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19 - Assessment, triage, and liver-directed therapies for neuroendocrine tumor metastases

from Section IV - Organ-specific cancers – liver metastases

Published online by Cambridge University Press:  05 September 2016

By
Terence P. Gade  and
Michael C. Soulen
Edited by
Jean-Francois H. Geschwind  and
Michael C. Soulen
Terence P. Gade
Affiliation:
University of Pennsylvania
Michael C. Soulen
Affiliation:
University of Pennsylvania
Jean-Francois H. Geschwind
Affiliation:
Yale University School of Medicine, Connecticut
Michael C. Soulen
Affiliation:
Department of Radiology, University of Pennsylvania Hospital, Philadelphia
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Summary

Once considered rare, the incidence and prevalence of neuroendocrine tumors (NET) have increased rapidly, with a more than fivefold increase in incidence in the USA from 1973 to 2004 and a prevalence that is two to five times that of esophageal cancer, gastric cancer, pancreatic cancer, and hepatobiliary cancer (Figure 19.1). The typically long delay in diagnosis of NETs and their propensity for hepatic metastases create an important role for liver-directed therapies. Challenged by the shortage of physicians experienced in the diagnosis and management of this disease, these long-lived patients often access strong advocacy groups and web-based support sites which direct them to centers of excellence with physician teams that offer a complete understanding of the spectrum of their disease. It is essential that interventional oncologists develop an intimate knowledge of the characteristics and management of NETs in order to know how and when best to apply the armamentarium of image-guided therapies, and guide patients in integrating these with surgical, systemic, and supportive therapies.

Defining neuroendocrine disease

Terminology

Comprising a spectrum of epithelial neoplasms that originate from cells which synthesize peptide hormones released in response to a neuronal stimulus, neuroendocrine neoplasms may develop sporadically or as part of familial syndromes including multiple endocrine neoplasia, von Hippel–Lindau syndrome, and neurofibromatosis. These neoplasms most often originate from the foregut gastroenteric, pancreatic, and pulmonary tissues but may arise from any organ given the widespread distribution of neuroendocrine cells within the body.

The World Health Organization (WHO) Classification of Tumours of the Digestive System of 2010 addresses the classification of gastroenteropancreatic NETs. This classification focuses on the major criteria determining malignant potential, including tumor histopathology or differentiation, grade, site, size, and stage, with the premise that all neuroendocrine neoplasms have malignant potential. Tumor differentiation describes the extent to which the neoplasm resembles its non-neoplastic counterpart. Tumor grade is based on proliferative activity, as determined by the number of mitoses per unit area of tumor (mitoses per 10 high-power microscopic fields or per 2 mm2) or by the proliferative index (the percentage of cells immunolabeling for Ki-67). Grades 1 and 2 imply well-differentiated histopathology based on the proliferative index, with the term carcinoma restricted to grade 3, which includes high-grade, poorly differentiated large-cell or small-cell neuroendocrine carcinomas. The WHO classification system replaces previous terminology, including carcinoid and apudoma, as well as descriptions of embryonic origin (Table 19.1).

Type
Chapter
Information
Interventional Oncology
Principles and Practice of Image-Guided Cancer Therapy
 , pp. 165 - 175
Publisher: Cambridge University Press
Print publication year: 2016

