Prognostic Factors Associated with the Efficacy of Hepatic Transarterial Embolization in Patients with Neuroendocrine Tumors

ABSTRACT

Introduction: To evaluate the safety and efficacy of hepatic transarterial embolization (TAE) or transarterial chemoembolization (TACE) in patients with irresectable liver metastases from neuroendocrine tumors (NETs) treated at two Brazilian cancer centers. Methods: Retrospective multicenter analysis of patients (pts) with histological diagnosis of neuroendocrine tumor of any origin with unresectable and measurable hepatic metastases who underwent at least one procedure of TAE or TACE. Endpoints: Hepatic progression free survival (HPFS), overall survival (OS), tumor response and toxicity assessment. Results: Thirty-six pts were evaluated. Primary tumors were as follow: midgut 20 pts, pancreas 7 pts, others 9 pts. Most of patients had grade (G) 1-2 tumors (93.3%). In patients with functioning NETs, clinically significant symptomatic control was 41.7%. Concerning type of embolization (TAE vs TACE), there were no significant differences in the proportion of patients achieving reduction of at least 50% of 5HIAA (45.5% vs 50%) and radiological disease control rate (91.3% vs 92.3%), respectively. In a median follow up of 40.8 months (m), median HPFS was 38.9m, and mean OS was 98m (median not reached). No significant differences were found in HPFS or OS by type of embolization procedure. Pancreatic primary tumor and G3 tumor by WHO classification were associated with significantly shorter HPFS. Tumor G3 was also associated with shorter OS. Adverse events of any grade were: abdominal pain (13.8%), fever (5.5%), and 2 pts developed biloma. Conclusion: Our study is the first in our region reporting results of TAE/TACE in patients with irresectable liver metastases from NETs. We observed that pts with pancreatic or G3 NET derive less benefit from these procedures. In pts with G1-2 NETs, both techniques offer similar results.

RESUMO

Resumo Introdução: Avaliar a segurança e eficácia da embolização transarterial hepática (TAE) ou quimioembolização transarterial (TACE) em pacientes com metástases hepáticas de tumores neuroendócrinos (TNEs) irressecáveis tratados em dois centros brasileiros de câncer. Métodos: retrospectiva analítica multicêntrica de pacientes (pts) com diagnóstico histológico de tumor neuroendócrino de qualquer origem com metástases hepáticas irressecáveis e mensuráveis que foram submetidas a pelo menos um procedimento de TAE ou TACE. Parâmetros: Sobrevida livre de progressão hepática (SLPH), sobrevida geral (SG), resposta tumoral e avaliação de toxicidade. Resultados: Trinta e seis pts foram avaliados. Os tumores primários foram os seguintes: 20 pts intestino médio, 7 pts pâncreas, 9 pts outros. A maioria dos pacientes apresentava tumores grau (G) 1-2 (93.3%). Em pacientes com TNEs funcionais, clinicamente o controle sintomático foi significativo foi 41.7%. Em relação ao tipo de embolização (TAE vs TACE), não houve diferenças significativas na proporção de pacientes que obtiveram redução de pelo menos 50% do 5HIAA (45.5% vs 50%) e a taxa de controle radiológico da doença (91.3% vs 92.3%), respectivamente. Em um acompanhamento médio de 40.8 meses (m), a SLPH intermediário foi de 38.9m, e a SG média foi de 98m (média não atingida). Não foram encontradas diferenças significativas na SLPH ou na SG pelo tipo de procedimento de embolização. Tumor primário pancreático e tumor G3, pela classificação da OMS, foram também associados com significativa redução da SLPH. O tumor G3 também foi associado com SG reduzida. Os eventos adversos de qualquer grau foram: dor abdominal (13.8%), febre (5.5%) e 2 pts desenvolveram biloma. Conclusão: Nosso estudo é o primeiro em nossa área que relata resultados de TAE/TACE em pacientes com metástases hepáticas irressecáveis de TNEs. Observamos que os pacientes com TNE G3 ou pancreático obtêm menos benefícios destes procedimentos. Em pts com TNEs G1-2, ambas as técnicas oferecem resultados similares.

Keywords:

Embolization, Therapeutic - Chemoembolization, Therapeutic - Neuroendocrine tumors - Neoplasm metastasis.

Descritores:

Embolização terapêutica - Quimioembolização terapêutica - Tumores neuroendócrinos - Metástases neoplásicas.

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