![Page 1: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/1.jpg)
Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization Geert Maleux MD, PhDDepartment of RadiologyUniversity Hospitals LeuvenBelgium
![Page 2: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/2.jpg)
Introduction
• Loco-regional therapies for NET liver metastases :
– Transarterial embolization• PVA-microparticles• Tris-acryl gelatin microspheres• Glue (mixture of enbucrylate and Lipiodol)
– Transarterial chemo-embolization• Conventional TACE (Lipiodol & drugs)• Drug-eluting beads• Starch microspheres & chemotherapeutic agents
– Yttrium-90 radioembolization (SIRT)
![Page 3: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/3.jpg)
Introduction
• Loco-regional therapies for NET liver metastases :– Transarterial embolization
• PVA-microparticles• Tris-acryl gelatin microspheres• Glue (mixture of enbucrylate and Lipiodol)
– Transarterial chemo-embolization• Conventional TACE (Lipiodol & drugs)• Drug-eluting beads• Starch microspheres & chemotherapeutic agents
– Yttrium-90 radioembolization (SIRT)
![Page 4: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/4.jpg)
Case 1
• 65-year-old female patient• 2006 : pNET
– Surgery (pancreatectomy, splenectomy, liver segmentectomies)
• 2009 – 2012 : everolimus• 2013 :
– Diffuse liver metastases– Hypoglycemias +++
![Page 5: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/5.jpg)
![Page 6: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/6.jpg)
![Page 7: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/7.jpg)
![Page 8: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/8.jpg)
Case 2
• 61-year-old woman• 2010 : pancreatic NET & liver metastases• R/ Sandostatin + everolimus• 2012 : progression of disease & hypoglycemia
![Page 9: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/9.jpg)
![Page 10: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/10.jpg)
![Page 11: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/11.jpg)
![Page 12: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/12.jpg)
Symptoms Complete relief
Partial relief No relief unknown
Carcinoidsyndrome:Diarrhea, flushing, headache
5 3 0 /
Islet cellsyndrome : hypoglycemia
3 1 0 /
pain 0 0 1 /
unknown / / / 3
Leuven experience with drug-eluting beads (SAP-microspheres)
![Page 13: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/13.jpg)
Complication N° of patients (n=17) %
Ischemic cholecystitis 1 6%
Carcinoid storm 1 6%
Insulin storm 1 6%
Post-embolization syndrome 14 82%
None 3 18%
Leuven experience with drug-eluting beads (SAP-microspheres)
![Page 14: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/14.jpg)
RECIST N° of patients (n=17) %
Partial response 2 13%
Stable disease 12 80%
Progression of disease 1 7%
unknown 2 /
EASL criteria N° of patients (n=17) %
Partial response 13 87%
Stable disease 1 7%
Progression of disease 1 7%
Unknown 2 /
![Page 15: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/15.jpg)
DEB-TACE
• SAP-microspheres : safe & effective– 0% bilomas– Tumor burden :
• DC-beads (100 – 300 micron)– 54 % bilomas– < 30% tumor burden
Tumor burden N° of patients (n=17)0-10% 310-20% 320-50% 5>50% 4Unknown / not measurable 2
Bhagat et al. CVIR 2013
![Page 16: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/16.jpg)
Case 3
• 43-year-old woman• 2008 : small bowel NET & liver metastases
– Enterectomy & RF-ablation– 90Y-DOTATOC
• 2011 progression of disease– SIRT (resin microspheres)
![Page 17: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/17.jpg)
![Page 18: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/18.jpg)
![Page 19: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/19.jpg)
![Page 20: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/20.jpg)
![Page 21: Cases of NET’s with liver metastases, technical ... · Cases of NET’s with liver metastases, technical illustration of radioembolization, chemoembolization . Geert Maleux MD,](https://reader031.vdocuments.mx/reader031/viewer/2022022118/5cc4e97688c993ab2a8cbb23/html5/thumbnails/21.jpg)
Yttrium-90 radioembolization
• Very effective : > 3 years no liver metastases
• Non-target embolization– Gastritis– Ulceration refractory to medical treatment– Surgery – Liver fibrosis -> cirrhosis ??