title: Selective internal radiation therapy in patients with progressive neuroendocrine liver metastases.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of selective internal radiation therapy (SIRT) in patients with unresectable liver metastases from neuroendocrine tumours (NETLMs).
  
  
  METHODS
  This retrospective study included 40 patients with progressive NETLMs (22 women, 18 men, mean age 61.6 years) who underwent SIRT with (90)Y-labelled resin microspheres. Tumour response was evaluated according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) on CT or MR images. Medical records were reviewed.
  
  
  RESULTS
  In the 40 patients, 54 evaluable SIRT procedures were performed, 33 to the right liver lobe (mean activity 1.31 GBq), 13 to the left lobe (mean activity 0.85 GBq), and 8 to both lobes (mean activity 1.61 GBq). Late follow-up imaging (mean 20 months) was performed after 44 of the treatments. Objective tumour response and disease control rates were 54 % (29 of 54 treatments) and 94 % (51 treatments), respectively, at the early follow-up examination (mean 3 months) and 34 % (15 treatments) and 57 % (25 treatments), respectively at the late follow-up examination. Mean overall survival from the first SIRT was 34,8 months and survival rates at 1, 2, 3 and 5 years were 76 %, 59 %, 52 % and 35 % respectively. Adverse effects were generally mild and easily manageable, except in one patient who died from radiation-induced liver failure. Of the 45 patients, 18 (45 %) had received peptide receptor radionuclide therapy (PRRT) prior to SIRT.
  
  
  CONCLUSIONS
  SIRT with (90)Y-labelled resin microspheres is a safe and effective treatment for patients with progressive NETLM, and also for those who have received prior PRRT.
authors.affiliation: Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden. Charlotte.Ebeling_Barbier@radiol.uu.se.
authors.forename: Charlotte Ebeling
authors.initials: CE
authors.lastname: Barbier
authors.affiliation: Department of Surgical Sciences, Section of Nuclear Medicine and PET, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Garske-Román
authors.affiliation: Department of Surgical Sciences, Section of Nuclear Medicine and PET, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Sandström
authors.affiliation: Department of Radiology, Uppsala University Hospital, 751 85, Uppsala, Sweden.
authors.forename: Rickard
authors.initials: R
authors.lastname: Nyman
authors.affiliation: Department of Medical Sciences, Division of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Granberg
mesh_terms: D000328:Adult; D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Neuroendocrine liver metastases; Selective internal radiation therapy; Transarterial; Yttrium