HEPATIC-ARTERY EMBOLOTHERAPY OF HEPATIC METASTASES FROM CARCINOID-TUMORS - VALUE OF USING A MIXTURE OF CYANOACRYLATE AND ETHIODIZED OIL

OBJECTIVE. Transcatheter embolization of the hepatic arterial supply i s a well-known palliative treatment of tumor deposits in the liver, We performed a prospective study to evaluate the use of a mixture of N-b utyl-2-cyanoacrylate and ethiodized oil with which a permanent vascula r occlusion can be obtained, as an embolizing agent for transcatheter hepatic artery embolization for treatment of carcinoid hepatic metasta ses. SUBJECTS AND METHODS. Six patients had clinical symptoms from hor monal release by carcinoid hepatic metastases as well as elevated leve ls of 5-hydroxyindole acetic acid (5-HIAA) in the urine. Unilobar sequ ential transcatheter embolization of both the hepatic artery and the s egmental hepatic arteries of both lobes of the liver was performed wit h a mixture of N-butyl-2- cyanoacrylate and ethiodized oil. CT and CT arterial portography (CTAP) were done to assess hepatic metastases and were used to monitor follow-up. Each patient had three CTAP studies; the third CTAP, performed 3 months after complete arterial devasculari zation, was compared with the first CTAP to evaluate tumor size. CT st udies were performed routinely every 3 months thereafter and were comp ared with the initial CT scan to evaluate further tumor regression or progression. Tumor decrease and biochemical and symptomatic response r ates were defined according to World Health Organization criteria. All complications and side effects of the treatment were documented. RESU LTS. All patients showed complete symptomatic relief after embolizatio n. The previously elevated levels of 5-HIAA in the urine returned to n ormal in three patients and in the other three patients were reduced b y a mean of 89% of preembolization values. A decrease in tumor size by more than 50% was demonstrable in one patient; in five patients, hepa tic lesions decreased in size by 25-50%. No new sites of metastatic li ver disease were demonstrable in any patient during follow-up. No deat hs or serious complications were directly attributable to the emboliza tion procedure. All patients are alive after 12, 17, 18, 19, 19, and 1 9 months (mean, 17.3 months), respectively, with permanent relief of s ymptoms so far. CONCLUSION. Transcatheter embolization of both the hep atic artery and the segmental hepatic arteries with a mixture of N-but yl-2-cyanoacrylate and ethiodized oil provided excellent palliation in patients with carcinoid hepatic metastases. Complete and long lasting relief of symptoms, a significant decrease or normalization of levels of 5-HIAA in the urine, and a reduction of metastatic tumor in the li ver seem most likely to be the effect of sustained ischemia obtained w ith this permanent embolizing agent.