Hepatic arterial chemoembolization in the management of advanced digestiveendocrine tumours

Liver metastases, in patients with gastroenteropancreatic endocrine tumours , are present in 25-90%, depending on the nature of the primary tumour. Sur gical resection is indicated only for localised liver metastasis, whereas i n most cases with diffuse liver involvement other therapeutic modalities su ch as intravenous chemotherapy, embolization or hepatic arterial chemoembol ization, ligation or intra-arterial chemotherapy are currently available. H epatic arterial chemoembolization is specifically indicated for progressive tumours (mainly carcinoids) confined to the liver especially after unsucce ssful systemic chemotherapy. A mixture of cytotoxic drug and iodised oil fo llowed by gelatine sponge particles are injected in the branches of the hep atic artery supplying the tumours. 66-100% positive results of this treatme nt have been reported in the carcinoid syndrome with a 50-91% decrease in 5 -HIAA secretion. Variation of tumour size (WHO criteria) has been reported in 33-80% of the cases, even if no direct comparison between chemoembolisat ion and other therapeutic modalities are currently available. Extensive fol low-up of the treated patients and additional studies will clarify the role of chemoembolisation in advanced digestive neuroendocrine tumours.