CIO 2021-5 Y-90 Radioembolization for Neuroendocrine Tumor Liver Metastases and Periprocedural Hemodynamic Instability

Purpose: Transarterial radioembolization (TARE) is commonly used for treatment of neuroendocrine tumor liver metastases (NETLMs). Hormonal release causing hemodynamic instability and carcinoid symptoms is frequently observed during bland embolization of NETLMs. The hemodynamic changes during TARE treatment of NETLMs have not been thoroughly explored. The purpose of our study was to investigate periprocedural hemodynamic instability (PPHDI) associated with TARE for NETLMs.

Material and Methods: From December 2009 to May 2019, 109 NETLMs patients (68 males, 41 females, median age of 62 years) were treated with TARE. Retrospective review of medical records was performed to evaluate the occurrence of PPHDI. Acute PPHDI was defined as a systolic blood pressure above 160 mmHg or below 100 mmHg, a diastolic blood pressure above 110 mmHg or below 60 mmHg, or a pulse below 60 bpm and required IV administration octreotide and/or antihypertensive medication. Delayed PPHDI was considered if the patient required new antihypertensive medication for blood pressure control within 24 hours after the procedure. Fisher exact test was used to compare the occurrence of PPHDI between patients who were receiving long-acting somatostatin analogs (LA-SSA) prior to TARE and patients who did not.

Results: 179 total TAREs were performed on 109 patients. 51 patients had 1 TARE and 58 had multiple TAREs (2 n=47; 3 n=10; and 4 n=1). 38 (21%) TAREs were associated with PPHDI. Acute PPHDI occurred during 31/179 (17%) TAREs. Delayed PPHDI occurred following 14/179 (8%) TAREs. PPHDI occurred in 7/28 (25%) TAREs in patients who were receiving LA-SSA. Of the 151 TAREs in which the patient had not been receiving LA-SSA, 31 (21%) were associated with PPHDI. There was no significant difference in the occurrence of PPHDI between patients who received LA-SSA and those who did not (p=0.6).

Conclusions: This retrospective analysis suggests that PPHDI occurs in 1 in 5 TAREs for NETLMs. Patients who are receiving LA-SSA prior to TARE have the same risk of developing PPHDI as patients who are not. Further analysis comparing the risks of developing PPHDI due to TARE and other embolotherapies for NETLMs is needed to better assess the relative safety of these treatments.