Hepatic artery chemoembolization in 122 patients with metastatic carcinoid tumor: lessons learned.

Abstract

BACKGROUND:

Hepatic artery chemoembolization (HACE) is a treatment option in the management of metastatic carcinoid. We reviewed our experience to identify potential factors that influence survival.

METHODS:

The records of 122 patients with metastatic carcinoid tumor undergoing HACE were reviewed. Log-rank analysis and Cox proportional hazards were applied to identify factors predictive of decreased survival.

RESULTS:

Median follow-up after HACE was 21.5 months. Complications occurred in 23% with periprocedural mortality of 5%. Radiographic tumor regression was seen in 82%, with stabilization of disease in 12%. Median duration of CT response was 19 months. Improvement in symptoms occurred in 92% for median duration of 13 months. HACE resulted in complete normalization of serum pancreastatin in 14%, with greater than 20% reduction in another 66%. Median overall survival was 33.3 months after HACE. Only pancreastatin level > or =5,000 pg/ml was associated with decreased survival by multivariate analysis.

CONCLUSION:

HACE offers symptom palliation and long-term survival in patients with incurable carcinoid metastases. Although safe, it should be approached cautiously in patients with significant tumor burden as evidenced by pancreastatin levels > or =5,000 pg/ml. We do not recommend whole-liver embolization in these patients but prefer a staged approach to each lobe of the liver.

• Authors: Mark Bloomston, Osama Al-Saif, Dori Klemanski, Joseph J Pinzone, Edward W Martin, Bryan Palmer, Gregory Guy, Hooman Khabiri, E Christopher Ellison, Manisha H Shah
• Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 11 Issue 3 Pg. 264-71 (Mar 2007) ISSN: 1091-255X [Print] United States
• PMID: 17458596 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (administration & dosage)
• Carcinoid Tumor (mortality, pathology, therapy)
• Chemoembolization, Therapeutic (adverse effects)
• Female
• Hepatic Artery
• Humans
• Liver Neoplasms (mortality, secondary, therapy)
• Male
• Middle Aged
• Palliative Care
• Prognosis
• Survival Rate