Yttrium-90 Radioembolization Versus Transarterial Embolization for Lung Carcinoid Hepatic Metastasis

To compare the safety and efficacy of transarterial embolization (TAE) and transarterial radioembolization (TARE) in the treatment of lung carcinoid liver metastasis.

This retrospective, single-institution study included 30 patients with lung carcinoid liver metastasis treated with 53 primary embolization procedures (24 TARE; 29 TAE) between 2009 and 2022. Survival analyses were performed using the Kaplan-Meier method. Adverse events were assessed using the Common Terminology Criteria of Adverse Events Version 5.0.

The local tumor progression-free survival (LTPFS) for the entire cohort was 16.2 (95% confidence interval [CI]: 12.6-22.2) months. Factors associated with poor LTFPS for all patients included chromogranin A positivity (hazard ratio [HR]: 10.13, 95% CI: 2.32-44.31, p = 0.002), previous octreotide treatment (HR: 2.37, 95% CI: 1.12-5.01, p = 0.01), and previous everolimus treatment (HR: 2.4, 95% CI: 1.12-5.01, p = 0.02).TARE was associated with significantly improved LTPFS; 30.57 (95% CI: 12.4-33.4) months compared with TAE 13.9 (95% CI: 10.87-20.13) months, (p = 0.01). Patients on concurrent everolimus at the time of TARE had a significant improvement in LTPFS (HR: 0.25, 95% CI: 0.16-0.41, p < 0.001).The median overall survival of the entire cohort was 43.5 (95% CI: 20.5-55.9) months; 40.6 (95% CI: 20-49.0) months for TAE versus 43.5 (95% CI: 12.3-61.4) months for TARE (p = 0.49).Postprocedure adverse events occurred in 28 out of 74 (38%) treatments, most being grade 1 and 2 (n = 24). Severe adverse events (Common Terminology Criteria of Adverse Events grade ≥3) included severe vomiting after TARE (2), acute kidney injury after TAE (1), and bacteremia after TAE (1).

TARE exhibited better local tumor control compared with TAE in patients with lung carcinoid, with no significant difference in overall survival. Both hepatic arterially directed therapies exhibited acceptable safety profiles.