title: Single-institution experience of radioembolization with yttrium-90 microspheres for unresectable metastatic neuroendocrine liver tumors.
abstract: OBJECTIVE
  The aim of this study was to assess the effectiveness of yttrium-90 (90Y) microspheres for the treatment of unresectable metastatic liver neuroendocrine tumors (NET).
  
  
  METHODS
  From February 2006 to September 2015, 36 patients (19 male and 17 female, age 63.6 ± 9.4 years) who underwent90Y therapy for unresectable liver metastases of NET were included and analyzed retrospectively. All patients received a variety of treatments before90Y therapy. The radiological response, symptoms improvement of carcinoid syndrome, tumor marker changes, complications, side effects/toxicity, survival, and factors related to survival were evaluated and analyzed.
  
  
  RESULTS
  Of the 36 patients, the mean delivered dose of90Y was 1.8 ± 0.7 GBq with a total of 40 treatments. Overall disease control rate was 88.9% (32/36) at 3 months following therapy. In 16 patients with carcinoid syndrome, 15 (93.8%) patients had symptomatic improvement. Tumor marker response (5-hydroxyindoleacetic acid [n = 7] and chromogranin A [n = 13]) at 3 months after treatment were as follows: none (n = 0, 4), partial (n = 6, 7), and complete (n = 1, 2). Radiation-induced gastrointestinal ulcers (n = 2, 5.6%) were identified. Side effects included fatigue (n = 31, 86.1%), anorexia (n = 26, 72.2%), nausea (n = 15, 41.7%), vomiting (n = 14, 38.9%), abdominal pain (n = 10, 27.8%), and fever (n = 8, 22.2%). The mean follow-up was 27.0 ± 16.4 months, with a median survival of 41.0 months. Child-Pugh classification (P = 0.008) and lymph node metastases (P = 0.045) had statistically significant influence on overall survival.
  
  
  CONCLUSIONS
  Yttrium-90 radioembolization can be effective in the treatment of unresectable liver metastases of NET who failed to respond to other treatments.
authors.affiliation: Department of Interventional Radiology, The Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, China.
authors.forename: Zhongzhi
authors.initials: Z
authors.lastname: Jia
authors.affiliation: Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Paz-Fumagalli
authors.affiliation: Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Frey
authors.affiliation: Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Sella
authors.affiliation: Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: J Mark
authors.initials: JM
authors.lastname: McKinney
authors.affiliation: Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA.
authors.forename: Weiping
authors.initials: W
authors.lastname: Wang
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008207:Lymphatic Metastasis; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; C000615496:Yttrium-90
keywords: liver metastases; neuroendocrine tumor; radioembolization; yttrium-90