INTRAHEPATIC ARTERIAL CHEMOEMBOLIZATION FOR HEPATOCELLULAR-CARCINOMA AND METASTATIC NEUROENDOCRINE TUMORS IN THE ERA OF LIVER-TRANSPLANTATION

Surgical resection has been the standard approach for primary and meta static liver tumors. Long-term survival, however, is limited because o f recurrence or hepatic decompensation. Failure of chemotherapeutic re gimens or liver transplantation (OLT) to prevent recurrence has result ed in the need for multimodality therapies. We report our experience w ith preoperative hepatic arterial chemoembolization (GET) followed by OLT in highly select patients. Over a 33-month period, 23 of 41 patien ts (56%) referred with primary (n = 16) or metastatic neuroendocrine ( n = 7) liver tumors met eligibility requirements. Despite mild, self-l imited chemical hepatitis, CET was well tolerated in all but three eld erly patients who succumbed to liver failure. Four of five patients ul timately received OLT. Three are alive and free of disease at a mean f ollowup of 17 months, one died of recurrent hepatocellular carcinoma, and one (NET) remains well at 33 months with elevated glucagon levels but no measurable disease. All NET patients are alive with resolution of hormonal symptoms. Four of five noncirrhotic patients died of disea se, and one has progressive tumor growth. Although OLT following CET a chieves superior survival, its application is limited to a minority of patients with such tumors. Careful pretreatment staging and patient s election combined with caution in the use of CET in elderly cirrhotic patients is critical to the success of such therapies.