Abstract
OBJECTIVE: To compare the safety and efficacy of transarterial embolization (TAE) and transarterial radioembolization (TARE) in the treatment of lung carcinoid liver metastasis. METHOD: 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. RESULTS: 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). CONCLUSION: 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.