Endocrine Abstracts

Background: Liver metastases occur in about 40–85% of patients with neuroendocrine tumours (NET). NET usually run a rather indolent course but the 5-year survival is about 40% in patients with liver metastases versus 75–99% in subjects free of hepatic lesions. The most effective management and timing of treatment for patients with surgically unresectable metastases remains still unsettled.

Purpose: To evaluate the feasibility, safety, and clinical benefits of percutaneous laser ablation (PLA) in patients with unresectable and progressive NET hepatic metastases.

Patients and methods: Eleven patients (6 male, mean age 54, range 24–79) with NET hepatic metastases and progressive disease under medical treatment underwent PLA. Primary tumors were localized in the pancreas and intestine in 4 and 2 patients respectively, five patients had lung NET. The lesions treated with PLA were 15; the number of treatments was 24. The mean diameter of metastases was 3.5 cm (range 1.5–12 cm) at baseline. Nine of eleven patients had symptoms related to either hormone secretion or mass effect. PLA was performed under ultrasound guidance. The treatment efficacy was assessed by CT and contrast-enhanced Ultrasound examination 24 h after PLA. Clinical and CT controls were performed every 3 months.

Results: Mean follow-up was 84 months (range 18–200). Nine hepatic tumors≤4.0 cm appeared completely ablated by PLA treatment, while larger metastases (diameter from 5.5 to 12 cm) showed over 60% ablation. Most patients (88%) reported symptom relief. Progression-free mean survival after PLA was 16 months (range 2–48). No major complications were observed during and after the procedures.

Conclusions: PLA is a feasible and well tolerated procedure for the palliative treatment of unresectable NET hepatic metastases. In the present series, most patients showed an improvement in their performance status and a long progression-free survival. Further controlled studies are required to evaluate the impact of PLA on the overall survival.