Towards new response criteria in neuroendocrine tumors : which changes in MRI parameters are associated with longer progression‐free survival after radioembolization of liver metastases?

Abstract

Purpose: To evaluate the association of therapy‐related changes in imaging parameters with progression‐free survival (PFS) of patients with unresectable liver metastases from neuroendocrine tumors (NETLMs).

Materials and Methods: Forty‐five radioembolized patients (median age: 62 years; range: 43–75) received a pre‐ and 3 months posttherapeutic magnetic resonance imaging (MRI) examination. The latter were evaluated for tumor size, arterial enhancement, and necrosis pattern. Influences of therapy‐related changes on PFS were analyzed. Statistical analysis included Student's t‐test, Wilcoxon test, Cox regression analysis, and Kaplan–Meier curves.

Results: The median percentage decrease in sum of diameters was 9.7% (range: 43.9% decrease to 15.4% increase). Twenty‐one patients (47%) showed increased necrosis. Three parameters were associated with significantly longer PFS: a decrease of diameter (hazard ratio [HR]: 0.206; 95% confidence interval [CI]: 0.058–0.725; P = 0.0139), a decrease in tumor arterial enhancement (HR: 0.143; 95% CI: 0.029–0.696; P = 0.0160), and an increase in necrosis after 3 months (HR: 0.321; 95% CI: 0.104–0.990; P = 0.0480). Multivariate analysis revealed that changes in diameter and arterial enhancement have complementary information and are associated independently with long PFS.

Conclusion: A decrease both in sum of diameters and arterial enhancement of metastases, as well as an increase in necrosis, are associated with significantly longer PFS after radioembolization.