1
|
Touloupas C, Faron M, Hadoux J, Deschamps F, Roux C, Ronot M, Yevich S, Joskin J, Gelli M, Barbé R, Lamartina L, Tissot H, Scoazec JY, Malka D, Ducreux M, Baudin E, de Baère T, Tselikas L. Long Term Efficacy and Assessment of Tumor Response of Transarterial Chemoembolization in Neuroendocrine Liver Metastases: A 15-Year Monocentric Experience. Cancers (Basel) 2021; 13:cancers13215366. [PMID: 34771531 PMCID: PMC8582443 DOI: 10.3390/cancers13215366] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
Simple Summary Neuroendocrine tumors (NET) are rare tumors, with long-term survival even for patients with liver metastases. Transarterial chemoembolization (TACE) is one of the most widely used treatments in this setting. The aim of the study was to assess the long-term efficacy of TACE in a large cohort of patients with NET liver metastases and to correlate imaging findings with survival. In our study including 202 patients with NET liver metastases and a mean follow-up of 8.2 years, TACE was effective to provide disease control for 26 months and a 5.3-year median overall survival (OS). Imaging responses using RECIST and mRECIST criteria were significantly correlated to OS: the median-OS was twice as long among mRECIST responders versus non-responders, with 80.5 months and 39.6 months respectively. These findings are of major importance for everyday practice as they confirm TACE’s effectiveness and usefulness of imaging evaluation to better tailor patient treatment and repeat TACE sessions whenever necessary. Abstract Background: transarterial chemoembolization (TACE) is an established treatment for neuroendocrine tumor (NET) liver metastases. The aim was to evaluate the long-term treatment efficacy of TACE for NET liver metastases, and correlate imaging response with survival. Methods: this IRB-approved, single-center, retrospective study evaluated all TACE procedures performed for NET liver metastases from 2003–2017 for imaging tumor response (RECIST and mRECIST), time to liver progression (TTLP), time to untreatable progression with TACE (TTUP), and overall survival (OS). Patient, tumor, and treatment characteristics were analyzed as prognostic factors. Survival curves according to the Kaplan–Meier method were compared by Log-rank test. Tumor responses according to RECIST and mRECIST were correlated with OS. Results: 555 TACE procedures were performed in 202 NET patients (38% grade 1, 60% grade 2) with primary tumors originating from pancreas, small bowel, and lung (39, 26, and 22% respectively). Median follow-up was 8.2 years (90–139 months). Median TTLP and TTUP were 19.3 months (95%CI 16.3–22.3) and 26.2 months (95%CI 22.3–33.1), respectively. Median OS was 5.3 years (95%CI 4.2–6.7), and was higher among mRECIST responders (80.5 months; 95%CI 64.6–89.8) than in non-responders (39.6 months; 95%CI = 32.8–60.2; p < 0.001). In multivariable analysis, age, tumor grade and liver involvement predicted worse OS, whereas administration of somatostatin analogs correlated with improved OS. Conclusion: TACE for NET liver metastases provides objective response and sustained local disease control rates. RECIST and mRECIST responses correlate with OS.
Collapse
Affiliation(s)
- Caroline Touloupas
- Gustave Roussy, Département d’Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France; (C.T.); (M.F.); (F.D.); (C.R.); (J.J.); (M.G.); (T.d.B.)
| | - Matthieu Faron
- Gustave Roussy, Département d’Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France; (C.T.); (M.F.); (F.D.); (C.R.); (J.J.); (M.G.); (T.d.B.)
- INSERM U1018 OncoStat, CESP, Universtié Paris-Sud, F-94805 Villejuif, France
| | - Julien Hadoux
- Gustave Roussy, Cancer Medicine Department, F-94805 Villejuif, France; (J.H.); (L.L.); (D.M.); (M.D.); (E.B.)
| | - Frédéric Deschamps
- Gustave Roussy, Département d’Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France; (C.T.); (M.F.); (F.D.); (C.R.); (J.J.); (M.G.); (T.d.B.)
| | - Charles Roux
- Gustave Roussy, Département d’Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France; (C.T.); (M.F.); (F.D.); (C.R.); (J.J.); (M.G.); (T.d.B.)
| | - Maxime Ronot
- Beaujon Hospital, Department of Radiology, Université de Paris, APHP.Nord, F-92110 Clichy, France;
| | - Steven Yevich
- MD Anderson Cancer Center, Medical Imaging Department, University of Texas, Houston, TX 77030, USA;
| | - Julien Joskin
- Gustave Roussy, Département d’Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France; (C.T.); (M.F.); (F.D.); (C.R.); (J.J.); (M.G.); (T.d.B.)
| | - Maximiliano Gelli
- Gustave Roussy, Département d’Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France; (C.T.); (M.F.); (F.D.); (C.R.); (J.J.); (M.G.); (T.d.B.)
| | - Rémy Barbé
- Gustave Roussy, Medical Imaging Department, F-94805 Villejuif, France; (R.B.); (H.T.)
