title: Transarterial Chemoembolization for Metastatic Neuroendocrine Tumors With Massive Hepatic Tumor Burden: Is the Benefit Worth the Risk?
abstract: Neuroendocrine tumors (NETs) have a propensity to metastasize to the liver, often resulting in massive tumor burden and hepatic dysfunction. While transarterial chemoembolization (TACE) is effective in treating patients with NET metastatic to the liver, there are limited data on its utility and benefit in patients with large hepatic involvement. The aim of our study was to determine the clinical benefit and complication rate of TACE in patients with massive hepatic tumor burden.
  
  
  
  Medical records were reviewed in patients with grade 1 or 2 NETs with hepatic metastasis at our institution from January 2000 to September 2014 who underwent TACE. Of 201 total patients, 68 had massive hepatic tumor burden involving >75 % of liver parenchyma.
  
  
  
  Carcinoid syndrome was present in 40 (59 %) patients, and 57 (84 %) of the 68 patients were symptomatic from their disease. Complications beyond post-TACE syndrome occurred in 21.7 % of patients, with the most common complication being cardiac arrhythmias. The 30-day mortality rate was 7 %. Biochemical response was observed in 78 % of patients, while symptomatic relief and radiographic response was achieved in 85 and 82 % of patients, respectively. Median overall survival following TACE was 28 months, with 1-, 2-, and 5-year overall survival of 76, 54, and 26 %, respectively.
  
  
  
  In spite of massive tumor burden, clinical and biochemical improvements were seen in the majority of patients. Morbidity was acceptable and reversible but with a fairly high mortality rate of 7 %. TACE should still be considered in selective patients with massive hepatic tumor burden from metastatic NET for symptom control and palliation.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA. mio.kitano@osumc.edu.
authors.forename: Mio
authors.initials: M
authors.lastname: Kitano
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Gail W
authors.initials: GW
authors.lastname: Davidson
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Shirley
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Schmidt
authors.affiliation: Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Guy
authors.affiliation: Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Hooman
authors.initials: H
authors.lastname: Khabiri
authors.affiliation: Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Dowell
authors.affiliation: Department of Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Manisha H
authors.initials: MH
authors.lastname: Shah
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001145:Arrhythmias, Cardiac / Q000209:etiology; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D053379:Chromogranin A / Q000097:blood; D005260:Female; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary / Q000628:therapy*; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D063189:Symptom Assessment; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D053379:Chromogranin A; C050836:pancreastatin