Safety and efficacy of doxorubicin-eluting superabsorbent polymer microspheres for the treatment of liver metastases from neuroendocrine tumors: preliminary results

Abstract

Purpose: To retrospectively evaluate the symptom control, tumor response, and complication rate in patients with liver-predominant metastatic neuroendocrine tumors treated with transarterial chemoembolization using doxorubicin-eluting superabsorbent polymer (SAP) microspheres.

Methods: Patients with neuroendocrine liver metastases who underwent hepatic transarterial chemoembolization using doxorubicin-eluting SAP-microspheres (50–100 µm Hepasphere/Quadrasphere Microsphere^® particles, Merit Medical, South Jordan, Utah, USA) were included in this study. Pre- and post-procedure imaging studies were evaluated to assess short and intermediate-term tumor response using modified RECIST criteria. Symptom relief and procedure-related complications were evaluated.

Results: A total of 27 embolization procedures were performed on 17 patients. Twelve  of 17 patients (70%) were symptomatic, including carcinoid syndrome (n=8) and severe, uncontrollable hyperglycemia (n=4). Eight  of 12 patients (67%) had complete symptom relief, and the remaining 4 (33%) had partial relief. One patient developed ischemic cholecystitis (6%). No other hepatobiliary complications occurred. Short-term and intermediate-term imaging follow-up was available  for 15/17 patients (88%) and 12/14 patients (86%) respectively. At short-term follow-up (< 3 months), 14 patients (93%) showed partial response and the remaining patient had progressive disease (7%). At intermediate-term imaging follow-up (> 3 months), partial response, stable disease and progressive disease were found respectively in 7 (58%), 3 (25%) and 2 (17%) patients.

Conclusions: Chemoembolization with doxorubicin-eluting SAP-microspheres is a safe and effective treatment option for neuroendocrine liver metastases and is associated with a low complication rate. In particular, no clinically evident liver necrosis or bile duct complications were encountered.