Large-volume liver metastases from neuroendocrine tumors: hepatic intraarterial 90Y-DOTA-lanreotide as effective palliative therapy.
OBJECTIVE
To prospectively evaluate the safety and effectiveness of hepatic intraarterial injection of yttrium 90 ((90)Y) tetraazacyclododecane tetraacetic acid (DOTA) lanreotide as a treatment for patients with progressive large-volume somatostatin receptor-positive liver metastases from neuroendocrine tumors.


METHODS
The study was local ethics committee approved, and all patients gave informed consent. Twenty-three patients (13 men, 10 women; age range, 21-69 years; median age, 57 years) with histologically proved large-volume liver metastases from neuroendocrine cancers were treated. All patients had radiologic evidence of liver disease progression and high uptake of indium 111 ((111)In) pentetreotide at scintigraphy. Selective hepatic intraarterial injection of (90)Y-DOTA-lanreotide (total of 36 treatments; median activity per dose, 1 GBq) was administered with or without embolization. Treatment cycles were performed in 8-week intervals. Clinical, biologic, and radiologic tumor responses were assessed 8-12 weeks after each treatment cycle. Objective tumor response was classified according to World Health Organization response criteria as complete regression, partial response, stable disease, or disease progression. Kaplan-Meier survival curves were used to calculate 1-year survivals.


RESULTS
Partial response to treatment was achieved in three (16%) of 19 patients, and stable disease was achieved in 12 (63%). Four (21%) of 19 patients had continued disease progression. Clinical improvement was reported by 14 (61%) of the 23 patients, and a reduction in biologic marker levels was observed in nine (60%) of 15 patients. Reversible hematologic toxicity (National Cancer Institute common toxicity criteria grade > 2) occurred in three patients. The 1-year survival rate was 63% (median survival time, 15 months).


CONCLUSIONS
Hepatic intraarterial injection of (90)Y-DOTA-lanreotide is a safe and effective palliative treatment for patients with progressive large-volume somatostatin receptor-positive liver metastases from neuroendocrine tumors.
McStay
Mary K G
MK
Department of Radiology, Royal Free Hospital, London NW3 2QG, England.
Maudgil
Dave
D
Williams
Martin
M
Tibballs
Jonathan M
JM
Watkinson
Anthony F
AF
Caplin
Martyn E
ME
Buscombe
John R
JR
D000328:Adult; D000368:Aged; D005260:Female; D006499:Hepatic Artery; D006571:Heterocyclic Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D010166:Palliative Care; D010456:Peptides, Cyclic / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000627:therapeutic use*; D015996:Survival Rate; D016896:Treatment Outcome
D006571:Heterocyclic Compounds; D010456:Peptides, Cyclic; D019275:Radiopharmaceuticals; C116408:yttrium 90-DOTA-lanreotide