Effective palliative treatment of metastatic carcinoid tumors with intra-arterial chemotherapy/chemoembolization combined with octreotide acetate.
Survival in patients with metastatic carcinoid tumors is dependent on control of tumor growth and adequate palliation of vasoactive amine-induced symptoms of flushing, diarrhea, wheezing, and valvular heart disease. Eight patients with carcinoid tumors metastatic to the liver were treated with long-term octreotide acetate therapy (100 to 500 micrograms three times a day), intra-arterial 5-fluorouracil infusion (2 g/day x 5 days), and hepatic tumor chemoembolization. All eight patients became asymptomatic and have remained so with a mean follow-up duration of 22 months from the time of first infusion. Following institution of subcutaneous octreotide acetate, intra-arterial infusion, and tumor chemoembolization, all patients are alive with a mean survival of 40 months from the time of diagnosis of carcinoid syndrome (range: 2 to 108 months). Four patients had greater than a 50% decrease in tumor size after therapy (mean follow-up duration: 10.6 months), and the other four patients have had stable disease after institution of therapy. It appears that combinations of long-term subcutaneous administration of octreotide acetate, intra-arterial 5-fluorouracil, and tumor chemoembolization effectively control progressive liver metastasis and provide excellent symptomatic palliation in patients with hepatic metastasis from functional carcinoid tumors.
Hajarizadeh
H
H
Department of Surgery, Oregon Health Sciences University, Portland 97201-3098.
Ivancev
K
K
Mueller
C R
CR
Fletcher
W S
WS
Woltering
E A
EA
D002276:Carcinoid Tumor / Q000556:secondary* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000008:administration & dosage*; D006801:Humans; D007261:Infusions, Intra-Arterial; D007279:Injections, Subcutaneous; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy; D015282:Octreotide / Q000008:administration & dosage*; D010166:Palliative Care
D015282:Octreotide; D005472:Fluorouracil