title: Repeat transarterial chemoembolization (TACE) for progressive hepatic carcinoid metastases provides results similar to first TACE.
abstract: BACKGROUND
  Transarterial chemoembolization (TACE) is commonly used to treat metastatic carcinoid tumors; however, the management of progressive disease is less clear. We sought to determine if patients with disease progression after TACE would benefit from repeat TACE.
  
  
  METHODS
  The records of 27 patients undergoing repeat TACE for radiologic or symptomatic progression after TACE for metastatic carcinoid were reviewed and compared to 122 undergoing first TACE. Overall and progression-free survivals were estimated by the Kaplan-Meier method.
  
  
  RESULTS
  Mean disease-free interval after first TACE was 11.8 months. Radiologic response was observed in 61% compared to 82% after first TACE (p=0.058); hormone response in 64% compared to 80% (p=0.159); and symptomatic response in 77% compared to 92% (p=0.053). The complication rate after repeat TACE was lower than after first TACE (p=0.03). Median overall survival was similar after repeat (28.1 months) and first TACE (33.3 months) (p=0.53). Progression-free survival was shorter after repeat TACE but not significantly so. No factor examined could predict survival after repeat TACE.
  
  
  CONCLUSIONS
  Repeat TACE for patients with hepatic carcinoid metastases failing first TACE or having evidence of disease progression is safe and offers a viable treatment option.
authors: Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA.
authors: Kimberly A
authors: KA
authors: Varker
authors: Edward W
authors: EW
authors: Martin
authors: Dori
authors: D
authors: Klemanski
authors: Bryan
authors: B
authors: Palmer
authors: Manisha H
authors: MH
authors: Shah
authors: Mark
authors: M
authors: Bloomston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002276:Carcinoid Tumor / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D019233:Retreatment; D016896:Treatment Outcome