HEPATIC-ARTERY CHEMOEMBOLIZATION FOR MANAGEMENT OF PATIENTS WITH ADVANCED METASTATIC CARCINOID-TUMORS

BACKGROUND: Patients with advanced metastatic carcinoid tumors who hav e disease progression despite conventional therapy are left with few t herapeutic options. Hepatic artery chemoembolization (HACE) may play a role in palliating these patients' symptoms. METHODS: Fifteen patient s with biopsy-proven advanced bilobar hepatic carcinoid metastases who demonstrated progression of symptoms and/or tumor size despite treatm ent with somatostatin analogues were treated with intra-arterial chemo therapy and HACE to determine efficacy and safety. Five days of intra- arterial 5-fluorouracil (1 g/m(2)) were followed by HACE with adriamyc in (60 mg), cisplatin (100 mg), mitomycin C (30 mg), and polyvinyl alc ohol (Ivalon); 200 mu to 710 mu) Patients were continued on octreotide at the same dose (150 to 2000 mu g subcutaneous q 8 hours) before, du ring, and after the procedure. RESULTS: Efficacy of treatment was asse ssed by comparing pretreatment and 3-month clinical, laboratory, radio graphic, and quality of life parameters. Symptoms were improved in 8 o f 12 patients who had diarrhea, 7 of 12 who had flushing, 9 of 12 who had abdominal pain, and in 4 of 7 who had malaise. Elevated tumor mark ers decreased in all patients. Biochemical markers (mean +/- SE) at 3 months decreased by 60% +/- 6% for 5-HIAA, 75% +/- 10% for chromograni n A and 50% +/- 7% for neuron-specific enolase. Tomographic assessment revealed tumor liquefaction in 10 of 13 patients. The Karnofsky perfo rmance status improved from a mean of 66 +/- 2 to 84 +/- 2 (P <0.001), Median follow-up was 16 months, with 13 deaths occurring from 1 week to 71 months after treatment. CONCLUSIONS: Hepatic artery chemoemboliz ation improves symptoms of carcinoid syndrome, has a high tumor respon se rate, and improves short-term quality of life in this group of pati ents with advanced hepatic carcinoid disease. (C) 1998 by Excerpta Med ica, Inc.