Department of Radiology, Division of Vascular and Interventional Radiology, University of Minnesota, 420 Delaware Street SE, MMC 292, Minneapolis, MN, 55455, USA.
Curr Treat Options Oncol. 2020 May 23;21(6):52. doi: 10.1007/s11864-020-00751-x.
Liver-directed therapy should be considered for patients with unresectable liver metastases from neuroendocrine tumor if symptomatic or progressing despite medical management. Our experience and current literature shows that the bland embolization, chemoembolization, and radioembolization are very effective in controlling symptoms and disease burden in the liver, and that these embolization modalities are similar in terms of efficacy and radiologic response. Their safety profiles differ, however, with recent studies suggesting an increase in biliary toxicity with drug-eluting bead chemoembolization over conventional chemoembolization, and a risk of long-term hepatotoxicity with radioembolization. For this reason, we tailor the type of embolotherapy to each patient according to their clinical status, symptoms, degree of tumor burden, histologic grade, and life expectancy. We do not recommend a "one-size-fits-all" approach. Our general strategy is to use bland embolization as first-line embolotherapy, and radioembolization for patients with high-grade tumors or who have failed other embolotherapy.
对于有不可切除的神经内分泌肿瘤肝转移且有症状或经药物治疗后进展的患者，应考虑进行肝定向治疗。我们的经验和目前的文献表明，单纯栓塞、化疗栓塞和放射性栓塞在控制肝脏症状和疾病负担方面非常有效，并且这些栓塞方式在疗效和影像学反应方面相似。然而，它们的安全性特征不同，最近的研究表明，与传统化疗栓塞相比，载药微球化疗栓塞会增加胆道毒性，放射性栓塞会有长期肝毒性的风险。因此，我们根据患者的临床状况、症状、肿瘤负担程度、组织学分级和预期寿命，为每位患者量身定制栓塞治疗的类型。我们不建议采用“一刀切”的方法。我们的一般策略是将单纯栓塞作为一线栓塞治疗，对于高级别肿瘤或其他栓塞治疗失败的患者，使用放射性栓塞。
