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Single‐institution experience of radioembolization with yttrium‐90 microspheres for unresectable metastatic neuroendocrine liver tumors
Author(s) -
Jia Zhongzhi,
PazFumagalli Ricardo,
Frey Gregory,
Sella David M,
McKinney J Mark,
Wang Weiping
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13752
Subject(s) - medicine , nausea , gastroenterology , vomiting , carcinoid syndrome , abdominal pain , neuroendocrine tumors , surgery
Background and Aim The aim of this study was to assess the effectiveness of yttrium‐90 ( 90 Y) microspheres for the treatment of unresectable metastatic liver neuroendocrine tumors (NET). Methods From February 2006 to September 2015, 36 patients (19 male and 17 female, age 63.6 ± 9.4 years) who underwent 90 Y therapy for unresectable liver metastases of NET were included and analyzed retrospectively. All patients received a variety of treatments before 90 Y therapy. The radiological response, symptoms improvement of carcinoid syndrome, tumor marker changes, complications, side effects/toxicity, survival, and factors related to survival were evaluated and analyzed. Results Of the 36 patients, the mean delivered dose of 90 Y was 1.8 ± 0.7 GBq with a total of 40 treatments. Overall disease control rate was 88.9% (32/36) at 3 months following therapy. In 16 patients with carcinoid syndrome, 15 (93.8%) patients had symptomatic improvement. Tumor marker response (5‐hydroxyindoleacetic acid [ n = 7] and chromogranin A [ n = 13]) at 3 months after treatment were as follows: none ( n = 0, 4), partial ( n = 6, 7), and complete ( n = 1, 2). Radiation‐induced gastrointestinal ulcers ( n = 2, 5.6%) were identified. Side effects included fatigue ( n = 31, 86.1%), anorexia ( n = 26, 72.2%), nausea ( n = 15, 41.7%), vomiting ( n = 14, 38.9%), abdominal pain ( n = 10, 27.8%), and fever ( n = 8, 22.2%). The mean follow‐up was 27.0 ± 16.4 months, with a median survival of 41.0 months. Child–Pugh classification ( P = 0.008) and lymph node metastases ( P = 0.045) had statistically significant influence on overall survival. Conclusions Yttrium‐90 radioembolization can be effective in the treatment of unresectable liver metastases of NET who failed to respond to other treatments.