title: Hepatic artery chemoembolization for management of patients with advanced metastatic carcinoid tumors.
abstract: BACKGROUND
  Patients with advanced metastatic carcinoid tumors who have disease progression despite conventional therapy are left with few therapeutic options. Hepatic artery chemoembolization (HACE) may play a role in palliating these patients' symptoms.
  
  
  METHODS
  Fifteen patients with biopsy-proven advanced bilobar hepatic carcinoid metastases who demonstrated progression of symptoms and/or tumor size despite treatment with somatostatin analogues were treated with intra-arterial chemotherapy and HACE to determine efficacy and safety. Five days of intra-arterial 5-fluorouracil (1 g/m2) were followed by HACE with adriamycin (60 mg), cisplatin (100 mg), mitomycin C (30 mg), and polyvinyl alcohol (Ivalon); 200 micron to 710 micron). Patients were continued on octreotide at the same dose (150 to 2000 microg subcutaneous q 8 hours) before, during, and after the procedure.
  
  
  RESULTS
  Efficacy of treatment was assessed by comparing pretreatment and 3-month clinical, laboratory, radiographic, and quality of life parameters. Symptoms were improved in 8 of 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 markers decreased in all patients. Biochemical markers (mean +/- SE) at 3 months decreased by 60% +/- 6% for 5-HIAA, 75% +/- 10% for chromogranin A and 50% +/- 7% for neuron-specific enolase. Tomographic assessment revealed tumor liquefaction in 10 of 13 patients. The Karnofsky performance 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 chemoembolization improves symptoms of carcinoid syndrome, has a high tumor response rate, and improves short-term quality of life in this group of patients with advanced hepatic carcinoid disease.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-4753, USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Drougas
authors.forename: L B
authors.initials: LB
authors.lastname: Anthony
authors.forename: T K
authors.initials: TK
authors.lastname: Blair
authors.forename: R R
authors.initials: RR
authors.lastname: Lopez
authors.forename: J K
authors.initials: JK
authors.lastname: Wright
authors.forename: W C
authors.initials: WC
authors.lastname: Chapman
authors.forename: L
authors.initials: L
authors.lastname: Webb
authors.forename: M
authors.initials: M
authors.lastname: Mazer
authors.forename: S
authors.initials: S
authors.lastname: Meranze
authors.forename: C W
authors.initials: CW
authors.lastname: Pinson
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D002276:Carcinoid Tumor / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000628:therapy*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D010400:Penicillin G / Q000008:administration & dosage; D010406:Penicillins / Q000008:administration & dosage; D011859:Radiography; D013997:Time Factors
chemical_list: D010406:Penicillins; D006493:Heparin; D010400:Penicillin G