DURABLE HEPATIC TUMOR-REGRESSION AFTER ARTERIAL CHEMOEMBOLIZATION-INFUSION IN PATIENTS WITH ISLET-CELL CARCINOMA OF THE PANCREAS METASTATICTO THE LIVER

Background. Islet cell carcinoma of the pancreas is a neuroendocrine t umor often presenting with left upper quadrant mass and radiographic e vidence of liver metastases. Because survival among these patients is determined largely by the pace of metastatic events in the liver, sign ificant palliation may be achieved by regional hepatic therapy. Method s. Five patients with islet cell carcinoma of the pancreas metastatic to the liver (four nonfunctional, one gastrin producing), were treated by hepatic arterial chemoembolization-infusion consisting of a mixtur e of polyvinyl alcohol sponge (150 mg) and cisplatin (150 mg) followed by 2-hour intraarterial infusion of vinblastine (10 mg/m2). Each pati ent received two such treatments, 1 month apart, requiring 3 to 6 days of hospital admission. Results. Significant tumor regression (> 50%) was observed in four of five patients, lasting from 8 to 44 months. To xicity was limited to right upper quadrant pain, paralytic ileus requi ring nasogastric suction for 24 to 72 hours, transient, mild bilirubin emia and liver enzyme elevation, hypomagnesemia and hypokalemia, and o ccasionally, moderate, self-limiting granulocytopenia. Conclusions. Th is preliminary, albeit limited, experience with hepatic chemoembolizat ion-infusion in patients with islet cell carcinoma metastatic to the l iver emphasizes the high incidences of durable tumor regression that c an be achieved with minimal iatrogenic intervention.