| | - Livia Lamartina
- Gustave Roussy, Cancer Medicine Department, F-94805 Villejuif, France; (J.H.); (L.L.); (D.M.); (M.D.); (E.B.)
| | - Hubert Tissot
- Gustave Roussy, Medical Imaging Department, F-94805 Villejuif, France; (R.B.); (H.T.)
| | - Jean-Yves Scoazec
- Gustave Roussy, Department of Medical Biology and Pathology, F-94805 Villejuif, France;
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
| | - David Malka
- Gustave Roussy, Cancer Medicine Department, F-94805 Villejuif, France; (J.H.); (L.L.); (D.M.); (M.D.); (E.B.)
| | - Michel Ducreux
- Gustave Roussy, Cancer Medicine Department, F-94805 Villejuif, France; (J.H.); (L.L.); (D.M.); (M.D.); (E.B.)
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
| | - Eric Baudin
- Gustave Roussy, Cancer Medicine Department, F-94805 Villejuif, France; (J.H.); (L.L.); (D.M.); (M.D.); (E.B.)
| | - Thierry de Baère
- Gustave Roussy, Département d’Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France; (C.T.); (M.F.); (F.D.); (C.R.); (J.J.); (M.G.); (T.d.B.)
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
| | - Lambros Tselikas
- Gustave Roussy, Département d’Anesthésie, Chirurgie et Interventionnel (DACI), F-94805 Villejuif, France; (C.T.); (M.F.); (F.D.); (C.R.); (J.J.); (M.G.); (T.d.B.)
- Faculty of Medicine, Paris-Saclay University, F-94276 Le Kremlin Bicêtre, France
- Correspondence: ; Tel.: +33-(0)142116724; Fax: +33-(0)142115278
| |
Collapse
|
2
|
Abstract
Cholangiocarcinoma (CCA) is the second most common type of primary liver malignancy. The latest classification includes intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma, with the latter one further categorized into perihilar and distal cholangiocarcinoma. Although surgical resection is the preferred treatment for CCA, less than half of the patients are actually eligible for radical surgical resection. Interventional treatment, such as intra-arterial therapies, ablation, and brachytherapy (iodine-125 seed implantation), has become an acceptable palliative treatment for patients with unresectable CCA. For these patients, interventional treatment is helpful for locoregional control, symptom relief, and improving quality of life. Herein, in a timely and topical manner, we will review these advances and highlight future directions of research in this article.
Collapse
Affiliation(s)
- Hang Li
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Li Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Guang-Yu Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Xijuan Yao
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Rui Dong
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| |
Collapse
|
3
|
Tsitskari M, Filippiadis D, Kostantos C, Palialexis K, Zavridis P, Kelekis N, Brountzos E. The role of interventional oncology in the treatment of colorectal cancer liver metastases. Ann Gastroenterol 2018; 32:147-155. [PMID: 30837787 PMCID: PMC6394269 DOI: 10.20524/aog.2018.0338] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/20/2018] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer is a leading cause of death both in Europe and worldwide. Unfortunately, 20-25% of patients with colorectal cancer already have metastases at the time of diagnosis, while 50-60% of the remainder will develop metastases later during the course of the disease. Although hepatic excision is the first-line treatment for patients with liver-limited colorectal metastases and is reported to prolong the survival of these patients, few patients are candidates. Locoregional therapy encompasses minimally invasive techniques practiced by interventional radiology. Most widely used locoregional therapies include ablative treatments (radiofrequency ablation, microwave ablation) and transcatheter intra-arterial therapies (transarterial chemoembolization, and radioembolization with yttrium-90).
Collapse
Affiliation(s)
- Maria Tsitskari
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitris Filippiadis
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Chrysostomos Kostantos
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Kostantinos Palialexis
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Periklis Zavridis
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Elias Brountzos
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| |
Collapse
|
4
|
Tsitskari M, Filippiadis D, Kostantos C, Palialexis K, Zavridis P, Kelekis N, Brountzos E. The role of interventional oncology in the treatment of colorectal cancer liver metastases. Ann Gastroenterol 2018. [PMID: 30837787 DOI: 10.20524/aog.2019.0338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Colorectal cancer is a leading cause of death both in Europe and worldwide. Unfortunately, 20-25% of patients with colorectal cancer already have metastases at the time of diagnosis, while 50-60% of the remainder will develop metastases later during the course of the disease. Although hepatic excision is the first-line treatment for patients with liver-limited colorectal metastases and is reported to prolong the survival of these patients, few patients are candidates. Locoregional therapy encompasses minimally invasive techniques practiced by interventional radiology. Most widely used locoregional therapies include ablative treatments (radiofrequency ablation, microwave ablation) and transcatheter intra-arterial therapies (transarterial chemoembolization, and radioembolization with yttrium-90).
Collapse
Affiliation(s)
- Maria Tsitskari
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitris Filippiadis
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Chrysostomos Kostantos
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Kostantinos Palialexis
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Periklis Zavridis
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Elias Brountzos
- Second Department of Radiology, Unit of Vascular and Interventional Radiology, Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| |
Collapse
|