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Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization Geert Maleux MD, PhDDepartment of RadiologyUniversity Hospitals LeuvenBelgium
Introduction
• Loco-regional therapies for NET liver metastases :
– Transarterial embolization• PVA-microparticles• Tris-acryl gelatin microspheres• Glue (mixture of enbucrylate and Lipiodol)
– Transarterial chemo-embolization• Conventional TACE (Lipiodol & drugs)• Drug-eluting beads• Starch microspheres & chemotherapeutic agents
– Yttrium-90 radioembolization (SIRT)
Introduction
• Loco-regional therapies for NET liver metastases :– Transarterial embolization
• PVA-microparticles• Tris-acryl gelatin microspheres• Glue (mixture of enbucrylate and Lipiodol)
– Transarterial chemo-embolization• Conventional TACE (Lipiodol & drugs)• Drug-eluting beads• Starch microspheres & chemotherapeutic agents
– Yttrium-90 radioembolization (SIRT)
Case 1
• 65-year-old female patient• 2006 : pNET
– Surgery (pancreatectomy, splenectomy, liver segmentectomies)
• 2009 – 2012 : everolimus• 2013 :
– Diffuse liver metastases– Hypoglycemias +++
Case 2
• 61-year-old woman• 2010 : pancreatic NET & liver metastases• R/ Sandostatin + everolimus• 2012 : progression of disease & hypoglycemia
Symptoms Complete relief
Partial relief No relief unknown
Carcinoidsyndrome:Diarrhea, flushing, headache
5 3 0 /
Islet cellsyndrome : hypoglycemia
3 1 0 /
pain 0 0 1 /
unknown / / / 3
Leuven experience with drug-eluting beads (SAP-microspheres)
Complication N° of patients (n=17) %
Ischemic cholecystitis 1 6%
Carcinoid storm 1 6%
Insulin storm 1 6%
Post-embolization syndrome 14 82%
None 3 18%
Leuven experience with drug-eluting beads (SAP-microspheres)
RECIST N° of patients (n=17) %
Partial response 2 13%
Stable disease 12 80%
Progression of disease 1 7%
unknown 2 /
EASL criteria N° of patients (n=17) %
Partial response 13 87%
Stable disease 1 7%
Progression of disease 1 7%
Unknown 2 /
DEB-TACE
• SAP-microspheres : safe & effective– 0% bilomas– Tumor burden :
• DC-beads (100 – 300 micron)– 54 % bilomas– < 30% tumor burden
Tumor burden N° of patients (n=17)0-10% 310-20% 320-50% 5>50% 4Unknown / not measurable 2
Bhagat et al. CVIR 2013
Case 3
• 43-year-old woman• 2008 : small bowel NET & liver metastases
– Enterectomy & RF-ablation– 90Y-DOTATOC
• 2011 progression of disease– SIRT (resin microspheres)
Yttrium-90 radioembolization
• Very effective : > 3 years no liver metastases
• Non-target embolization– Gastritis– Ulceration refractory to medical treatment– Surgery – Liver fibrosis -> cirrhosis ??
• Thank you for your attention