The Neuroendocrine Cancer Foundation Podcast - Top 10 FAQs with neuroendocrine cancer experts - Episode 38 - NEN Treatments: Focus on Liver-Directed Therapies (Part I: Overview and Ablative Techniques Including Histotripsy)

Episode 38 - NEN Treatments: Focus on Liver-Directed Therapies (Part I: Overview and Ablative Techniques Including Histotripsy)

10/21/24 • 31 min

The Neuroendocrine Cancer Foundation Podcast - Top 10 FAQs with neuroendocrine cancer experts

ABOUT THIS EPISODE

In this 2-part series, Dr. Osman Ahmed from University of Chicago covers liver-directed therapies for neuroendocrine neoplasms (NENs or neuroendocrine cancer). In this first episode, he outlines the types of liver-directed therapies and elaborates on ablative techniques including the newest technique, histotripsy. Listen to a frank discussion of how histotripsy works, when it might be used, and what its current limitations are.

TOP TEN QUESTIONS ABOUT LIVER-DIRECTED THERAPY INCLUDING HISTOTRIPSY:

What is liver-directed therapy? How does it work? Is this considered “surgery”? What is a surgery and what is a “procedure?”
What are the types of liver-directed therapies used for neuroendocrine cancer?
Which neuroendocrine cancers are they used for and when are they used? How do you decide who is a good candidate and if it will be effective?
When are liver-directed therapies NOT used? Can someone who has had a Whipple undergo liver-directed therapy?
What is the ablation zone? What is a heat sink effect?
What is histotripsy? How does it work?
When is histotripsy used (tumor grade, type of tumor - PNET/lung NET, size, number of tumor, location)? Can they be used for liver tumors even if there are tumors outside the liver?
What are the limitations to histotripsy?
What happens to the liver tissue after ablation? What are the results or success rates of patients being treated? Can histotripsy “cure” NET?
How do you decide between the various types of liver-directed therapies?

MEET DR. OSMAN AHMED:
Osman Ahmed, MD, is an expert vascular and interventional radiologist who diagnoses and treats a wide range of conditions. Using image-guided technology and small, sophisticated instruments, Dr. Ahmed performs minimally invasive procedures for acute and chronic deep vein thrombosis, benign prostatic hyperplasia, peripheral vascular disease, liver/bone/lung/kidney cancer, spinal fractures, uterine fibroids and more. He also implants inferior vena cava (IVC) filters, which prevent a blood clot from traveling around the body or creating a blockage.

In addition to his clinical expertise, Dr. Ahmed researches novel treatment options that improve outcomes for patients. His research on liver cancer, IVC filters and venous diseases has been published in several high-impact, peer-reviewed journals, including the Journal of Vascular and Interventional Radiology, Radiology, Chest, Journal of American College of Radiology, and Journal of Surgical Oncology.

Dr. Ahmed also believes in the importance of educating medical students, residents, fellowships and peers in order to enhance health care across the world. He has been invited to speak at a number of symposiums, practicums and national/international meetings about the newest advancements in interventional radiology.
Visit lacnets.org/podcast/38 for the podcast, transcript, and resources.

For more information, visit LACNETS.org.

ABOUT THIS EPISODE

TOP TEN QUESTIONS ABOUT LIVER-DIRECTED THERAPY INCLUDING HISTOTRIPSY:

What is liver-directed therapy? How does it work? Is this considered “surgery”? What is a surgery and what is a “procedure?”
What are the types of liver-directed therapies used for neuroendocrine cancer?
Which neuroendocrine cancers are they used for and when are they used? How do you decide who is a good candidate and if it will be effective?
When are liver-directed therapies NOT used? Can someone who has had a Whipple undergo liver-directed therapy?
What is the ablation zone? What is a heat sink effect?
What is histotripsy? How does it work?
When is histotripsy used (tumor grade, type of tumor - PNET/lung NET, size, number of tumor, location)? Can they be used for liver tumors even if there are tumors outside the liver?
What are the limitations to histotripsy?
What happens to the liver tissue after ablation? What are the results or success rates of patients being treated? Can histotripsy “cure” NET?
How do you decide between the various types of liver-directed therapies?

For more information, visit LACNETS.org.

Previous Episode

Episode 37: Supportive Oncology for Neuroendocrine Cancer

What is supportive care or supportive oncology? What is cancer-related distress? How might NET patients benefit from supportive care? Yale oncologist Dr. Maryam Lustberg suggests strategies to manage cancer-related fatigue, diarrhea, nausea, mouth sores, peripheral neuropathy, distress, anxiety, and anxiety. She also addresses considerations for fertility and sexual health.
MEET DR. MARYAM LUSTBERG
Dr. Maryam Lustberg is an American breast oncologist. She is the Director of The Breast Center at Smilow Cancer Hospital and Chief of

Breast Medical Oncology at Yale Cancer Center. Dr. Lustberg previously served as the Medical Director of Cancer Supportive Care Services at

Ohio State’s Comprehensive Cancer Center. She is the Immediate Past President of the Multinational Association of Supportive Care in Cancer. She is also an Associate Editor for the Journal of Cancer Survivorship.
TOP TEN QUESTIONS ABOUT SUPPORTIVE CARE:

What is supportive care in cancer (or supportive oncology)? What is survivorship? How do these concepts apply to the NET community?
What is the 1st step for patients to get supportive care?
What are the most common treated-related adverse events or side effects? What are risk factors for them? (Will all patients experience all potential side effects?)
What causes cancer-related fatigue (CRF)? What are some strategies to manage cancer-related fatigue?
What are some strategies to manage diarrhea?
What are some strategies to manage nausea?
What are some strategies to manage mouth sores?
What is peripheral neuropathy? When do patients experience it and what can be done to prevent it?
What should patients understand about sexual health and fertility?
How can psychosocial needs such as distress, anxiety, and depression be addressed and supported?

For more information, please visit https://www.lacnets.org/podcast/37.

For more information, visit LACNETS.org.

Next Episode

Episode 39: NEN Treatments: Focus On Liver-Directed Therapies (Part II: Intra-Arterial Techniques and Sequencing)

ABOUT THIS EPISODE

In this 2-part series, Dr. Osman Ahmed from the University of Chicago covers liver-directed therapies for neuroendocrine neoplasms (NENs or neuroendocrine cancer). In this second episode, he details the embolization techniques, including bland embolization (TAE), chemoembolization (TACE), and radioembolization (TARE, SIRT, y90). He discusses decision-making, sequencing, and follow-up after these procedures.
TOP TEN QUESTIONS ABOUT LIVER-DIRECTED THERAPY PART 2:

1. What do patients need to know about bland embolization (TAE)?
a. What are the possible side effects?
b. How do the size of beads play a role?
c. When is this recommended?
d. Do you always do both sides of the liver? If so, what is the timing and why?
e. What is the recovery like? What is post-embolization syndrome?
2. What do patients need to know about chemoembolization (TACE)?
a. What drug is used & does this go through the whole body?
b. What is the recovery like? What are the possible side effects?
3. What do patients need to know about radioembolization (TARE, SIRT, y90)?
a. In the era of PRRT, is there a concern with using y90 or radioembolization? How is the approach and technique used with radioembolization different than how it was done in the past? Is there a total lifetime limit of radiation?
b. What is the recovery like? What are the possible side effects?
4. Is there a limit to how much LDT one can do? Can they be repeated?
5. How does one decide between the various types of liver-directed therapies?
6. Is there a sequencing to treatments?
7. Are there certain treatments that make you ineligible for other treatments? [PRRT, chemo, y90 etc]
8. If someone has had surgery such as a Whipple or surgery or procedures involving the bile duct, such as a stent in the bile duct or surgical removal of part of the bile duct, how does this weigh into the decision-making process for LDT?
9. How do you determine if the treatment “worked?” What is the follow-up like? What scan might you do and in what timing?
10. What do you see as the future of liver-directed therapy in neuroendocrine cancer treatment?

MEET DR. OSMAN AHMED

Osman Ahmed, MD, is an expert vascular and interventional radiologist who diagnoses and treats a wide range of conditions. Using image-guided technology and small, sophisticated instruments, Dr. Ahmed performs minimally invasive procedures for acute and chronic deep vein thrombosis, benign prostatic hyperplasia, peripheral vascular disease, liver/bone/lung/kidney cancer, spinal fractures, uterine fibroids and more. He also implants inferior vena cava (IVC) filters, which prevent a blood clot from traveling around the body or creating a blockage.

For more information, visit https://www.lacnets.org/lacnets-podcast

For more information, visit LACNETS.org.