GEP-NETS update: Interventional radiology: role in the treatment of liver metastases from GEP-NETs.
Neuroendocrine tumors from gastro-pancreatic origin (GEP-NET) can be responsible for liver metastases. Such metastases can be the dominant part of the disease as well due to the tumor burden itself or the symptoms related to such liver metastases. Intra-arterial therapies are commonly used in liver only or liver-dominant disease and encompass trans-arterial chemoembolization (TACE), trans-arterial embolization (TAE), and radioembolization (RE). TACE performed with drug emulsified in Lipiodol has been used for the past 20 years with reported overall survival in the range of 3-4 years, with objective response up to 75%. Response to TACE is higher when treatment is used as a first-line therapy and degree of liver involvement is lower. Benefit of TACE over TAE is unproven in randomized study, but reported in retrospective studies namely in pancreatic NETs. RE provides early interesting results that need to be further evaluated in terms of benefit and toxicity. Radiofrequency ablation allows control of small size and numbered liver metastases, with low invasiveness. Ideal metastases to target are one metastasis <5 cm, or three metastases <3 cm, or a sum of diameter of all metastases below 8 cm. Ablation therapies can be applied in the lung or in the bones when needed, and more invasive surgery should be probably saved for large-size metastases. Even if the indication of image-guided therapy in the treatment of GEP-NET liver metastases needs to be refined, such therapies allow for manageable invasive set of treatments able to address oligometastatic patients in liver, lung, and bones. These treatments applied locally will save the benefit and the toxicity of systemic therapy for more advanced stage of the disease.
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France debaere@igr.fr.
Thierry
T
de Baere
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France.
Frederic
F
Deschamps
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France.
Lambros
L
Tselikas
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France.
Michel
M
Ducreux
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France.
David
D
Planchard
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France.
Ernesto
E
Pearson
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France.
Amandine
A
Berdelou
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France.
Sophie
S
Leboulleux
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France.
Dominique
D
Elias
Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France.
Eric
E
Baudin
D000075202:Contraindications; D003952:Diagnostic Imaging / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000628:therapy*; D008991:Monitoring, Physiologic / Q000379:methods; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D015642:Radiology, Interventional / Q000639:trends*; D013274:Stomach Neoplasms / Q000473:pathology / Q000628:therapy*