internal radiation therapy in treating patients with liver metastases from neuroendocrine tumors

Conditions: Head and Neck Cancer; Islet Cell Tumor; Metastatic Cancer; Pheochromocytoma

Summary: rationale: specialized radiation therapy that delivers a high dose of radiation directly to the tumor may kill more tumor cells and cause less damage to normal tissue. purpose: this phase ii trial is studying how well internal radiation therapy works in treating patients with liver metastases from neuroendocrine tumors.

objectives: primary * determine tumor response to selective internal radiation therapy with yttrium y 90 resin microspheres (sir-spheres®) in patients with progressive liver metastases from neuroendocrine tumors. secondary * determine the toxicity of this treatment in these patients. * determine the symptomatic relief of patients treated with this regimen. * determine the health-related quality of life of patients receiving this treatment. outline: patients have an catheter placed into the hepatic artery percutaneously through the groin and then undergo selective internal radiation therapy with yttrium y 90 resin microspheres (sir-spheres®) via the catheter on day 1. patients also receive octreotide acetate iv 1 hour prior to, during, and 2 hours after sir-spheres® injection. patients may undergo above treatment in another lobe of the liver (if each lobe is treated separately) 4 weeks later. patients undergo functional performance, health-related quality of life, and symptom severity assessment prior to initial treatment and after completion of study treatment. after completion of study treatment, patients are followed periodically for at least 1 year. projected accrual: a total of 25 patients will be accrued for this study.

Eligibility criteria:
disease characteristics: * pathologically confirmed neuroendocrine tumor metastatic to the liver * well-differentiated or moderately well-differentiated neuroendocrine tumors * measurable disease, defined as ≥ 1 unidimensionally measurable lesion ≥ 20 mm with conventional techniques or ≥ 10 mm with spiral ct scan * symptomatic disease, meeting one of the following criteria: * refractory carcinoid symptoms, defined as carcinoid symptom severity scale \> 2 despite use of octreotide acetate at ≥ 200 mcg subcutaneously three times daily (or 20 mg intramuscularly once monthly) for ≥ 4 weeks * evidence of radiographic progression with either of the following manifestations: * moderate-severe right upper quadrant pain and unintentional weight loss \> 10% * decline in karnofsky performance status \> 10 points * at least a 20% increase in the sum of the longest diameters of target lesions in the liver within the past 12 months * no more than 75% replacement of normal liver by neuroendocrine tumor * no more than 20% arteriovenous lung shunting on a technetium tc 99m macro-aggregated albumin nuclear scan * no equivocal, nonmeasurable, or nonevaluable liver metastasis patient characteristics: * karnofsky performance status 50-100% * life expectancy ≥ 6 months * not pregnant or nursing * negative pregnancy test * fertile patients must use effective contraception * creatinine ≤ 1.5 mg/dl * bilirubin ≤ 2.0 mg/dl * albumin ≥ 3.0 g/dl * absolute granulocyte count ≥ 1,500/mm³ * platelet count ≥ 65,000/mm³ * hemoglobin \> 9.0 g/dl * inr ≤ 1.4 * no hepatic arterial anatomy that would preclude the administration of study treatment into the liver * no nonmalignant disease that would preclude study participation * no other malignancy within the past 5 years except for cured basal cell carcinoma of the skin or cured carcinoma in situ of the uterine cervix prior concurrent therapy: * prior surgery, chemotherapy, or locally ablative technique for the liver cancer allowed * no prior radiotherapy to the upper abdomen that includes the liver in the treatment field * no investigational drug or agent/procedure (i.e., participation in another clinical trial) within the past 4 weeks * no other specific anticancer treatment (other than octreotide acetate) during and for 3 months after completion of study therapy

Keywords: neoplastic syndrome metastatic gastrointestinal carcinoid tumor recurrent gastrointestinal carcinoid tumor thyroid gland medullary carcinoma metastatic pheochromocytoma recurrent islet cell carcinoma liver metastases recurrent pheochromocytoma gastrinoma insulinoma wdha syndrome glucagonoma pancreatic polypeptide tumor somatostatinoma