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References

1. Yao, JC, Hassan, M, Phan, A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 2008; 26: 3063–3072.Google Scholar
2. Singh, S, Law, C. Multidisciplinary reference centers: the care of neuroendocrine tumors. J Oncol Pract 2010; 6: e11–e16.Google Scholar
3. Zikusoka, MN, Kidd, M, Eick, G, Latich, I, Modlin, IM. The molecular genetics of gastroenteropancreatic neuroendocrine tumors. Cancer 2005; 104: 2292–2309.Google Scholar
4. Bosman, FT, Carneiro, F, Hruban, RH, Theise, ND. WHO Classification of Tumours of the Digestive System, 4th edn. Lyon: IARC Press; 2010.
5. Klimstra, DS, Modlin, IR, Adsay, NV, et al. Pathology reporting of neuroendocrine tumors: application of the Delphic consensus process to the development of a minimum pathology data set. Am J Surg Pathol 2010; 34: 300–313.Google Scholar
6. Volante, M, Righi, L, Berruti, A, Rindi, G, Papotti, M. The pathological diagnosis of neuroendocrine tumors: common questions and tentative answers. Virkows Arch 2011; 458: 393–402.Google Scholar
7. Gustafsson, BI, Kidd, M, Modlin, IM. Neuroendocrine tumors of the diffuse neuroendocrine system. Curr Opin Oncol 2008; 20: 1–12.Google Scholar
8. Modlin, IM, Kidd, M, Latich, I, Zikusoka, MN, Shapiro, MD. Current status of gastrointestinal carcinoids. Gastroenterology 2005; 128: 1717–1751.Google Scholar
9. Dromain, C, Baere, T de, Lumbroso, J, et al. Detection of liver metastases from endocrine tumors: a prospective comparison of somatostatin receptor scintigraphy, computed tomography, and magnetic resonance imaging. J Clin Oncol 2005; 23: 70–78.Google Scholar
10. Rodrigues, M, Traub-Weidinger, T, Li, S, Ibi, B, Virgolini, I. Comparison of 111In-DOTA-DPhe1-Tyr3-octreotide and 111In-DOTA-lanreotide scintigraphy and dosimetry in patients with neuroendocrine tumours. Eur J Nucl Med Mol Imaging 2006; 33: 532–540.Google Scholar
11. Janson, ET. Treatment of neuroendocrine tumors with somatostatin analogs. Pituitary 2006; 9: 249–256.Google Scholar
12. Hofmann, M, Maecke, H, Borner, R, et al. Biokinetics and imaging with the somatostatin receptor PET radioligand (68)Ga-DOTATOC: preliminary data. Eur J Nucl Med 2001; 28: 1751–1757.Google Scholar
13. Carrasquillo, JA, Chen, CC. Molecular imaging of neuroendocrine tumors. Semin Oncol 2010; 37: 662–679.Google Scholar
14. Orlefors, H, Sundin, A, Garske, U, et al. Whole-body (11)C-5-hydroxytryptophan positron emission tomography as a universal imaging technique for neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and computed tomography. J Clin Endocrinol Metab 2005; 90: 3392–3400.Google Scholar
15. Abgral, R, Leboulleux, S, Deandreis, D, et al. Performance of (18)fluorodeoxyglucose-positron emission tomography and somatostatin receptor scintigraphy for high Ki67 (>/=10%) well-differentiated endocrine carcinoma staging. J Clin Endocrinol Metab 2011; 96: 665–671.Google Scholar
16. Chamberlain, RS, Canes, D, Brown, KT, et al. Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 2000; 190: 432–445.Google Scholar
17. Knox, CD, Anderson, CD, Lamps, LW, Adkins, RB, Pinson, CW. Long-term survival after resection for primary hepatic carcinoid tumor. Ann Surg Oncol 2003; 10: 1171–1175.Google Scholar
18. Touzios, JG, Kiely, JM, Pitt, SC, et al. Neuroendocrine hepatic metastases: does aggressive management improve survival? Ann Surg 2005; 241: 776–783; discussion 83–85.Google Scholar
19. Pavel, M, Baudin, E, Couvelard, A, Krenning, E, Öberg, K, Steinmüller, T, Anlauf, M, Wiedenmann, B, Salazar, R; Barcelona Consensus Conference participants. ENETS Consensus Guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology 2012; 95 (2): 157–176.Google Scholar
20. Kvols, LK, Moertel, CG, O'Connell, MJ, Schutt, AJ, Rubin, J, Hahn, RG. Treatment of the malignant carcinoid syndrome. Evaluation of a long-acting somatostatin analogue. N Engl J Med 1986; 315: 663–666.Google Scholar
21. Rinke, A, Muller, HH, Schade-Brittinger, C, et al. Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol 2009; 27: 4656–4663.Google Scholar
22. Pavel, ME, Hainsworth, JD, Baudin, E, Peeters, M, Hörsch, D, Winkler, RE, Klimovsky, J, Lebwohl, D, Jehl, V, Wolin, EM, Oberg, K, Cutsem, E Van, Yao, JC; RADIANT-2 Study Group. Everolimus plus octreotide long-acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT-2): a randomised, placebo-controlled, phase 3 study. Lancet 2011; 378: 2005–2012.Google Scholar
23. Yao, JC, Shah, MH, Ito, T, et al. Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med 2011; 364: 514–523.Google Scholar
24. Raymond, E, Dahan, L, Raoul, JL, et al. Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med 2011; 364: 501–513.Google Scholar
25. Fine, RL, Gulati, AP, Krantz, BA, Moss, RA, Schreibman, S, Tsushima, DA, Mowatt, KB, Dinnen, RD, Mao, Y, Stevens, PD, Schrope, B, Allendorf, J, Lee, JA, Sherman, WH, Chabot, JA. Capecitabine and temozolomide (CAPTEM) for metastatic, well-differentiated neuroendocrine cancers: The Pancreas Center at Columbia University experience. Cancer Chemother Pharmacol 2013; 71 (3): 663–670.Google Scholar
26. Ezziddin, S, Attassi, M, Yong-Hing, CJ, Ahmadzadehfar, H, Willinek, W, Grünwald, F, Guhlke, S, Biersack, HJ, Sabet, A. Predictors of long-term outcome in patients with well-differentiated gastroenteropancreatic neuroendocrine tumors after peptide receptor radionuclide therapy with 177Lu-octreotate.J Nucl Med 2014; 55 (2): 183–190.Google Scholar
27. Vliet, EI Van, Teunissen, JJ, Kam, BL, Jong, M de, Krenning, EP, Kwekkeboom, DJ. Treatment of gastroenteropancreatic neuroendocrine tumors with peptide receptor radionuclide therapy. Neuroendocrinology 2013; 97 (1): 74–85.Google Scholar
28. Carrasquillo, JA, Pandit-Taskar, N, Chen, CC. Radionuclide therapy of adrenal tumors. J Surg Oncol 2012; 106 (5): 632–642.Google Scholar
29. Gurusamy, KS, Ramamoorthy, R, Sharma, D, Davidson, BR. Liver resection versus other treatments for neuroendocrine tumours in patients with resectable liver metastases. Cochrane Database Syst Rev 2009; CD007060.Google Scholar
30. Chen, H, Hardacre, JM, Uzar, A, Cameron, JL, Choti, MA. Isolated liver metastases from neuroendocrine tumors: does resection prolong survival? J Am Coll Surg 1998; 187: 88–92; discussion 93.Google Scholar
31. Hellman, P, Lundstrom, T, Ohrvall, U, et al. Effect of surgery on the outcome of midgut carcinoid disease with lymph node and liver metastases. World J Surg 2002; 26: 991–997.Google Scholar
32. Musunuru, S, Chen, H, Rajpal, S, et al. Metastatic neuroendocrine hepatic tumors: resection improves survival. Arch Surg 2006; 141: 1000–1004; discussion 1005.Google Scholar
33. Capurso, G, Bettini, R, Rinzivillo, M, Boninsegna, L, Fave, G Delle, Falconi, M. Role of resection of the primary pancreatic neuroendocrine tumour only in patients with unresectable metastatic liver disease: a systematic review. Neuroendocrinology 2011; 93: 223–229.Google Scholar
34. Norton, JA, Kivlen, M, Li, M, Schneider, D, Chuter, T, Jensen, RT. Morbidity and mortality of aggressive resection in patients with advanced neuroendocrine tumors. Arch Surg 2003; 138: 859–866.Google Scholar
35. Osborne, DA, Zervos, EE, Strosberg, J, et al. Improved outcome with cytoreduction versus embolization for symptomatic hepatic metastases of carcinoid and neuroendocrine tumors. Ann Surg Oncol 2006; 13: 572–581.Google Scholar
36. Pathak, S, Dash, I, Taylor, MR, Poston, GJ. The surgical management of neuroendocrine hepatic metastases. Eur J Surg Oncol 2013; 39: 224–228.Google Scholar
37. Treut, YP Le, Grégoire, E, Klempnauer, J, Belghiti, J, Jouve, E, Lerut, J, Castaing, D, Soubrane, O, Boillot, O, Mantion, G, Homayounfar, K, Bustamante, M, Azoulay, D, Wolf, P, Krawczyk, M, Pascher, A, Suc, B, Chiche, L, Urbina, JO de, Mejzlik, V, Pascual, M, Lodge, JP, Gruttadauria, S, Paye, F, Pruvot, FR, Thorban, S, Foss, A, Adam, R; For ELITA. Liver transplantation for neuroendocrine tumors in Europe-results and trends in patient selection: a 213-case European liver transplant registry study. Ann Surg 2013; 257 (5): 807–815.Google Scholar
38. Gamblin, TC, Christians, K, Pappas, SG. Radiofrequency ablation of neuroendocrine hepatic metastasis. Surg Oncol Clin N Am 2011; 20: 273–279, vii–viii.Google Scholar
39. Solbiati, L, Ierace, T, Tonolini, M, Osti, V, Cova, L. Radiofrequency thermal ablation of hepatic metastases. Eur J Ultrasound 2001; 13: 149–158.Google Scholar
40. Wettstein, M, Vogt, C, Cohnen, M, et al. Serotonin release during percutaneous radiofrequency ablation in a patient with symptomatic liver metastases of a neuroendocrine tumor. Hepatogastroenterology 2004; 51: 830–832.Google Scholar
41. Elias, D, Pietroantonio, D, Gachot, B Di, Menegon, P, Hakime, A, Baere, T de. Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure. Gastroenterol Clin Biol 2006; 30: 823–827.Google Scholar
42. Akyildiz, HY, Mitchell, J, Milas, M, Siperstein, AE, Berber, E. Laparoscopic radiofrequency thermal ablation of neuroendocrine hepatic metastases: long-term follow-up. Surgery 2010; 148: 1288–1293.Google Scholar
43. Henn, AR, Levine, EA, McNulty, W, Zagoria, RJ. Percutaneous radiofrequency ablation of hepatic metastases for symptomatic relief of neuroendocrine syndromes. AJR Am J Roentgenol 2003; 181: 1005–1010.Google Scholar
44. Karabulut, K, Akyildiz, HY, Lance, C, et al. Multimodality treatment of neuroendocrine liver metastases. Surgery 2011; 150: 316–325.Google Scholar
45. Livraghi, T, Vettori, C, Lazzaroni, S. Liver metastases: results of percutaneous ethanol injection in 14 patients. Radiology 1991; 179: 709–712.Google Scholar
46. Sofocleous, CT, Petre, EN, Gonen, M, Reidy-Lagunes, D, Ip, IK, Alago, W, Covey, AM, Erinjeri, JP, Brody, LA, Maybody, M, Thornton, RH, Solomon, SB, Gertrajdman, GI, Brown, KT. Factors affecting periprocedural morbidity and mortality and long-term patients survival after embolization of hepatic neuroendocrine metastases. J Vasc Interv Radiol 2014; 25: 22–30.Google Scholar
47. Roche, A, Girish, BV, Baere, T de, et al. Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol 2003; 13: 136–140.Google Scholar
48. Engstrom, PF, Lavin, PT, Moertel, CG, Folsch, E, Douglass, HO, Jr. Streptozocin plus fluorouracil versus doxorubicin therapy for metastatic carcinoid tumor. J Clin Oncol 1984; 2: 1255–1259.Google Scholar
49. Schell, SR, Camp, ER, Caridi, JG, Hawkins, IF, Jr. Hepatic artery embolization for control of symptoms, octreotide requirements, and tumor progression in metastatic carcinoid tumors. J Gastrointest Surg 2002; 6: 664–670.Google Scholar
50. Pueyo, I, Jimenez, JR, Hernandez, J, et al. Carcinoid syndrome treated by hepatic embolization. AJR Am J Roentgenol 1978; 131: 511–513.Google Scholar
51. Lunderquist, A, Ericsson, M, Nobin, A, Sanden, G. Gelfoam powder embolization of the hepatic artery in liver metastases of carcinoid tumors. Radiologe 1982; 22: 65–70.Google Scholar
52. Ajani, JA, Carrasco, CH, Charnsangavej, C, Samaan, NA, Levin, B, Wallace, S. Islet cell tumors metastatic to the liver: effective palliation by sequential hepatic artery embolization. Ann Intern Med 1988; 108: 340–344.Google Scholar
53. Madoff, DC, Gupta, S, Ahrar, K, Murthy, R, Yao, JC. Update on the management of neuroendocrine hepatic metastases. J Vasc Interv Radiol 2006; 17: 1235–1249; quiz 1250.Google Scholar
54. Dominguez, S, Denys, A, Madeira, I, et al. Hepatic arterial chemoembolization with streptozotocin in patients with metastatic digestive endocrine tumours. Eur J Gastroenterol Hepatol 2000; 12: 151–157.Google Scholar
55. Baere, T de, Dufaux, J, Roche, A, et al. Circulatory alterations induced by intra-arterial injection of iodized oil and emulsions of iodized oil and doxorubicin: experimental study. Radiology 1995; 194: 165–170.Google Scholar
56. Baere, T de, Denys, A, Briquet, R, Chevallier, P, Dufaux, J, Roche, A. Modification of arterial and portal hemodynamics after injection of iodized oils and different emulsions of iodized oils in the hepatic artery: an experimental study. J Vasc Interv Radiol 1998; 9: 305–310.Google Scholar
57. Gaur, SK, Friese, JL, Sadow, CA, et al. Hepatic arterial chemoembolization using drug-eluting beads in gastrointestinal neuroendocrine tumor metastatic to the liver. Cardiovasc Intervent Radiol 2011; 34: 566–572.Google Scholar
58. Carter, S, II, RC Martin. Drug-eluting bead therapy in primary and metastatic disease of the liver. HPB (Oxford) 2009; 11: 541–550.Google Scholar
59. Vogl, TJ, Lammer, J, Lencioni, R, Malagari, K, Watkinson, A, Pilleul, F, Denys, A, Lee, C. Liver, gastrointestinal, and cardiac toxicity in intermediate hepatocellular carcinoma treated with PRECISION TACE with drug-eluting beads: results from the PRECISION V randomized trial. AJR Am J Roentgenol 2011; 197: W562–W570.Google Scholar
60. Guiu, B, Deschamps, F, Aho, S, Munck, F, Dromain, C, Boige, V, et al. Liver/biliary injuries following chemoembolisation of endocrine tumours and hepatocellular carcinoma: Lipiodol vs. drug-eluting beads. J Hepatol 2011; 56: 609–617.Google Scholar
61. Bhagat, N, Reyes, D, Lin, M, Kamel, I, Pawlik, TM, Frangakis, C, Geschwind, JF. Phase II study of chemoembolization with drug-eluting beads in patients with hepatic neuroendocrine metastases: high incidence of biliary injury. Cardiovasc Intervent Radiol 2013; 36: 449–459.Google Scholar
62. Kim, W, Clark, TWI, Baum, RA, Soulen, MC. Risk factors for liver abscess formation following hepatic chemoembolization. JVIR 2001; 12: 965–968.Google Scholar
63. Patel, S, Tuite, CM, Mondschein, JI, Soulen, MC. Effectiveness of an aggressive antibiotic regimen for chemoembolization in patients with previous biliary intervention. J Vasc Interv Radiol 2006; 17: 1931–1934.Google Scholar
64. Khan, W, Sullivan, KL, McCann, JW, Gonsalves, CF, Sato, T, Eschelman, DJ, Brown, DB. Moxifloxacin prophylaxis for chemoembolization or embolization in patients with previous biliary interventions: a pilot study. AJR Am J Roentgenol 2011; 197: W343–W345.Google Scholar
65. Roche, A, Girish, BV, Baere, T de, et al. Prognostic factors for chemoembolization in liver metastasis from endocrine tumors. Hepatogastroenterology 2004; 51: 1751–1756.Google Scholar
66. Gupta, S. Intra-arterial liver-directed therapies for neuroendocrine hepatic metastases. Semin Intervent Radiol 2013; 30: 28–38.Google Scholar
67. Eriksson, BK, Larsson, EG, Skogseid, BM, Lofberg, AM, Lorelius, LE, Oberg, KE. Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 1998; 83: 2293–2301.Google Scholar
68. Stokes, KR, Stuart, K, Clouse, ME. Hepatic arterial chemoembolization for metastatic endocrine tumors. J Vasc Interv Radiol 1993; 4: 341–345.Google Scholar
69. Ruutiainen, AT, Soulen, MC, Tuite, CM, et al. Chemoembolization and bland embolization of neuroendocrine tumor metastases to the liver. J Vasc Interv Radiol 2007; 18: 847–855.Google Scholar
70. Kennedy, A, Nag, S, Salem, R, et al. Recommendations for radioembolization of hepatic malignancies using yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 2007; 68: 13–23.Google Scholar
71. Rhee, TK, Lewandowski, RJ, Liu, DM, et al. 90Y Radioembolization for metastatic neuroendocrine liver tumors: preliminary results from a multi-institutional experience. Ann Surg 2008; 247: 1029–1035.Google Scholar
72. Kennedy, AS, Dezarn, WA, McNeillie, P, et al. Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol 2008; 31: 271–279.Google Scholar
73. Whitney, R, Valek, V, Fages, JF, et al. Transarterial chemoembolization and selective internal radiation for the treatment of patients with metastatic neuroendocrine tumors: a comparison of efficacy and cost. Oncologist 2011; 16: 594–601.Google Scholar
74. Liu, DM, Kennedy, A, Turner, D, et al. Minimally invasive techniques in management of hepatic neuroendocrine metastatic disease. Am J Clin Oncol 2009; 32: 200–215.Google Scholar
75. Kennedy, A, Coldwell, D, Sangro, B, Wasan, H, Salem, R. Integrating radioembolization into the treatment paradigm for metastatic neuroendocrine tumors in the liver. Am J Clin Oncol 2012; 35 (4): 393–398.Google Scholar
76. Memon, K, Lewandowski, RJ, Mulcahy, MF, Riaz, A, Ryu, R, Sato, KT, Gupta, R, Nikolaidis, P, Miller, FH, Yaghmai, V, Gates, VL, Atassi, B, Newman, S, Omary, RA, Benson, AB 3rd, Salem, R. Radioembolization for neuroendocrine liver metastases: safety, imaging, and long-term outcomes. Int J Radiat Oncol Biol Phys 2012; 83: 887–894.Google Scholar
77. Loewe, C, Schindl, M, Cejna, M, Niederle, B, Lammer, J, Thurnher, S. Permanent transarterial embolization of neuroendocrine metastases of the liver using cyanoacrylate and Lipiodol: assessment of mid- and long-term results. AJR Am J Roentgenol 2003; 180: 1379–1384.Google Scholar
78. Swärd, C, Johanson, V, Dijkum, E Nieveen van, Jansson, S, Nilsson, O, Wängberg, B, Ahlman, H, Kölby, L. Prolonged survival after hepatic artery embolization in patients with midgut carcinoid syndrome. Br J Surg 2009; 96: 517–521.Google Scholar
79. Pitt, SC, Knuth, J, Keily, JM, McDermott, JC, Weber, SM, Chen, H, Rilling, WS, Quebbeman, EJ, Agarwal, DM, Pitt, HA. Hepatic neuroendocrine metastases: chemo- or bland embolization? J Gastrointest Surg 2008; 12: 1951–1960.Google Scholar
80. Gupta, S, Johnson, MM, Murthy, R, Ahrar, K, Wallace, MJ, Madoff, DC, McRae, SE, Hicks, ME, Rao, S, Vauthey, JN, Ajani, JA, Yao, JC. Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer 2005; 104: 1590–1602.Google Scholar
81. Varker, KA, Martin, EW, Klemanski, D, Palmer, B, Shah, MH, Bloomston, M. Repeat transarterial chemoembolization (TACE) for progressive hepatic carcinoid metastases provides results similar to first TACE. J Gastrointest Surg 2007; 11 (12): 1680–1685.Google Scholar
82. Hur, S, Chung, JW, Kim, H-C, Oh, D-Y, Lee, S-H, Bang, Y-J, Kim, WH. Survival outcomes and prognostic factors of transcatheter arterial chemoembolization for hepatic neuroendocrine metastases. J Vasc Intervent Radiol 2013; 24: 947–956.Google Scholar
83. King, J, Quinn, R, Glenn, DM, Janssen, J, Tong, D, Liaw, W, Morris, DL. Radioembolization with selective internal radiation microspheres for neuroendocrine liver metastases. Cancer 2008; 113: 921–929.Google Scholar
84. Paprottka, PM, Hoffmann, RT, Haug, A, Sommer, WH, Raessler, F, Trumm, CG, Schmidt, GP, Ashoori, N, Reiser, MF, Jakobs, TF. Radioembolization of symptomatic, unresectable neuroendocrine hepatic metastases using yttrium-90 microspheres. Cardiovasc Intervent Radiol 2012; 35: 334–342.Google Scholar

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