LIVER METASTASES OF DIGESTIVE ENDOCRINE TUMORS - NATURAL-HISTORY AND RESPONSE TO MEDICAL-TREATMENT

Background: Few data are available about the natural history of liver metastases of digestive endocrine tumours. Moreover, results of studie s on treatment with intravenous chemotherapy, hepatic arterial chemoem bolization and somatostatin analogues are conflicting. Aims of the stu dy: To assess the progression of liver metastases of digestive endocri ne tumours before antitumoral treatment, and to evaluate a stepwise th erapeutic strategy in these patients. Patients and methods: 22 patient s with histologically-confirmed liver metastases were studied. Primary tumours were carcinoids in nine, gastrinomas in five, non-functioning pancreatic tumours in six and calcitonin-secreting tumours in two pat ients. The progression of liver metastases was assessed according to t he World Health Organization criteria in 10 patients before treatment, and during treatment in all patients. Intravenous (i.v.) chemotherapy with streptozotocin and 5-fluorouracil was used in patients with more than 25% progression in tumour size or with more than 50% liver invol vement. Hepatic arterial chemoembolization was performed if i.v. chemo therapy failed, or as a first-choice treatment after 1993. The somatos tatin analogues octreotide or lanreotide were used as a third-choice t reatment. Results: Progression (+90%, range 28-600%) of liver metastas es was identified in the 10 patients studied before treatment, after a median follow-up of 11.5 months. Objective and minor responses were o btained in 2/10 patients (20%) and 1/10 patients (10%) receiving i.v. chemotherapy. Corresponding figures were 3/7 (43%) and 2/7 (29%) for h epatic arterial chemoembolization. No objective response was observed with somatostatin analogues, although 2 patients experienced a minor r esponse. Conclusion: Untreated liver metastases of digestive endocrine tumours show an objective increase (their size approximately doubles after 1 year of follow-up). Among the currently available therapeutic modalities, hepatic arterial chemoembolization provides the highest re sponse rates. An increase in patient survival as a result of this proc edure remains to be determined.