Transarterial chemoembolization is ineffective for neuroendocrine tumors metastatic to the caudate lobe: a single institution review.
BACKGROUND
Caudate lobe liver metastases occur commonly in patients with neuroendocrine tumors. It is unknown, however, how these lesions respond to regional therapy and how their presence impacts outcomes. We reviewed our experience treating these lesions using transarterial chemoembolization (TACE).


METHODS
We reviewed radiographic response to TACE in 86 patients with metastatic neuroendocrine tumors to the liver. We determined the impact of caudate lesions on outcomes in comparison to the cohort of patients without caudate lesions, as well as response of caudate lesions to TACE versus lesions elsewhere in the liver.


RESULTS
Caudate lesions were identified in 45 (52%) patients. All patients had disease in other liver segments. Only seven caudate lesions (12.3%) had a radiographic response to TACE, whereas 82% of lesions elsewhere in the liver demonstrated a response. The presence or absence of a caudate lesion did not impact the overall radiographic (82.2% vs. 82.9%), symptomatic (64.4% vs. 56.1%), or biochemical (97.6% vs. 88.9%) response to TACE (P > 0.1 for all). However, median overall survival was reduced in those presenting with caudate lesions (87.1 vs. 45.6 months, P = 0.031).


CONCLUSIONS
Metastatic neuroendocrine tumors to the caudate lobe respond poorly to TACE. Symptomatic or threatening caudate lobe lesions should be considered for palliative resection in spite of additional inoperable liver metastases.
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W. 10th Ave, Columbus, OH, 43210, USA. lawrence.shirley@osumc.edu.
Lawrence A
LA
Shirley
Department of Surgery, Saint Luke's Health System and University of Missouri-Kansas City, 100 NE St. Lukes Blvd, Lee's Summit, MO 64086, USA. memcnally81@gmail.com.
Megan
M
McNally
Division of Surgical Oncology, Rutgers University-New Jersey Medical School, 205 South Orange Avenue, G-1222, Newark, NJ 07103, USA. chokshrj@njms.rutgers.edu.
Ravi
R
Chokshi
Department of Surgery, Riverside Methodist Hospital, 1654 Upham Dr., Columbus, OH, 43210, USA. jonesnatalieb@gmail.com.
Natalie
N
Jones
Department of Otolaryngology, Thomas Jefferson University Hospital, 925 Chestnut Street, 6th Floor, Philadelphia, PA, 19107, USA. p.t.tassone@gmail.com.
Patrick
P
Tassone
Department of Radiology, The Ohio State University Wexner Medical Center, Room 460, 395 W. 12th Ave, Columbus, OH, 43210, USA. Gregory.guy@osumc.edu.
Gregory
G
Guy
Department of Radiology, The Ohio State University Wexner Medical Center, Room 460, 395 W. 12th Ave, Columbus, OH, 43210, USA. hooman.khabiri@osumc.edu.
Hooman
H
Khabiri
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W. 10th Ave, Columbus, OH, 43210, USA. carl.schmidt@osumc.edu.
Carl
C
Schmidt
Division of Medical Oncology, The Ohio State University Wexner Medical Center, 4th Floor Starling Loving Hall, 320 W. 10th Ave, Columbus, OH, 43210, USA. manisha.shah@osumc.edu.
Manisha
M
Shah
Division of Surgical Oncology, The Ohio State University Wexner Medical Center, N924 Doan Hall, 410 W. 10th Ave, Columbus, OH, 43210, USA. mark.bloomston@osumc.edu.
Mark
M
Bloomston
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016461:Chemoembolization, Therapeutic / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate