title: Radioembolization of symptomatic, unresectable neuroendocrine hepatic metastases using yttrium-90 microspheres.
abstract: OBJECTIVE
  To evaluate safety, efficacy, and symptom-control of radioembolization in patients with unresectable liver metastases from neuroendocrine tumors (NETLMs).
  
  
  METHODS
  Forty-two patients (mean age of 62 years) with treatment-refractory NETLMs underwent radioembolization using yttrium-90 ((90)Y) resin microspheres. Posttreatment tumor response was assessed by cross-sectional imaging using the Response Evaluation Criteria in Solid Tumors (RECIST) and tumor-marker levels. Laboratory and clinical toxicities and clinical symptoms were monitored.
  
  
  RESULTS
  The median activity delivered was 1.63 GBq (range 0.63-2.36). Imaging follow-up using RECIST at 3-month follow-up demonstrated partial response, stable disease, and progressive disease in 22.5, 75.0, and 2.5% of patients, respectively. In 97.5% of patients, the liver lesions appeared hypovascular or partially necrotic. The mean follow-up was 16.2 months with 40 patients (95.2%) remaining alive. The median decrease in tumor-marker levels at 3 months was 54.8% (chromogranin A) and 37.3% (serotonin), respectively. There were no acute or delayed toxicities greater than grade 2 according to Common Terminology Criteria for Adverse Events [CTCAE (v3.0)]. No radiation-induced liver disease was noted. Improvement of clinical symptoms 3 months after treatment was observed in 36 of 38 symptomatic patients.
  
  
  CONCLUSIONS
  Radioembolization with (90)Y-microspheres is a safe and effective treatment option in patients with otherwise treatment-refractory NETLMs. Antitumoral effect is supported by good local tumor control, decreased tumor-marker levels, and improved clinical symptoms. Further investigation is warranted to define the role of radioembolization in the treatment paradigm for NETLMs.
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, 81377 Munich, Germany. philipp.paprottka@med.uni-muenchen.de
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Paprottka
authors.forename: Ralf-T
authors.initials: RT
authors.lastname: Hoffmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Haug
authors.forename: Wieland H
authors.initials: WH
authors.lastname: Sommer
authors.forename: Franziska
authors.initials: F
authors.lastname: Raessler
authors.forename: Christoph G
authors.initials: CG
authors.lastname: Trumm
authors.forename: Gerwin P
authors.initials: GP
authors.lastname: Schmidt
authors.forename: Nima
authors.initials: N
authors.lastname: Ashoori
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Jakobs
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004066:Digestive System Diseases / Q000209:etiology; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005221:Fatigue / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary*; D011829:Radiation Dosage; D012189:Retrospective Studies; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D015021:Yttrium Radioisotopes