Transarterial chemoembolization of liver metastases from well differentiated gastroenteropancreatic endocrine tumors with doxorubicin-eluting beads: preliminary results.
OBJECTIVE
To evaluate the feasibility, safety, and efficacy of transarterial chemoembolization (TACE) of progressive liver metastases from well differentiated gastroenteropancreatic endocrine (GEP) tumors with drug-eluting beads (DEBs).


METHODS
From June 2004 to July 2005, eight men and 12 women aged 34 to 75 years (mean +/- SD, 59 y +/- 12), including 13 patients with bilobar disease and seven with unilobar disease, underwent 34 sessions of TACE with DEBs (500-700 mum) loaded with doxorubicin. Morphologic response was evaluated with computed tomography (CT) at 1 and 3 months according to Response Evaluation Criteria In Solid Tumors. Clinical and laboratory data were also assessed.


RESULTS
The complete dose of 4 mL of DEBs loaded with 100 mg doxorubicin was injected during 22 TACE sessions and 1-3.5 mL of DEBs was injected during 12 TACE sessions. Three months after TACE, 16 of 20 patients (80%) exhibited a partial response, three (15%) had stable disease, and one (5%) had progressive disease. The mean size of the largest metastasis in each patient decreased from 42 mm +/- 24 before treatment (median, 39.5 mm) to 33 mm +/- 23 (median, 29 mm) 1 month after treatment and 30 mm +/- 21 (median, 26.5 mm) 3 months after treatment. After a median follow-up of 15 months (range, 6-24 months), nine patients' disease remained controlled without tumor progression and 10 patients had progressive disease. The median time to progression was 15 months. Postembolization syndrome lasted less than 7 days in 23 sessions (67%) and more than 7 days in seven sessions (22%), and no symptoms at all were observed in four sessions (11%). Peak aspartate aminotransferase, alanine aminotransferase, and bilirubin levels after TACE were 35-490 IU (mean, 125 IU +/- 77; normal, <35 IU), 20-440 IU (mean, 149 IU +/- 155; normal, <45 IU), and 8-90 mol/L (mean, 26 IU +/- 25; normal, <17 IU), respectively, at 2-3 days. In five patients, follow-up CT at 1 month revealed TACE-induced peripheral liver necrosis.


CONCLUSIONS
TACE with DEBs is well tolerated and appears effective. A comparative study with a standard TACE or transarterial embolization regimen is warranted to define the best protocol for transarterial treatment of GEP liver metastases.
de Baere
Thierry
T
Department of Interventional Radiology, Institut Gustave Roussy, Rue Camille Desmoulins, Villejuif 94805, France. debaere@igf.fr
Deschamps
Frederic
F
Teriitheau
Christophe
C
Rao
Pramod
P
Conengrapht
Kenneth
K
Schlumberger
Martin
M
Leboulleux
Sophie
S
Baudin
Eric
E
Hechellhammer
Lukas
L
D000328:Adult; D000368:Aged; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018450:Disease Progression; D004317:Doxorubicin / Q000008:administration & dosage*; D004701:Endocrine Gland Neoplasms / Q000556:secondary / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy*; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden / Q000187:drug effects
D004317:Doxorubicin