title: The role of hepatic trans-arterial chemoembolization in metastatic medullary thyroid carcinoma: a specialist center experience and review of the literature.
abstract: BACKGROUND
  Liver metastases are relatively common in patients with metastatic medullary thyroid carcinoma (MTC), carrying a negative impact on disease prognosis. The options for selective therapy of liver metastases in MTC patients are limited to catheter-guided procedures such as trans-arterial chemoembolization (TACE). Data regarding the effectiveness and safety of this procedure in MTC are limited.
  
  
  OBJECTIVE
  To explore the clinical outcome, survival and safety profile of TACE for liver metastases in a group of MTC patients.
  
  
  METHODS
  Retrospective case series of patients treated at a single tertiary University Medical Center from 2005 to 2015.
  
  
  RESULTS
  Seven consecutive patients (mean age 64.5 ± 10.9 years, 5 females) with histologically confirmed MTC with liver metastases were included. Metastatic involvement of the liver was less than 50% of the liver volume in all patients. The median size of the largest liver lesion was 40 ± 6.9 mm. The patients underwent in total 20 sessions of TACE. Clinical improvement as well as tumor response (PR) were observed in all patients. The median time to tumor progression was 38 months (range 8-126). Three patients were still alive at the end of the follow-up period (a median overall survival rate of 57 ± 44 months).
  
  
  CONCLUSIONS
  TACE in MTC patients with hepatic metastases is usually well tolerated and induces both clinical improvement and tumor response for prolonged periods of time in the majority of patients. This therapeutic option should always be considered, irrespective of the presence of extrahepatic metastasis.
authors.affiliation: Neuroendocrine Tumor UnitEndocrinology & Metabolism Service, Department of Medicine.
authors.forename: S
authors.initials: S
authors.lastname: Grozinsky-Glasberg
authors.affiliation: Department of RadiologyHadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: A I
authors.initials: AI
authors.lastname: Bloom
authors.affiliation: Department of RadiologyHadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Lev-Cohain
authors.affiliation: Department of RadiologyHadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Klimov
authors.affiliation: Neuroendocrine Tumor UnitEndocrinology & Metabolism Service, Department of Medicine.
authors.forename: H
authors.initials: H
authors.lastname: Besiso
authors.affiliation: Neuroendocrine Tumor UnitEndocrinology & Metabolism Service, Department of Medicine.
authors.forename: D J
authors.initials: DJ
authors.lastname: Gross
mesh_terms: D018278:Carcinoma, Neuroendocrine / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D006499:Hepatic Artery; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008113:Liver Neoplasms / Q000378:metabolism / Q000473:pathology / Q000556:secondary / Q000628:therapy*; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy*