Radioembolisation von nicht-resektablen neuroendokrinen Lebermetastasen

Introduction: Treatment options for neuroendocrine tumor liver metastases (NETLMs) have evolved in recent years. A novel approach to hepatic metastases involves arterial embolization of ⁹⁰Y either embedded in a resin microsphere (SIR-Spheres®, Sirtex Medical Ltd®, Lane Cove, Australia) or a glass microsphere (TheraSphere®, MDS-Nordion Inc®, Ontario, Canada). Material and Methods: The author reviewed the recent literature on radioembolization for NETLMs and summarized the results according to tumor response, toxicity, eventual improvement of clinical symptoms and prognostic factors. Results: The patient population is fairly homogenous, heavily pretreated with a median age of 60 years. The Disease Contol rate varies in different studies between 65 % and 99 %. As a result, the median survival time is 28 - 70 months for radioembolization using resin microspheres. The early and late toxicities, according to the Common Terminology Criteria for Adverse Events v3.0, are in comparison to liver metastases of other tumors as well as to other intra-arterial therapies significantly lower. The observed improvement in pre-therapeutically symptomatic patients varies between 75 % and 94.5 %. A low tumor burden, the female gender, a well-differentiated tumor, no extrahepatic tumor burden, and PR or SD after 3 months are significant factors with respect to survival. Conclusions: Radioembolization with ⁹⁰Y resin microspheres is a safe and effective treatment option in patients with otherwise treatment-refractory NETLMs. Antitumoral effect is supported by good local tumor control (RECIST), prolonged survival and improved clinical symptoms. Further prospective investigation is necessary to define the role of radioembolization in the treatment paradigm of NETLMs.