LIVER EMBOLIZATIONS OF PATIENTS WITH MALIGNANT NEUROENDOCRINE GASTROINTESTINAL TUMORS

BACKGROUND. Patients with neuroendocrine gastrointestinal tumors usual ly present with inoperable metastatic disease and severe hormonal symp toms. Specific chemotherapy, interferon-alpha (IFN), and somatostatin analogs are established therapies for these patients, but all of them eventually fail. Hepatic arterial embolization can provide reduction o f both hormonal symptoms and tumor burden in these patients. METHODS, Between 1981 and 1995, a total of 55 liver embolizations with gel foam powder were performed on 41 patients with histopathologically verifie d neuroendocrine tumors; 29 had carcinoid tumors and 12 had endocrine pancreatic tumors (EPTs). All patients had received medical treatment, including chemotherapy (n = 18), IFN (n = 31), and octreotide (n = 19 ), and were experiencing treatment failure when liver embolization was performed at a median of 37 months after diagnosis of liver metastase s. Medical treatment was continued after embolization. RESULTS. An ove rall objective response was noted in 15 of 29 patients with carcinoid tumors (52%). The median duration of effect was 12 months in patients with midgut carcinoid tumors. An overall objective response was observ ed in 6 of 12 patients with EPTs (50%), with a median duration of effe ct of 10 months. Adverse events were observed, and, in agreement with earlier reports, the rate of serious complications was 10%. Survival a nalyses showed a median survival of 80 months and a 5-year survival ra te of 60% from the performance of embolization on patients with midgut carcinoid tumors, whereas for patients with EPTs the median survival from embolization was only 20 months. CONCLUSIONS. Liver embolizations performed relatively late in the clinical course in our series appear ed to be as effective as ''early'' embolizations in other series of pa tients with carcinoid tumors. The results for those with EPTs were poo rer, and earlier embolizations may result in better outcomes for these patients. Considering the morbidity associated with the procedure, it is imperative to select patients according to extent of liver involve ment, severity of carcinoid heart disease, and somatostatin receptor s tatus. (C) 1998 American Cancer Society.