title: Chemoembolization of Neuroendocrine Liver Metastases Using Streptozocin and Tris-acryl Microspheres: Embozar (EMBOsphere + ZAnosaR) Study.
abstract: OBJECTIVE
  The purpose of this prospective observational study was to evaluate the efficacy and tolerability of transarterial chemoembolization (TACE) for neuroendocrine liver metastases using a combination of streptozocin, Lipiodol, and tris-acryl microspheres.
  
  
  METHODS
  A total of 16 men and 9 women aged 59.6 ± 11.3 years, all with predominant liver disease, underwent 54 courses of TACE using an emulsion of 1.5 g of streptozocin and 10 ml of Lipiodol. Additional embolization was performed using 300-500 µm tris-acryl microspheres. Morphological response was evaluated using the RECIST criteria on multi-detector computed tomography or MRI. Clinical efficacy was evaluated particularly in patients with carcinoid syndrome.
  
  
  RESULTS
  The primary tumor was located in the small bowel or pancreas in 21 (84%) patients. Eleven (44%) patients presented with a carcinoid syndrome. Nineteen (76%) patients presented with more than 10 liver nodules. One delayed case of ischemic cholecystitis was treated conservatively. After a median follow-up of 36.1 months, 1 (4%) patient had a complete response, 12 (48%) patients had a partial response, and 7 (28%) patients had a stable disease corresponding to a disease control rate of 80%. All patients with carcinoid syndrome had significant improvement. Median time to progression was 18.8 months and overall survival was 100, 100, and 92% at 1, 2, and 3 years, respectively. Seven patients presented with extrahepatic progression with abdominal lymphadenopathies or metastases to the brain, ovary, adrenal gland, or lung.
  
  
  CONCLUSIONS
  Optimized TACE using a combination of streptozocin, Lipiodol, and tris-acryl microspheres is effective and well tolerated.
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, Caen University and Medical Center, Avenue Cote de Nacre, 14033, Caen Cedex 9, France. pelage-jp@chu-caen.fr.|CERVOxy, CEA, CNRS, ISTCT - Imagerie et Stratégie Thérapeutiques des Pathologies Cérébrales et Tumorales (M Bernaudin), Université de Basse-Normandie UNICAEN, Caen, France. pelage-jp@chu-caen.fr.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Pelage
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, Caen University and Medical Center, Avenue Cote de Nacre, 14033, Caen Cedex 9, France.|CERVOxy, CEA, CNRS, ISTCT - Imagerie et Stratégie Thérapeutiques des Pathologies Cérébrales et Tumorales (M Bernaudin), Université de Basse-Normandie UNICAEN, Caen, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Fohlen
authors.affiliation: Department of Hepatogastroenterology and Oncology, Hopital Ambroise Pare, 9, Avenue Charles de Gaulle, 92104, Boulogne Cedex, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mitry
authors.affiliation: Department of Radiology, Hopital Ambroise Pare, 9, Avenue Charles de Gaulle, 92104, Boulogne Cedex, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Lagrange
authors.affiliation: Department of Biostatistics and Public Health, Hopital Ambroise Pare, 9, Avenue Charles de Gaulle, 92104, Boulogne Cedex, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Beauchet
authors.affiliation: Department of Hepatogastroenterology and Oncology, Hopital Ambroise Pare, 9, Avenue Charles de Gaulle, 92104, Boulogne Cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rougier
mesh_terms: D000180:Acrylic Resins / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004701:Endocrine Gland Neoplasms / Q000473:pathology*; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D005780:Gelatin / Q000008:administration & dosage*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013311:Streptozocin / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000180:Acrylic Resins; D000903:Antibiotics, Antineoplastic; C496735:trisacryl gelatin microspheres; D013311:Streptozocin; D004998:Ethiodized Oil; D005780:Gelatin
keywords: Arterial; Chemoembolization; Neuroendocrine tumors