‐arterial administration of 90 Y microspheres is a promising technique for the treatment of liver metastases from small intestinal neuroendocrine tumors (SI‐NET) not amenable to surgery or local ablation. However, studies comparing RE to other loco‐regional therapies are lacking. The aim of this randomized study was to compare the therapeutic response and safety after RE and bland hepatic arterial embolization (HAE), and to investigate early therapy‐induced changes with diffusion‐weighted MRI (DWI‐MRI). Methods Eleven patients were included in a prospective randomized controlled pilot study, six assigned to RE and five to HAE. Response according to RECIST 1.1 using MRI or CT at 3 and 6 months post‐treatment was recorded as well as changes in DWI‐MRI parameters after 1 month. Data on biochemical tumor response, toxicity, and side effects were also collected. Results Three months after treatment, all patients in the HAE group showed partial response according to RECIST while none in the RE group did ( p = 0.0022). After 6 months, the response rates were 4/5 (80%) and 2/6 (33%) in the HAE and RE groups, respectively (NS). DWI‐MRI metrics could not predict RECIST response, but lower pretreatment ADC (120–800) and larger ADC (0–800) increase at 1 month were related to larger decrease in tumor diameter when all tumors were counted. Conclusion HAE resulted in significantly higher RECIST response after 3 months, but no difference compared to RE remained after 6 months. These preliminary findings indicate that HAE remains a safe option for the treatment of liver metastases from SI‐NET, and further studies are needed to establish the role of RE and the predictive value of MR‐DWI.