TARE for Neuroendocrine Tumour Liver Metastases

TACE or Transarterial Chemoembolization is one of the modalities which is used in patients who have got isolated liver metastasis, small volume liver metastasis. What they do is to actually do a Hepatic Angiography and implant the Chemotherapeutic Agent right into the tumor in the liver. Now while TACE is often used in small Hepatocellular Carcinomas where it can actually be ablative, it can actually cure the tumor. Often in patients of Neuroendocrine Tumors there are Widespread Disease. There are multiple lesions in the liver. They usually present with a high volume of tumors in the liver. And in such a situation TACE is not really the ideal way. Now, If you look at the NCCN Guidelines or you look at any of the Australian Guidelines, the European Guidelines if the tumor is a lowgrade tumor and it expresses somatostatin receptors or is positive on a dotanoc scan the ideal treatment of choice in such a situation would be PRRT. There are some tumors which do not express the receptors and in such situations a Transarterial Radioembolisation is a much better technique than a Transarterial Chemoembolization in patients of Neuroendocrine Tumors. The Advantages of a Transarterial Radioembolisation is that the post embolisation syndrome is much less with a Transarterial Radioembolisation as compared to a TACE so post TACE there may be a deterioration of liver function, there may be pain, there may be a fever, the patients feels unwell. Now all these things are not very common with TARE infact they don' t exist with TARE. The other advantages that even if a person has got multiple lesions in both lobes of the liver you can still undergo TARE while TACE is not an option in patients who have got tumors in both lobes of the liver. If their is evidence of any portal vein thrombosis, so if the portal vein is infiltrated by the tumour even in such a situation TACE cannot be done but TARE can still be done. If cost is not an issue because TARE is typically more expensive than TACE. A Transarterial Radioembolisation often costs almost two to three times more than a Transarterial Chemoembolization across the world. But if cost is not an issue then a TARE is probably a prefer technique in all situations unless you are looking at a very small tumor where you can actually do an ablation with the TACE.

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