title: Extrahepatic disease should not preclude transarterial chemoembolization for metastatic neuroendocrine carcinoma.
abstract: BACKGROUND
  Transarterial chemoembolization (TACE) is often utilized for patients with inoperable neuroendocrine carcinoma liver metastases. Often, metastatic disease is not limited to the liver. The impact of extrahepatic disease (EHD) on outcomes and response after TACE has not been described.
  
  
  METHODS
  We reviewed 192 patients who underwent TACE for large hepatic tumor burden, progression of liver metastases, or poorly controlled carcinoid syndrome due to neuroendocrine carcinoma. Demographics, clinicopathologic characteristics, response to TACE, complications, and survival were compared between patients with (n = 123) and without (n = 69) EHD.
  
  
  RESULTS
  Demographics, histopathologic characteristics, and complications were similar between groups. As well, those with and without EHD had similar biochemical (85 vs. 88 %) and radiographic response (76 vs. 79 %) to TACE (all p = NS); however, symptomatic responses were improved in those with EHD (79 vs. 60 %, p = 0.01). The group without EHD had better overall survival compared to those with EHD disease at the time of TACE (median 62 vs. 28 months, p = 0.001).
  
  
  CONCLUSIONS
  Although patients with EHD from neuroendocrine carcinoma experience shorter overall survival after TACE compared to those without EHD, they had similar symptomatic, biochemical, and radiographic response to TACE. Meaningful response to TACE is still possible in the presence of EHD and should be considered, particularly in those with carcinoid syndrome.
authors: Department of Surgery, Riverside Methodist Hospital, Columbus, OH, USA.
authors: David
authors: D
authors: Arrese
authors: Megan E
authors: ME
authors: McNally
authors: Ravi
authors: R
authors: Chokshi
authors: Enrique
authors: E
authors: Feria-Arias
authors: Carl
authors: C
authors: Schmidt
authors: Dori
authors: D
authors: Klemanski
authors: Guy
authors: G
authors: Gregory
authors: Hooman
authors: H
authors: Khabiri
authors: Manisha
authors: M
authors: Shah
authors: Mark
authors: M
authors: Bloomston
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018278:Carcinoma, Neuroendocrine / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult