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

• Published in: The American journal of surgery Vol. 175; no. 5; pp. 408 - 412
• Main Authors: Drougas, James G., Anthony, Lowell B., Blair, Taylor K., Lopez, Richard R., Kelly Wright, J., Chapman, William C., Webb, Laura, Mazer, Murray, Meranze, Steven, Wright Pinson, C.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1998; Elsevier; Elsevier Limited
• Subjects: 5-Fluorouracil; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Biochemical markers; Biological and medical sciences; Biopsy; Carcinoid Tumor - diagnostic imaging; Carcinoid Tumor - secondary; Carcinoid Tumor - therapy; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - methods; Chemoembolization, Therapeutic - statistics & numerical data; Chemotherapy; Cisplatin; Diarrhea; Diseases of the digestive system; Drug Therapy, Combination; Effectiveness; Female; Health services; Heparin - administration & dosage; Hepatic artery; Hepatic Artery - diagnostic imaging; Humans; Liquefaction; Liver diseases; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - secondary; Liver Neoplasms - therapy; Lymphatic Metastasis; Male; Medical sciences; Metastases; Metastasis; Middle Aged; Mitomycin C; Neuroendocrine tumors; Octreotide; Palliative Care - methods; Palliative Care - statistics & numerical data; Patients; Penicillin G - administration & dosage; Penicillins - administration & dosage; Phosphopyruvate hydratase; Polyvinyl alcohol; Quality of life; Radiography; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Signs and symptoms; Somatostatin; Time Factors; Tumor markers; Tumors; Veins & arteries; Hepatic artery; Human; Chemosurgery; Prognosis; Liver; Instrumentation therapy; Hepatic disease; Palliative treatment; Malignant tumor; Metastasis; Chemotherapy; Malignant carcinoid tumor; Digestive diseases; Complication; Embolization; Combined treatment; Technique
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(98)00042-7

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. 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/m 2) were followed by HACE with adriamycin (60 mg), cisplatin (100 mg), mitomycin C (30 mg), and polyvinyl alcohol (Ivalon); 200 μ 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. 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. 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.