HEPATIC ARTERIAL CHEMOEMBOLIZATION FOR METASTATIC NEUROENDOCRINE TUMORS

Background. Patients with neuroendocrine neoplasms, even with metastas es to the liver, often have indolent disease and are treated conservat ively. However, when debilitating symptoms from hormonal syndromes or mass effect arise, more aggressive treatment may be warranted. Methods . Thirty-nine chemoembolization procedures were performed in 30 patien ts with significant symptoms, with carcinoids and islet cell tumors. A n emulsification of intraarterial doxorubicin, iodized oil, and water- soluble contrast was followed by embolization with absorbable gelatin powder or pledgets. Results. Twenty-seven patients exhibited subjectiv e improvement in clinical symptoms. Hormonal markers and/or tumor size decreased by at least 50% in 79% of patients. Inclusion of minor resp onses raises this to 92%. Seven complications were noted, and no proce dure-related deaths occurred. Median survival was 24 months after chem oembolization or 53 months after diagnosis. Computed tomographic featu res of tumor vascularity, distribution of metastatic lesions, and dist ribution of ethiodized oil were not clearly correlated with outcome. P resence of a nonresected primary tumor had a negative effect on surviv al. Conclusions. Compared with previously described treatments for neu roendocrine liver metastases, this technique appears to be more effect ive and to be associated with less morbidity, and is recommended for p atients with significant symptoms who have failed to respond to more c onservative therapy and who are not surgical candidates.