Hormonal Tumor Mapping for Liver Metastases of Gastroenteropancreatic Neuroendocrine Neoplasms: a Novel Therapeutic Strategy

Overview

Journal J Cancer Res Clin Oncol

Specialty Oncology

Date 2021 Apr 27

PMID 33904982

Authors

Aya Maekawa

Atsushi Kudo

Mitsuhiro Kishino

Yoshiki Murase

Shuichi Watanabe

Yoshiya Ishikawa

Hiroki Ueda

Keiichi Akahoshi

Kosuke Ogawa

Hiroaki Ono

Shinji Tanaka

Yuko Kinowaki

Minoru Tanabe

Affiliations

Soon will be listed here.

Abstract

Purpose: In patients with metastatic functional gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs), it is unknown what degree of tumor reduction is required to eliminate hormonal symptoms. We aimed to reduce hormonal symptoms derived from advanced GEP-NENs by efficient minimal intervention, constructing a hormonal tumor map of liver metastases.

Methods: Between 2013 and 2019, we treated 12 insulinoma or gastrinoma patients with liver metastases. Liver segments containing hormone-producing tumors were identified by injecting calcium gluconate via the hepatic arteries and monitoring the change in serum hormone concentration in the three hepatic veins. A greater-than-twofold increase in hormone concentration indicated a tumor-feeding vessel.

Results: Cases included eight insulinomas and four gastrinomas. Primary lesions were functional in three patients and nonfunctional in 9. Nine patients showed hormonal step-up indicating the presence of functional lesions; eight showed step-up in tumor-bearing liver segments, while one with synchronous liver metastases showed step-up only in the pancreatic region. Five patients underwent surgery. Serum hormone concentration decreased markedly after removing the culprit lesions in 3; immediate improvement in hormonal symptoms was achieved in all patients. Three patients with previous surgical treatment who showed step-up underwent transcatheter arterial embolization, achieving temporary improvement of hormonal symptoms. Four patients showed unclear localization of the hormone-producing tumors; treatment options were limited, resulting in poor outcomes.

Conclusion: Hormonal tumor mapping demonstrated heterogeneity in hormone production among primary and metastatic tumors of GEP-NENs. Minimally invasive treatment based on hormonal mapping may be a viable alternative to conventional cytoreduction.

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