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Endocrine Abstracts (2014) 35 P575 | DOI: 10.1530/endoabs.35.P575

Endocrinology and Nutrition Service from Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Murcia, Spain.

Introduction: We present the results of chemoembolization used as a locoregional treatment for liver metastases (on a transplanted liver) from a bronchial carcinoid neuroendocrine tumor with stage IV disease progression.

Case report: A 60-year-old man diagnosed of bronchial carcinoid NET in 2002, underwent surgery by lung lobectomy and excision of lymph node metastases. Treated also with somatostatin analogues (SA) after subsequent discovery of liver metastases with initial stabilization. 2005, due to the finding of elevated biomarkers and liver uptake on the Octreoscan/PET, he received a liver transplant with subsequent disease stabilization without SA. In 2008 he was still free from liver affection, but he had bone metastases, so he was treated with radiopharmaceutical 177 Lutetium–Octreotate. In 2011 he showed mediastinum uptake on the Octreoscan/PET–CT, so he underwent an exploratory thoracotomy and subtotal mediastinal lymphadenectomy, finding NET on the pathology. In 2012 he relapsed with metastases on the transplanted liver, and was treated with mTOR inhibitors. Despite this treatment, he continued with disease progression (5–10% Ki-67 index, indicative of well differentiated NET), so he was considered a candidate for debulking chemoembolization therapy, alongside palliative radiotherapy for bone metastases. In June 2013, the first chemoembolization was performed: segmental branches of the right hepatic lobe (RHL) were accessed by selective arteriography, with embolization of RHL nodules with microspheres loaded with adriamycin. The final angiographic control showed a significant decrease in the number of hypervascular nodules. A second chemoembolization was performed on the left hepatic lobe nodular lesions in October 2013. Overall, there was a good clinical, radiological and analytical response.

Conclusion: Chemoembolization is a valid treatment option for locoregional metastatic liver disease of well differentiated NETs when systemic treatment has failed to stabilize the disease. Although it is not curative, it does seem to improve both survival and qualitiy of life of these patients, as described in previous studies.

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