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    The content on this page is not current guidance and is only for the purposes of the consultation process.

    Interventional procedure overview of selective internal radiation therapy for neuroendocrine tumours that have metastasised to the liver

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    Existing assessments of this procedure

    European Neuroendocrine Tumour Society (ENETS) 2022 Consensus Guidelines on carcinoid syndrome and carcinoid heart disease recommended:

    • Loco-regional therapies may be considered for patients with predominant liver inoperable metastases, requiring carcinoid symptom control. TAE, TACE or SIRT controls carcinoid syndrome symptoms in up to 75% cases and can be repeated if there is preserved liver function. For patients with carcinoid syndrome and grade 1 intestinal NET, where chemotherapy offers little benefit, bland hepatic embolisation is preferred.

    • TACE or SIRT may be reserved for grade 2 intestinal or non-intestinal NET. In the absence of conclusive data on which trans-arterial treatment is most efficient, the selection should be made based on individual factors such as tumour load, topography of metastases, and arterial anatomy.

    European Neuroendocrine Tumor Society (ENETS) 2016 Consensus Guidelines Update for the management of distant metastatic disease of intestinal, pancreatic, bronchial neuroendocrine neoplasms (NEN) and NEN of unknown primary origin recommended:

    • Locoregional therapies, including TAE, TACE, SIRT and ablative techniques, should be considered for the control of symptoms and tumour growth in unresectable disease.

    • Choice of locoregional therapy is based on individual patient features and physician expertise.

    • There is consensus that SIRT is investigational and comparative trial evidence of SIRT compared to TAE is required as well as more long-term safety data to establish the procedure in the treatment of NETs.

    Recommendations from the NET-Liver-Metastases Consensus Conference (2012) were endorsed by European–African Hepato-Pancreato-Biliary Association (E-AHPBA), the European Neuroendocrine Tumor Society (ENETS), the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS), the European Society of Surgical Oncology (ESSO), the Great Britain and Ireland Hepato-Pancreato- Biliary Association (GBIHPBA), the International Hepato-Pancreato-Biliary Association (IHPBA) and the UK and Ireland Neuroendocrine Tumour Society (UKINETS). The recommendations, published in Kennedy, et al., (2015), were:

    • TAE, TACE and SIRT were all recommended for use in mNETs.

    • The quality and strength of reports available at the time did not allow any modality to be determined as superior in terms of imaging or symptomatic response, or in terms of overall survival.

    • SIRT may be more beneficial than TAE and TACE because it may have less side effects and requires less treatment sessions.

    • Based on European Neuroendocrine Tumor Society (ENETS) Consensus Guidelines at the time, the recommendations stated that SIRT can be substituted for TAE or TACE in patients with either liver-only disease or those with limited extrahepatic metastases.