Hepatic Neuroendocrine Metastases: Bland Or Chemoembolization?
Susan C. Pitt*2,6, Jamie Knuth6, James M. Kiely4, John C. Mcdermott1, Sharon M. Weber2, William S. Rilling3, Edward J. Quebbeman4, David M. Agarwal5, Henry a. Pitt6
1Department of Radiology, University of Wisconsin, Madison, WI; 2Department of Surgery, University of Wisconsin, Madison, WI; 3Department of Radiology, Medical College of Wisconsin, Milwaukee, WI; 4Department of Surgery, Medical College of Wisconsin, Milwaukee, WI; 5Department of Radiology, Indiana University, Indianapolis, IN; 6Department of Surgery, Indiana University, Indianapolis, IN
Introduction: Aggressive management of hepatic neuroendocrine (NE) metastases improves symptoms and prolongs survival. Treatment options include hepatic resection, tumor ablation, and hepatic artery embolization. However, most of these patients have multiple, bilobar metastases. As a result, in recent years hepatic artery approaches have become more popular. Because of the rarity of these tumors, however, the best method for hepatic artery embolization has not been established. Therefore, we designed a study to test the hypothesis that hepatic artery chemoembolization (HACE) would result in better survival than bland embolization (HAE) in patients with hepatic NE metastases.
Methods: Retrospective review identified all patients with NE hepatic metastases managed by HACE or HAE at three institutions from January 1996 through June 2007. Overall survival from both the date of diagnosis of metastases and the date of first treatment was calculated using the Kaplan-Meier method.
Results: The study identified 98 patients managed by HACE (n=47) and HAE (n=51). Patients were similar with respect to age (57.7 vs. 54.4 yrs), gender (49 vs. 37% female), and primary tumor type (gastrointestinal carcinoid 60 vs. 51% or pancreatic islet cell 30 vs. 29%). However, the HACE patients underwent a greater number of hepatic artery procedures (2.98 vs. 2.08, p=0.01). Median and 5-year survival results are presented in the table below from the time of metastatic disease diagnosis and the time of first embolization procedure.
Conclusions: These data suggest that survival is similar in patients with hepatic NE metastases managed by hepatic artery chemoembolization or bland embolization. We conclude that hepatic artery embolization with or without chemotherapy may be employed in patients not amenable to resection and/or ablative techniques.
| Metastases Diagnosis | First Embolization | |||
| Treatment | Median (mo) | 5-year (%) | Median (mo) | 5-year (%) |
| HAE | 39.1 | 33.4 | 26.2 | 13.0 |
| HACE | 50.1 | 47.9 | 25.5 | 20.4 |
| p= 0.51 | p= 0.73 | |||
