Introduction Transarterial embolisation (TAE) and transarterial chemoembolisation (TACE) are established treatments, mainly for symptom control, in patients with advanced NETs with predominantly hepatic tumour burden. The aim was to assess efficacy, toxicity, overall survival and predictive factors in patients undergoing TAE and TACE.
Methods We carried out a retrospective analysis of 50 patients with NETs who underwent a total of 67 embolisation procedures in a period of nine years. All patients had either symptomatic and/or radiological progression despite previous treatments.
Results The patients’ median age was 62 years (30 males/20 females). Thirty two had TAE and 19 had TACE. The majority of them had midgut (53%) followed by pancreatic NETs (27%). Symptomatic response was observed in 46 patients (69%), and radiological response (either disease stabilisation or partial response) in 51 (76%). There was no significant association between the type of procedure and symptomatic relief (p = 0.36) or radiological response rates (p = 0.23). Urinary 5HIAA and plasma CgA levels were reduced in 50% and 65% patients respectively, post procedures. Increase of plasma CgA levels post procedures was significantly associated with reduced OS (p = 0.0001). The median PFS for the whole group was 19.0 months (95% CI 13.2–24.8), whilst the median OS was 65.0 months (95% CI 22.7–107.3). High grade (G3) NETs were associated with significantly reduced OS (p = 0.002) and PFS (p = 0.043). There was no survival advantage on OS (p = 0.21) and PFS (p = 0.19) comparing TAE to TACE treatment. The presence of extra-hepatic metastases at the time of diagnosis was not associated with reduced survival (p = 0.72). Patients already on somatostatin analogues (38/50.76%), at the time of procedures, survived 46 months longer than those off analogues (p = 0.013), but somatostatin analogues did not affect PFS (p = 0.216). The commonest complication observed was post embolisation syndrome (22/50.44%), whilst mortality rate was 4%. Overall, the complication rate was not significantly different between TAE and TACE (p = 0.4).
Conclusion TAE/TACE are beneficial treatments for control symptoms’ as well as tumour growth with acceptable morbidity and mortality rates. No significant efficacy and survival differences were shown between TAE and TACE. Extra-hepatic metastases at the time of treatment did not affect survival. Increase of plasma CgA levels, post-treatment, was associated with worse prognosis. The use of Somatostatin analogues at the time of treatment improved OS but not PFS.
Abbreviations 5HIAA = 5-hydroxyindoleacetic acid, PFS = Progression-Free Survival, OS = Overall Survival, CgA = Chromogranin
Disclosure of Interest None Declared.