Radioembolization for neuroendocrine tumors: procedure, application and clinical outcomes.

Abstract

Neuroendocrine liver metastases significantly affect patient prognosis and quality of life due to their symptomatic burden and challenging management. Besides conventional systemic therapies, liver-directed therapies improve patient outcomes in patients with liver-dominant disease. These liver-directed therapies have gained interest over the past decade, but their placement in the treatment algorithm of neuroendocrine liver metastases remains largely unclear. The purpose of this review is to evaluate the current role of selective internal radiation therapy (radioembolization) as a treatment for neuroendocrine liver metastases. This review examines the patient selection, procedural aspects, applications, and clinical outcomes. Radioembolization is effective as a standalone treatment. This treatment achieves disease control rates exceeding 90% and improves symptoms and quality of life. Moreover, combining radioembolization with systemic therapies may provide improved treatment response and additional benefits, but further investigation is required. The treatments effectiveness is influenced by appropriate patient selection, including consideration of liver function, tumor vascularity and previous interventions. A multidisciplinary approach is essential in assessing treatment eligibility. Patient management should be tailored on an individual level to optimize outcomes. The incidence of complications is rare (<1%), with radiation-induced liver disease being the most concerning. This review underscores the need for continued research to better understand the optimal use of radioembolization. Specifically, its placement within treatment, particularly in combination with other therapies, requires further exploration, ultimately to improve survival and quality of life for patients with neuroendocrine liver metastases.