title: Embolisation therapy in the midgut carcinoid syndrome: just tumour ischaemia?
abstract: Forty-eight patients with midgut carcinoid tumours and disseminated disease were treated at our unit 1986-1991. All patients underwent primary surgery with optimal tumour reduction. Twenty-seven patients with bilobar liver metastases had subsequent embolizations of the hepatic arteries to further reduce the functional tumour mass and were thereafter treated with a low dose of octreotide. The response to this treatment was evaluated by CT at 3 months postembolization. The patients could then be divided into 13 responders (no visible hepatic tumours or more than 50% reduction, group I) and 14 non-responders (less than 50 reduction or progression, group II). When these patients were studied biochemically and in terms of prognosis, the reduction of 5-HIAA levels postembolization was much more pronounced in group I (80 +/- 3%) then in group II (28 +/- 12%). The biochemical and radiological responses were long-lasting in group I, none of the patients needed further ischaemic treatment. Of specific interest were 3 patients with bilobar disease, who after selective unilobar embolisation normalised their 5-HIAA levels and had bilateral tumour regression. These findings indicate involvement of systemic effects in addition to tumour ischaemia alone. The initial biochemical response with marked decrease of 5-HIAA levels in combination with tumour regression may thus serve as an indicator of good prognosis.
authors.affiliation: Department of Surgery, University of Göteborg, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Wängberg
authors.forename: K
authors.initials: K
authors.lastname: Geterud
authors.forename: O
authors.initials: O
authors.lastname: Nilsson
authors.forename: S
authors.initials: S
authors.lastname: Jansson
authors.forename: A
authors.initials: A
authors.lastname: Dahlström
authors.forename: U
authors.initials: U
authors.lastname: Tylén
authors.forename: H
authors.initials: H
authors.lastname: Ahlman
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000652:urine; D007414:Intestinal Neoplasms / Q000473:pathology / Q000628:therapy*; D007511:Ischemia / Q000209:etiology; D008113:Liver Neoplasms / Q000098:blood supply / Q000556:secondary / Q000628:therapy; D008297:Male; D008303:Malignant Carcinoid Syndrome / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use; D011379:Prognosis
chemical_list: D006897:Hydroxyindoleacetic Acid; D015282:Octreotide