Hepatic artery embolization (HAE) has been utilized for treatment of advanced hepatic
carcinoid metastases, with promising symptom palliation and
tumor control. Our institution employs transcatheter HAE using
Lipiodol/
Gelfoam for treatment of
carcinoid hepatic
metastases, and this report presents our experience with twenty-four patients, examining symptom control, quality-of-life,
octreotide dependence, and
tumor progression. Twenty-four (11 male, 13 female, mean age = 59.4 +/- 2.5 yr) patients with
carcinoid and unresectable hepatic
metastases, confirmed by urinary
5-hydroxyindole acetic acid (5-HIAA) measurement and biopsy, were treated with
Lipiodol/
Gelfoam HAE from 1993-2001. Median follow-up was 35.0 months. Before HAE, 14 patients (58.3%) had
malignant carcinoid syndrome, with symptoms quantified using our previously reported
Carcinoid Symptom Severity Score, and 13 patients (54.2%) required
octreotide for symptom palliation. Following treatment, symptom severity,
octreotide dose, and
tumor response were measured. Asymptomatic patients did not develop symptoms or require following treatment. Hepatic
metastases remained stable (n = 4) or decreased (n = 19) in 23 patients (95.8%). Mean pretreatment Symptom Severity Scores (3.8 +/- 0.2), decreased to 1.4 +/- 0.1 post-treatment (P < 0.00001), with 64.3% of patients becoming asymptomatic. Mean pretreatment
octreotide dosages (679.6 +/- 73.0 microg/d), decreased to 262.9 +/- 92.7 microg/d (P = 0.0024) post-treatment, with 46.2% of patients discontinuing
octreotide. There were no treatment-related serious complications or deaths. This study demonstrates that
Lipiodol/
Gelfoam HAE produces excellent control of
malignant carcinoid syndrome, allowing patients to decrease or eliminate use of
octreotide, while controlling hepatic
tumor burden.