RSNA 2016

Abstract Archives of the RSNA, 2016


VSIO51-16

Comparing cTACE, DEB-TACE and 90Yttrium Radioembolization as Treatment Options for Patients with Neuroendocrine Tumor Liver Metastases

Thursday, Dec. 1 4:55PM - 5:05PM Room: S405AB



Duc Do Minh, BSc, Berlin, Germany (Presenter) Nothing to Disclose
Julius Chapiro, MD, New Haven, CT (Abstract Co-Author) Research Grant, Koninklijke Philips NV
Boris Gorodetski, MD, Berlin, Germany (Abstract Co-Author) Nothing to Disclose
Susanne Smolka, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Qiang Huang, Hangzhou, China (Abstract Co-Author) Nothing to Disclose
Cuihong Liu, Jinan, China (Abstract Co-Author) Nothing to Disclose
David Wainstejn, Berlin, Germany (Abstract Co-Author) Nothing to Disclose
Ming De Lin, PhD, Cambridge, MA (Abstract Co-Author) Employee, Koninklijke Philips NV
Lynn J. Savic, Baltimore, MD (Abstract Co-Author) Nothing to Disclose
Todd Schlachter, MD, Farmington, CT (Abstract Co-Author) Nothing to Disclose
Bernhard Gebauer, MD, Berlin, Germany (Abstract Co-Author) Research Consultant, C. R. Bard, Inc ; Research Consultant, Sirtex Medical Ltd; Research Grant, C. R. Bard, Inc; Research Consultant, PAREXEL International Corporation; Travel support, AngioDynamics , Inc
Jean-Francois H. Geschwind, MD, Westport, CT (Abstract Co-Author) Consultant, BTG International Ltd; Consultant, Bayer AG; Consultant, Guerbet SA; Consultant, Sterigenics International LLC; Consultant, Koninklijke Philips NV; Consultant, Jennerex Biotherapeutics, Inc; Grant, BTG International Ltd; Grant, Bayer AG; Grant, Koninklijke Philips NV; Grant, Sterigenics International LLC; Grant, Threshold Pharmaceuticals, Inc; Grant, Guerbet SA; Founder and CEO, PreScience Labs, LLC
PURPOSE

To compare efficacy, survival outcomes and identify prognostic factors of conventional transarterial chemoembolization (cTACE), drug-eluting beads TACE (DEB-TACE), and 90Yttrium-radioembolization (Y90) for the treatment of gastro-entero-pancreatic (GEP) neuroendocrine tumor liver metastases (NELMs).

METHOD AND MATERIALS

This retrospective single center-study included 192 patients (58.6 years mean age, 56% men) with NELM of known GEP origin treated with cTACE (N=122), DEB-TACE (N=26), or Y90 (N=44) between 2000 and 2014. Follow-up imaging studies were compared with baseline imaging to determine the radiologic response. Median overall survival (OS) and hepatic progression-free survival (HPFS) were evaluated. Propensity score analysis (PSA) was performed to minimize selection bias. Survival analysis was calculated using the PS-adjusted Kaplan-Meier method with the PS-adjusted log-rank test and the uni- and multivariate (MVA) Cox proportional hazards model.

RESULTS

Median OS and HPFS were 28.8 and 18.1 months for entire study group, 34.0 and 20.1 months after cTACE, 23.6 and 12.4 months after Y90, 21.7 and 13.3 months after DEB-TACE treatment, respectively. In PSA, cTACE demonstrated significant prolonged median OS compared to Y90 (p=0.035) but not compared to DEB-TACE (p=0.198). Five-year survival time after first intra-arterial treatment (IAT) for cTACE, DEB-TACE and Y90 were 28.2%, 10.3% and 18.5%, respectively. No significant differences in HPFS were seen among evaluated IAT. MVA of the entire study cohort identified extra-hepatic metastasis (HR, 1.63, p<0.01) and tumor burden >50% (HR, 1.93, p<0.01) as predictive for reduced OS whereas 3≥ embolization sessions were related to prolonged OS (HR, 0.59, p<0.05). Among all IAT options the response rates (RR) and the incidence of adverse effects were not significantly different. In MVA, DEB-TACE corresponded with improved RR compared to cTACE (OR, 1.2, p=0.04).

CONCLUSION

Due to significantly improved OS cTACE revealed to be the preferable IAT option compared to Y90. DEB-TACE vs. cTACE and DEB-TACE vs. Y90 appeared equally effective according to OS. Prospective studies are warranted to determined the optimal IAT option for patients with unresectable NELM.

CLINICAL RELEVANCE/APPLICATION

NELM decreases OS dramatically. IAT appealed as an indispensable mainstay in palliative treatment of unresectable NELM to increase OS. Thus, choice of IAT with greatest improved OS still needs to be investigated.