title: The efficacy of hepatic 90Y resin radioembolization for metastatic neuroendocrine tumors: a meta-analysis.
abstract: (90)Y resin radioembolization is an emerging treatment in patients with liver-dominant metastatic neuroendocrine tumors (mNETs), despite the absence of level I data. The aim of this study was to evaluate the efficacy of this modality in a meta-analysis of the published literature.
  
  
  METHODS
  A comprehensive review protocol screened all reports in the literature. Strict selection criteria were applied to ensure consistency among the selected studies: human subjects, complete response data with time interval, resin microspheres, more than 5 patients, not a duplicate cohort, English language, and separate and complete data for resin-based (90)Y treatment of mNET if the study included multiple tumor and microsphere types. Selected studies were critically appraised on 50 study criteria, in accordance with the research reporting standards for radioembolization. Response data (Response Evaluation Criteria in Solid Tumors) were extracted and analyzed using both fixed and random-effects meta-analyses.
  
  
  RESULTS
  One hundred fifty-six studies were screened; 12 were selected, totaling 435 procedures for response assessment. Funnel plots showed no evidence of publication bias (P = 0.841). Critical appraisal revealed a median of 75% of desired criteria included in selected studies. Very high between-study heterogeneity ruled out a fixed-effects model. The random-effects weighted average objective response rate (complete and partial responses, CR and PR, respectively) was 50% (95% confidence interval, 38%-62%), and weighted average disease control rate (CR, PR, and stable disease) was 86% (95% confidence interval, 78%-92%). The percentage of patients with pancreatic mNET was marginally associated with poorer response (P = 0.030), accounting for approximately 23% of the heterogeneity among studies. The percentage of CR and PR correlated with median survival (R = 0.85; P = 0.008).
  
  
  CONCLUSIONS
  This meta-analysis confirms radioembolization to be an effective treatment option for patients with hepatic mNET. The pooled data demonstrated a high response rate and improved survival for patients responding to therapy.
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, Stanford, California.
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Devcic
authors.affiliation: Radiology Sciences Laboratory, Stanford University School of Medicine, Stanford, California; and.
authors.forename: Jarrett
authors.initials: J
authors.lastname: Rosenberg
authors.affiliation: Department of Radiology and Nuclear Medicine, UMC Utrecht, The Netherlands.
authors.forename: Arthur J A
authors.initials: AJ
authors.lastname: Braat
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, Stanford, California.
authors.forename: Tust
authors.initials: T
authors.lastname: Techasith
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, Stanford, California.
authors.forename: Arjun
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, Stanford, California.
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
authors.affiliation: Division of Interventional Radiology, Stanford University School of Medicine, Stanford, California Department of Radiology and Nuclear Medicine, UMC Utrecht, The Netherlands m.lam@umcutrecht.nl.
authors.forename: Marnix G E H
authors.initials: MG
authors.lastname: Lam
mesh_terms: D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology* / Q000556:secondary; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes
keywords: 90Y radioembolization; liver metastases; neuroendocrine tumor; radioembolization; resin microspheres