Background: Hepatic arterial embolisation (HAE) is a recommended treatment option for patients with neuro-endocrine neoplasms (NENs) and liver metastasis. We aimed to describe outcomes after HAE for NENs at a single United Kingdom centre and investigate the influence of tumour characteristics.
Methods: Retrospective analysis of sequential patients with NENs undergoing HAE at The Christie NHS Foundation Trust between 2004 and 2018. Primary end points were symptomatic and radiological response; secondary end-points included overall-survival (OS), progression-free survival (PFS) and adverse events.
Results: Embolisation was performed in 47 patients: median follow up was 25 months; mean age 63 years (range 3482); primary site gastrointestinal (64%), pancreas (17%), lung (11%), or unknown (8%); functional tumour in 70% (33 patients, of whom 21 had diarrhoea, 28 flushing, and 5 wheeze); 98% well differentiated tumour; grade 1/2/3 in 49%/45%/4% (maximum proliferation index 29%); liver only disease in 9 patients (20%), and 1/≥2 other metastatic sites in 47%/34%. Therapies received prior to HAE were somatostatin analogue (all patients), chemotherapy (16), targeted therapies (12), radionuclide therapy (5), and debulking surgery (4). At least 2 prior therapies were received by 27 patients, and ≥3 in 18 patients. Indications for HAE were: symptom control in 21% of patients, disease progression (38%), or both (40%). Bilobar HAE was performed in 64% of patients (unilobar 35%). Where documented, symptomatic response was experienced by 76% of patients. Partial radiological response was achieved in 15%, and disease stabilisation at 6 months in a further 57%. Median PFS was 9.8 months (95% confidence interval (CI) 6.514.8). Patients with functional tumours had significantly longer PFS; 14.5 months (95% CI 8.031.5) vs 6.1 months (95% CI 4.46.9), multivariable hazard ratio 0.35, 95% CI 0.150.81, P=0.02. No differences in PFS were observed between patients with grade 1 and grade 2 tumours, or between different primary sites. Median OS was 30.0 months (95% CI 12.263.3). Adverse events were experienced by 29 patients; most commonly pain (13 patients, 45%).
Conclusion: HAE provides symptomatic response and disease control in the majority of patients with NENs, and those with functional tumours may experience differential benefit.
02 Dec 2019
UK and Ireland Neuroendocrine Tumour Society