Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization Geert Maleux MD, PhD Department of Radiology University Hospitals Leuven Belgium
Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization Geert Maleux MD, PhDDepartment of RadiologyUniversity Hospitals LeuvenBelgium
Introduction
• Loco-regional therapies for NET liver metastases :
– Transarterial embolization• PVA-microparticles• Tris-acryl gelatin microspheres• Glue (mixture of enbucrylate and Lipiodol)
– Transarterial chemo-embolization• Conventional TACE (Lipiodol & drugs)• Drug-eluting beads• Starch microspheres & chemotherapeutic agents
– Yttrium-90 radioembolization (SIRT)
Introduction
• Loco-regional therapies for NET liver metastases :– Transarterial embolization
• PVA-microparticles• Tris-acryl gelatin microspheres• Glue (mixture of enbucrylate and Lipiodol)
– Transarterial chemo-embolization• Conventional TACE (Lipiodol & drugs)• Drug-eluting beads• Starch microspheres & chemotherapeutic agents
– Yttrium-90 radioembolization (SIRT)
Case 1
• 65-year-old female patient• 2006 : pNET
– Surgery (pancreatectomy, splenectomy, liver segmentectomies)
• 2009 – 2012 : everolimus• 2013 :
– Diffuse liver metastases– Hypoglycemias +++
Case 2
• 61-year-old woman• 2010 : pancreatic NET & liver metastases• R/ Sandostatin + everolimus• 2012 : progression of disease & hypoglycemia
Symptoms Complete relief
Partial relief No relief unknown
Carcinoidsyndrome:Diarrhea, flushing, headache
5 3 0 /
Islet cellsyndrome : hypoglycemia
3 1 0 /
pain 0 0 1 /
unknown / / / 3
Leuven experience with drug-eluting beads (SAP-microspheres)
Complication N° of patients (n=17) %
Ischemic cholecystitis 1 6%
Carcinoid storm 1 6%
Insulin storm 1 6%
Post-embolization syndrome 14 82%
None 3 18%
Leuven experience with drug-eluting beads (SAP-microspheres)
RECIST N° of patients (n=17) %
Partial response 2 13%
Stable disease 12 80%
Progression of disease 1 7%
unknown 2 /
EASL criteria N° of patients (n=17) %
Partial response 13 87%
Stable disease 1 7%
Progression of disease 1 7%
Unknown 2 /
DEB-TACE
• SAP-microspheres : safe & effective– 0% bilomas– Tumor burden :
• DC-beads (100 – 300 micron)– 54 % bilomas– < 30% tumor burden
Tumor burden N° of patients (n=17)0-10% 310-20% 320-50% 5>50% 4Unknown / not measurable 2
Bhagat et al. CVIR 2013
Case 3
• 43-year-old woman• 2008 : small bowel NET & liver metastases
– Enterectomy & RF-ablation– 90Y-DOTATOC
• 2011 progression of disease– SIRT (resin microspheres)
Yttrium-90 radioembolization
• Very effective : > 3 years no liver metastases
• Non-target embolization– Gastritis– Ulceration refractory to medical treatment– Surgery – Liver fibrosis -> cirrhosis ??
• Thank you for your attention