Radioembolisation von nicht-resektablen neuroendokrinen Lebermetastasen

Zusammenfassung

Einleitung: Die Therapieoptionen für Patienten mit neuroendokrinen Lebermetastasen (Neuroendocrine Tumor Liver Metastases/NETLMs) haben sich in den letzten Jahren deutlich verbessert. Ein neuer Ansatz zur Therapie von NETLMs ist die intraarterielle Therapie unter Verwendung von ⁹⁰Yttrium-beschichteten Harz- (SIR-Spheres®, Sirtex Medical Ltd®, Lane Cove, Australia) oder Glasmikrosphären (TheraSphere®, MDS- Nordion Inc®, Ontario, Canada).

Material und Methoden: Der Autor sichtete die aktuelle Literatur in Bezug auf die Radioembolisation bei NETLMs und fasste die Ergebnisse (Tumoransprechen, Toxizität, Veränderung der klinischen Symptome, prognostische Faktoren) zusammen.

Ergebnisse: Das behandelte Patientenkollektiv ist relativ homogen und durch eine Vielzahl von vorausgegangenen Therapien gekennzeichnet. Das mediane Alter liegt bei ca. 60 Jahren. Die Disease Control Rate schwankt in den einzelnen Studien zwischen 65 % und 99 %, daraus resultierend ergibt sich für die Radioembolisation mit Harzmikrosphären eine mediane Überlebenszeit von 28 – 70 Monaten. Die frühen und späten Toxizitäten nach den Common Terminology Criteria for Adverse Events v3.0 fallen im Vergleich zu Lebermetastasen anderer Tumore als auch zu anderen intraarteriellen Therapien deutlich geringer aus. Die beobachtete Verbesserung der prätherapeutisch symptomatischen Patienten variiert von 75 – 94,5 %. Einen signifikanten Einfluss auf das Überleben haben eine geringe Tumorlast, das weibliche Geschlecht, gut differenzierte Tumore, eine fehlende extrahepatische Tumorlast sowie eine partielle Remission bzw. Stable Disease nach 3 Monaten.

Schlussfolgerung: Die Radioembolisation mit ⁹⁰Y beschichteten Mikrosphären ist eine sichere und effektive Therapieoption für Patienten mit therapierefraktären NETLMs. Der anti-tumorale Effekt wird durch die gute lokale Tumorkontrolle (RECIST), das verlängerte Überleben als auch die Verbesserung der klinischen Symptome bewiesen. Um den genauen Standpunkt der Radioembolisation im Therapieregime bei NETLMs zu evaluieren, sind weitere prospektive Studien dringend notwendig.

Abstract

Introduction: Treatment options for neuroendocrine tumor liver metastases (NETLMs) have evolved in recent years. A novel approach to hepatic metastases involves arterial embolization of ⁹⁰Y either embedded in a resin microsphere (SIR-Spheres®, Sirtex Medical Ltd®, Lane Cove, Australia) or a glass microsphere (TheraSphere®, MDS-Nordion Inc®, Ontario, Canada).

Material and Methods: The author reviewed the recent literature on radioembolization for NETLMs and summarized the results according to tumor response, toxicity, eventual improvement of clinical symptoms and prognostic factors.

Results: The patient population is fairly homogenous, heavily pretreated with a median age of 60 years. The Disease Contol rate varies in different studies between 65 % and 99 %. As a result, the median survival time is 28 – 70 months for radioembolization using resin microspheres. The early and late toxicities, according to the Common Terminology Criteria for Adverse Events v3.0, are in comparison to liver metastases of other tumors as well as to other intra-arterial therapies significantly lower. The observed improvement in pre-therapeutically symptomatic patients varies between 75 % and 94.5 %. A low tumor burden, the female gender, a well-differentiated tumor, no extrahepatic tumor burden, and PR or SD after 3 months are significant factors with respect to survival.

Conclusions: Radioembolization with ⁹⁰Y resin microspheres is a safe and effective treatment option in patients with otherwise treatment-refractory NETLMs. Antitumoral effect is supported by good local tumor control (RECIST), prolonged survival and improved clinical symptoms. Further prospective investigation is necessary to define the role of radioembolization in the treatment paradigm of NETLMs.

Schlüsselwörter

Radioembolisation - neuroendokrine Tumoren - Lebermetastasen - Therapieansprechen - Überleben - klinische Symptome

Key words

radioembolization - neuroendocrine tumor - liver metastases - response - survival - clinical symptoms

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