AJR InBrief Banner 


October 2014


When Catheter-Based Treatment Is Best   

 Kenneth J. Kolbeck 


Neuroendocrine tumors are notoriously difficult to diagnose and treat. Kenneth J. Kolbeck, coauthor of “Catheter-Based Treatments for Hepatic Metastases From Neuroendocrine Tumors,” published in the October 2014 issue of the American Journal of Roentgenology, talked with AJR InBrief about catheter-based treatment for this type of tumor  

Why is it so difficult to diagnose neuroendocrine tumors?

The large variety and variable intensity of symptoms of a neuroendocrine tumor can mimic other diseases that occur much more frequently. Since other explanations are more common, neuroendocrine tumors tend to fall near the bottom of the differential diagnosis list for many physicians.

Treating these tumors is as challenging as diagnosing them. What factors determine whether catheter-based treatment or surgery is appropriate?

A patient with a liver-dominant tumor burden and poorly controlled symptoms responds best to catheter-based therapy. In some cases, partial liver resection may be appropriate; however, given the frequently delayed diagnosis, multifocal disease with bilobar involvement often limits surgical options.

What are the advantages of catheter-based versus systemic treatment?

Systemic treatment (frequently prescribed for high-grade tumors) has the advantage of being able to treat tumor burden throughout the whole body with the corresponding disadvantage of systemic side effects. With liver-dominant disease catheter-based local regional therapy may result in an excellent tumor response and symptom control with a favorable side-effect profile.

What should radiologists glean from your article?

Patients with neuroendocrine tumors can present with a wide variety of symptoms and imaging findings. Including neuroendocrine tumor on the differential diagnosis list may accelerate the identification of the correct disease entity and reduce the time to diagnosis in patients.