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Radioembolization Versus Bland Embolization for Hepatic Metastases from Small Intestinal Neuroendocrine Tumors: Short-Term Results of a Randomized Clinical Trial.

Journal article
Authors Anna-Karin Elf
Mats Andersson
Olof Henrikson
Oscar Jalnefjord
Maria Ljungberg
Johanna Svensson
Bo Wängberg
Viktor Johanson
Published in World Journal of Surgery
Volume 42
Issue 2
Pages 506-513
ISSN 0364-2313
Publication year 2018
Published at Institute of Clinical Sciences, Department of Radiation Physics
Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences, Department of Oncology
Institute of Clinical Sciences, Department of Radiology
Pages 506-513
Language en
Links dx.doi.org/10.1007/s00268-017-4324-...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Diagnostic radiology, Cancer and Oncology

Abstract

Radioembolization (RE) with intra-arterial administration of 90Y microspheres is a promising technique for the treatment of liver metastases from small intestinal neuroendocrine tumors (SI-NET) not amenable to surgery or local ablation. However, studies comparing RE to other loco-regional therapies are lacking. The aim of this randomized study was to compare the therapeutic response and safety after RE and bland hepatic arterial embolization (HAE), and to investigate early therapy-induced changes with diffusion-weighted MRI (DWI-MRI).Eleven patients were included in a prospective randomized controlled pilot study, six assigned to RE and five to HAE. Response according to RECIST 1.1 using MRI or CT at 3 and 6 months post-treatment was recorded as well as changes in DWI-MRI parameters after 1 month. Data on biochemical tumor response, toxicity, and side effects were also collected.Three months after treatment, all patients in the HAE group showed partial response according to RECIST while none in the RE group did (p = 0.0022). After 6 months, the response rates were 4/5 (80%) and 2/6 (33%) in the HAE and RE groups, respectively (NS). DWI-MRI metrics could not predict RECIST response, but lower pretreatment ADC(120-800) and larger ADC(0-800) increase at 1 month were related to larger decrease in tumor diameter when all tumors were counted.HAE resulted in significantly higher RECIST response after 3 months, but no difference compared to RE remained after 6 months. These preliminary findings indicate that HAE remains a safe option for the treatment of liver metastases from SI-NET, and further studies are needed to establish the role of RE and the predictive value of MR-DWI.

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