Ho Li Shen, Baetens Tarik, Lam Marnix G E H, Braat Arthur J A T
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
Endocr Oncol. 2025 May 31;5(1):e240053. doi: 10.1530/EO-24-0053. eCollection 2025 Jan.
Neuroendocrine liver metastases significantly affect patient prognosis and quality of life due to their symptomatic burden and challenging management. Besides conventional systemic therapies, liver-directed therapies improve patient outcomes in patients with liver-dominant disease. These liver-directed therapies have gained interest over the past decade, but their placement in the treatment algorithm of neuroendocrine liver metastases remains largely unclear. The purpose of this review is to evaluate the current role of selective internal radiation therapy (radioembolization) as a treatment for neuroendocrine liver metastases. This review examines the patient selection, procedural aspects, applications, and clinical outcomes. Radioembolization is effective as a standalone treatment. This treatment achieves disease control rates exceeding 90% and improves symptoms and quality of life. Moreover, combining radioembolization with systemic therapies may provide improved treatment response and additional benefits, but further investigation is required. The treatments effectiveness is influenced by appropriate patient selection, including consideration of liver function, tumor vascularity and previous interventions. A multidisciplinary approach is essential in assessing treatment eligibility. Patient management should be tailored on an individual level to optimize outcomes. The incidence of complications is rare (<1%), with radiation-induced liver disease being the most concerning. This review underscores the need for continued research to better understand the optimal use of radioembolization. Specifically, its placement within treatment, particularly in combination with other therapies, requires further exploration, ultimately to improve survival and quality of life for patients with neuroendocrine liver metastases.
神经内分泌肝转移由于其症状负担和具有挑战性的管理，显著影响患者的预后和生活质量。除了传统的全身治疗外，肝导向治疗可改善以肝脏为主的疾病患者的预后。在过去十年中，这些肝导向治疗受到了关注，但其在神经内分泌肝转移治疗方案中的地位仍 largely 不清楚。本综述的目的是评估选择性内放射治疗（放射性栓塞）作为神经内分泌肝转移治疗方法的当前作用。本综述考察了患者选择、操作方面、应用和临床结果。放射性栓塞作为一种独立治疗方法是有效的。这种治疗实现了超过90%的疾病控制率，并改善了症状和生活质量。此外，将放射性栓塞与全身治疗相结合可能会提供更好的治疗反应和额外益处，但还需要进一步研究。治疗效果受适当的患者选择影响，包括对肝功能、肿瘤血管和既往干预措施的考虑。多学科方法对于评估治疗资格至关重要。患者管理应根据个体情况进行调整，以优化结果。并发症的发生率很低（<1%），放射性肝病是最令人担忧的。本综述强调需要持续研究，以更好地理解放射性栓塞的最佳使用方法。具体而言，其在治疗中的地位，特别是与其他疗法联合使用时，需要进一步探索，最终改善神经内分泌肝转移患者的生存率和生活质量。
