Hepatic artery chemoembolization for management of patients with advanced metastatic carcinoid tumors

https://doi.org/10.1016/S0002-9610(98)00042-7Get rights and content

background

Patients with advanced metastatic carcinoid tumors who have disease progression despite conventional therapy are left with few therapeutic options. Hepatic artery chemoembolization (HACE) may play a role in palliating these patients' symptoms.

methods

Fifteen patients with biopsy-proven advanced bilobar hepatic carcinoid metastases who demonstrated progression of symptoms and/or tumor size despite treatment with somatostatin analogues were treated with intra-arterial chemotherapy and HACE to determine efficacy and safety. Five days of intra-arterial 5-fluorouracil (1 g/m2) were followed by HACE with adriamycin (60 mg), cisplatin (100 mg), mitomycin C (30 mg), and polyvinyl alcohol (Ivalon); 200μ to 710 μ). Patients were continued on octreotide at the same dose (150 to 2000 μg subcutaneous q 8 hours) before, during, and after the procedure.

results

Efficacy of treatment was assessed by comparing pretreatment and 3-month clinical, laboratory, radiographic, and quality of life parameters. Symptoms were improved in 8 of 12 patients who had diarrhea, 7 of 12 who had flushing, 9 of 12 who had abdominal pain, and in 4 of 7 who had malaise. Elevated tumor markers decreased in all patients. Biochemical markers (mean ± SE) at 3 months decreased by 60% ±6% for 5-HIAA, 75% ± 10% for chromogranin A and 50% ± 7% for neuron-specific enolase. Tomographic assessment revealed tumor liquefaction in 10 of 13 patients. The Karnofsky performance status improved from a mean of 66 ± 2 to 84 ± 2 (P <0.001). Median follow-up was 16 months, with 13 deaths occurring from 1 week to 71 months after treatment.

conclusions

Hepatic artery chemoembolization improves symptoms of carcinoid syndrome, has a high tumor response rate, and improves short-term quality of life in this group of patients with advanced hepatic carcinoid disease.

References (24)

  • HajarizadehH et al.

    Effective palliative treatment of metastatic carcinoid tumors with intra-arterial chemotherapy/chemoembolization combined with octreotide acetate

    Am J Surg.

    (1992)
  • WangL et al.

    Repeated dearterialization of an experimental liver tumor: short-and long-term results

    J Surg Res.

    (1994)
  • GoodwinJ

    Carcinoid tumors. An analysis of 2837 cases

    Cancer.

    (1975)
  • ZeiteisJ et al.

    Carcinoid tumors: a 37-year experience

    Arch Surg.

    (1982)
  • EngstromP et al.

    Streptozocin and 5-FU vs doxorubicin therapy for metastatic carcinoid tumor

    J Clin Oncol.

    (1984)
  • AjaniJ et al.

    Combination chemotherapy of metastatic tumors with 5-FU vs adriamycin, cytoxan and 5-FU vs adriamycin, mitomycin C and methyl CCNU

    Proc Am Assoc Clin Oncol.

    (1983)
  • McEnteeG et al.

    Cytoreductive hepatic surgery for neuroendocrine tumors

    Surgery.

    (1990)
  • SouquetJ et al.

    Clinical and hormonal effects of a long-acting somatostatin analogue in pancreatic endocrine tumors and in carcinoid syndrome

    Cancer.

    (1987)
  • CarrascoC et al.

    The carcinoid syndrome: palliation by hepatic artery embolization

    Am J Res.

    (1986)
  • AzizkhanG et al.

    Malignant rectal carcinoid: approach for successful treatment of hepatic metastases

    Am J Surg.

    (1985)
  • MartenssonH et al.

    Embolization of the liver in the management of metastatic carcinoid tumors

    J Surg Oncol.

    (1984)
  • MatonP et al.

    Pole of hepatic arterial embolization in the carcinoid syndrome

    BMJ.

    (1983)

    • Cited by (122)

    • Neuroendocrine Tumors

      2016, Gastroenterology Clinics of North America

    • Neuroendocrine Gastrointestinal and Lung Tumors (Carcinoid Tumors), the Carcinoid Syndrome, and Related Disorders

      2015, Williams Textbook of Endocrinology

    • Factors affecting periprocedural morbidity and mortality and long-term patient survival after arterial embolization of hepatic neuroendocrine metastases

      2014, Journal of Vascular and Interventional Radiology

    • Management of well-differentiated gastrointestinal neuroendocrine tumors metastatic to the liver

      2013, Seminars in Oncology

    • Radioembolization and chemoembolization for unresectable neuroendocrine liver metastases - A systematic review

      2012, Surgical Oncology
      Citation Excerpt :

      The primary tumor was carcinoid in 728 patients (63.2%). Twelve of 25 studies reported the presence of extrahepatic disease in 0–93.3% of patients (median = 45%) [14,16,17,20,21,25,26,29,31,34–36]. The median duration of follow up was recorded in ten studies, ranging from 11.8 months to 79 months (median = 18.5 months) [14,17,19,20,23,24,31,33,34,37] (Table 1).

    • Chemoembolization Beyond Hepatocellular Carcinoma: What Tumors Can We Treat and When?

      2024, Seminars in Interventional Radiology
    View all citing articles on Scopus
    View full text
    Copyright © 1998 Published by Elsevier Inc.