title: Transarterial chemoembolization and selective internal radiation for the treatment of patients with metastatic neuroendocrine tumors: a comparison of efficacy and cost.
abstract: BACKGROUND
  Hepatic arterial therapy (HAT) has been proven to be effective at palliation of hormonal symptoms of metastatic neuroendocrine tumors (NETs), as well as a means of cytoreduction. Recently, the newer modalities of yttrium-90 and drug-eluting beads with doxorubicin (DEBDOX) have been reported to be effective in the treatment of metastatic NETs. The aim of this study was to compare the safety, efficacy, and cost of selective internal radiation with DEB therapy.
  
  
  METHODS
  An institutional review board-approved, multicenter, multinational prospective treatment registry to investigate the safety and efficacy of yttrium-90 and doxorubicin microspheres was reviewed.
  
  
  RESULTS
  In all, 43 patients underwent a combined 69 HAT treatments, with 15 patients receiving 23 yttrium-90 treatments and 28 patients receiving 46 DEBDOX treatments. The extent of disease-based on the number of lesions, bilobar distribution, patient performance status, and size of largest lesion-was similar in both the yttrium-90 and DEBDOX groups. After a median follow-up of 12 months, response rates were similar with the two treatments, but then there was a significantly lower response rate in the yttrium-90 group at 12 months than in the DEBDOX group. In an evaluation of cost for the two treatments, the median cost for yttrium-90 was $25,243 and the median cost for DEBDOX was $13,400.
  
  
  CONCLUSIONS
  HAT is a safe and effective therapy in patients with unresectable NETs to the liver. The size of the lesions, total lesion volume, and expense of therapy need to be considered when choosing which HAT method is optimal.
authors.affiliation: Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Whitney
authors.forename: Vlatimil
authors.initials: V
authors.lastname: Vàlek
authors.forename: Joan Falco
authors.initials: JF
authors.lastname: Fages
authors.forename: Agustin
authors.initials: A
authors.lastname: Garcia
authors.forename: Govindarajan
authors.initials: G
authors.lastname: Narayanan
authors.forename: Cliff
authors.initials: C
authors.lastname: Tatum
authors.forename: Mike
authors.initials: M
authors.lastname: Hahl
authors.forename: Robert C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D004317:Doxorubicin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes; D004317:Doxorubicin