| Title | Hepatic artery chemoembolization for management of patients with advanced metastatic carcinoid tumors. | | Author(s) | Drougas JG, Anthony LB, Blair TK, Lopez RR, Wright JK, Chapman WC, Webb L, Mazer M, Meranze S, Pinson CW | | Institution | Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4753, USA. | | Source | Am J Surg 1998 May; 175(5):408-12. | | MeSH | Adult
Aged
Antineoplastic Combined Chemotherapy Protocols
Carcinoid Tumor
Chemoembolization, Therapeutic
Drug Therapy, Combination
Female
Heparin
Hepatic Artery
Humans
Liver Neoplasms
Lymphatic Metastasis
Male
Middle Aged
Palliative Care
Penicillin G
Penicillins
Time Factors
| | Abstract | 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); 200 micron to 710 micron). Patients were continued on octreotide at the same dose (150 to 2000 microg 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. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 9600289 |
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