Chemoembolization for liver metastases from medullary thyroid carcinoma.
BACKGROUND
Medullary thyroid carcinoma (MTC) is a well-differentiated neuroendocrine tumor. Distant metastases are the main cause of cancer-related death. Systemic chemotherapy produces only rare tumor responses. Somatostatin analogs and other available modalities are poorly effective to control symptoms.


OBJECTIVE
The aim of our study was to evaluate the impact of liver transarterial chemoembolization (TACE) in MTC patients with predominant and progressive liver metastases.


METHODS
Twelve MTC patients underwent 18 TACE courses (mean, 1.5; range, 1-2). Response evaluation criteria in solid tumors were used to evaluate tumor responses. Symptomatic responses were defined by more than a 25% decrease of symptoms intensity.


RESULTS
Partial radiological tumor response was obtained in five patients (42%) with a median duration of 17 months (mean, 19; range, 15-28 months), stabilization in five (42%) with a median duration of 24 months (mean, 24; range, 4-39 months), and progression in the remaining two (16%). The five partial tumor responses were observed in the nine patients with less than 30% liver involvement. Clinical response was observed in two of the five patients with diarrhea. Carcinoembryonic antigen did not appear to be a useful marker in this setting. Significant grade 3-4 toxicity was observed in one patient who had a major tumor necrosis after TACE.


CONCLUSIONS
TACE should be considered for treating MTC patients with progressive and predominant liver metastasis, and preferably at an early stage during the course of metastatic disease.
Fromigué
J
J
Institut Gustave Roussy, rue Camille Desmoulins, 94805 Villejuif Cedex, France.
De Baere
T
T
Baudin
E
E
Dromain
C
C
Leboulleux
S
S
Schlumberger
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002116:Calcitonin / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D018276:Carcinoma, Medullary / Q000556:secondary*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D013964:Thyroid Neoplasms; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D002272:Carcinoembryonic Antigen; D002116:Calcitonin