Transarterial chemoembolization of advanced liver metastases of neuroendocrine tumors--a retrospective single-center analysis.
BACKGROUND
In neuroendocrine tumors, metastases are a negative prognostic factor for survival and quality of life. Transcatheter arterial chemoembolization (TACE) is thought to be an effective symptomatic and antiproliferative treatment in patients with otherwise progressive disease.


METHODS
62 chemoembolization procedures in 26 patients with progressive neuroendocrine tumors were reviewed. The underlying disease was carcinoid syndrome in 10, non-functional midgut tumor in 2, non-functional pancreatic tumor in 7, malignant insulinoma in 2 patients, non-functional tumor of the stomach in 1 and of unknown origin in 4 patients. Tumor burden of the liver was <25% in 3, 25-50% in 11, 50-75% in 6 and >75% in 6 patients.


RESULTS
TACE was technically successful in 57 cases. Four patients developed minor and 5 major complications. The 30-day mortality rate was 7.7%. According to WHO criteria, 14 patients had no change in tumor burden, 2 had regression and 5 progress after chemoembolization. Patients with a tumor burden >75% of the liver did not benefit from TACE due to the development of major complications, whereas patients with low (<50%) tumor burden and high (>50%) lipiodol uptake showed a trend towards longer survival. Five-year survival time after diagnosis was 48%. Patients treated with octreotide and/or alpha-interferon had no benefit from chemoembolization with regard to their carcinoid syndrome.


CONCLUSIONS
In this retrospective study, patients with low (<50%) tumor burden and high (>50%) lipiodol uptake responded better to TACE than end-stage patients.
Department of Diagnostic Radiology, Philipps University Hospital, Marburg, Germany. kresso@med.uni-marburg.de
O
O
Kress
H-J
HJ
Wagner
M
M
Wied
K J
KJ
Klose
R
R
Arnold
H
H
Alfke
D000328:Adult; D000368:Aged; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D003287:Contrast Media / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D012189:Retrospective Studies; D016896:Treatment Outcome
D003287:Contrast Media; D007459:Iodized Oil; D004317:Doxorubicin