Endocrine Abstracts

Abstract: Transarterial embolisation (TAE) is an effective treatment for liver metastases from neuroendocrine tumour (NET). It reduces arterial blood flow to the tumour resulting in ischemia and necrosis. In this single centre retrospective study the effectiveness and safety of TAE was evaluated.

Patients and methods: 30 patients with histological confirmed gastro-entero-pancreatic NET with liver metastases were investigated. Tumour response, decline in symptomatic carcinoid syndrome, the overall survival and adverse events were evaluated in the whole population.

Results: Among 30 patients (15 male) 47 TAE procedures were performed. The median age was 61.5 years. The primary NET site is ileum in 16 patients (53.3%), colon in 6 patients (20%), pancreas in one patient (3.3%), lung in one patient and unknown in six patients. 18 patients (60%) received surgery for their primary NET prior to TAE. 22 patients (73.3%) were also diagnosed with extrahepatic metastases. The number of patients with a decrease in liver tumour on CT were significantly higher when liver involvement before TAE was <50%. 29 patients (96.7%) received octreotide treatment prior to TAE. The median time from diagnosis to first TAE was 36.5 months. There was a significant decrease in chromogranin A both 1 and 3 months after TAE (P=0.001 and P=0.017, resp.). 80.9% of the cases had a decrease of neuroendocrine liver metastases after TAE. 26 patients had carcinoid syndrome of which 88% had a decrease in clinical symptoms at 1 month follow up. This was 69.6% at 3 months follow up. Liver functions assessed 1 and 3 months after TAE were compared to baseline values. Bilirubin shows a significant decrease at 1 month. Alkaline phosphatase is significantly higher after both 1 and 3 months. γGT is significantly higher at 1 month. ASAT, ALAT and LDH show no significant differences. Two patients had major TAE related complications. No TAE related death occurred. The overall survival at 1 year follow up is 86.7%, which is not statistically different compared to the overall survival of the group of patients who had a second or third TAE.

Conclusion: Transarterial embolisation is a relative safe treatment for to the liver metastasized NET which can be done multiple times within one patient. It reduces carcinoid syndrome and shows a significant reduction in tumour marker. Radiological decrease rate is significantly higher with patients who have less tumours in the liver.