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Neuroendocrine Tumour — SCE Medical Oncology MCQ

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ModerateGI CancersNeuroendocrine TumourSCE Medical Oncology

A 50-year-old man with metastatic midgut neuroendocrine tumour (Ki-67 3%, G1) has progressive liver-predominant disease on octreotide LAR 30 mg monthly. He has >10 liver metastases. Somatostatin receptor PET-CT shows intense uptake (Krenning grade 4). Before proceeding to PRRT, what liver-directed therapy might be considered?

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Correct answer: A — Hepatic arterial embolisation (bland embolisation or TACE)

For liver-predominant metastatic NET, hepatic arterial embolisation (transarterial embolisation [TAE] or transarterial chemoembolisation [TACE]) is an effective liver-directed therapy exploiting the hepatic arterial blood supply of NET metastases. It can achieve symptom control in >70% and objective response in approximately 40-50%. It can be used as a bridge to PRRT or as an alternative in patients with very high hepatic tumour burden where PRRT-related hepatotoxicity risk is a concern.

Reference: ESMO 2024 NET Clinical Practice Guidelines; NICE NG Neuroendocrine tumours pathway; ENETS Guidelines