Carcinoid syndrome treated by hepatic embolization

Pueyo, I; Jiménez,; Hernandez, J; Brugarolas, Antonio; García-Morán, M; Jl, García-Muñíz; Arroyo, Francisco Ramon Garcia

doi:10.2214/ajr.131.3.511

Cited by 24 publications

(3 citation statements)

References 15 publications

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“…Several centers have reported good symptom palliation by embolization in patients with the midgut carcinoid syndrome related to proved tumor cell necrosis [7,[31][32][33][34][35]. Similar biochemical and clinical tumor responses have been reported also for temporary dearterialization by external vessel loops and repeated periods of applied ischemia [36].…”

Section: Hepatic Arterial Embolizationmentioning

confidence: 74%

Treatment of Liver Metastases of Carcinoid Tumors

et al. 1996

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Liver metastases imply a major problem in patients with carcinoid tumors. Patients with localized disease should always undergo resection for cure. Patients with distant metastatic disease can also undergo resection for potential cure or symptom palliation because of the slow growth rate of many carcinoid tumors. In patients with the midgut carcinoid syndrome and bilobar hepatic disease we have performed primary surgery to relieve such symptoms as intestinal obstruction and ischemia, followed by successive embolizations of the hepatic arteries to reduce functional tumor burden in the liver. For optimal palliation, all patients with residual tumor were treated by octreotide. In a consecutive series of 64 patients with the midgut carcinoid syndrome we thus attained a 5-year survival rate of 70%. Fourteen of the patients underwent intentionally curative surgery (e.g., primary surgery followed by liver surgery). Of these patients, none died from their tumor disease during the period of study. The value of adjunctive interferon therapy is currently under evaluation.

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Section: Hepatic Arterial Embolizationmentioning

confidence: 74%

Treatment of Liver Metastases of Carcinoid Tumors

et al. 1996

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“…Selective embolizations of the hepatic arteries cause a temporary, but complete, ischemia distal to the point of injection [30]. Good symptom palliation by this technique has been reported in patients with the midgut carcinoid syndrome related to proved tumor cell necrosis [18,[31][32][33][34][35]. The timing of embolization in this series differed, however, from other studies, in which ischemic treatment was given late in the course of disease.…”

Section: Discussionmentioning

confidence: 90%

Survival of Patients with Disseminated Midgut Carcinoid Tumors after Aggressive Tumor Reduction

et al. 1996

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Sixty-four consecutive patients with disseminated midgut carcinoids were treated during an 8-year period according to a single clinical protocol aimed at aggressive tumor reduction by surgery alone or with subsequent hepatic artery embolization. All patients had markedly elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) levels (581 +/- 79 micromol/24 h) and hormonal symptoms. Fourteen patients (22%) reached anatomic and biochemical cure by surgery alone. At follow-up, the mean 5-HIAA levels were still normal after 69.0 +/- 6. 2 months; two patients had died from unrelated causes. With the introduction of somatostatin receptor scintigraphy, subclinical disease was diagnosed in 7 of these 14 patients. Forty patients with bilobar hepatic disease underwent embolization in combination with octreotide. In this group, 5-HIAA levels were still reduced by 55% after 71 +/- 11 months of follow-up, and the 5-year survival was 56%, estimated from the total death hazard function. After embolization, two subgroups could be identified with marked differences in their long-term response to treatment. Ten patients were not embolized owing to complicating diseases. The 5-year survival for the entire series was 58%. A significantly increased risk of cardiovascular deaths was seen, which underlines the importance of total survival analysis in a disease with multiple hormonal effects. It is concluded that an active surgical approach must be recommended to patients with the midgut carcinoid syndrome. In patients with bilobar hepatic disease, embolization combined with octreotide treatment markedly reduced the 5-HIAA excretion and suggested a prolonged 5-year survival.

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“…A similar strategy can also be followed for patients with previous hemihepatectomy and recurrent tumours in the residual liver. Immediately before embolization an arteriogram is performed to demonstrate the arterial anatomy, tumour blood flow and patency of the portal vein [31, 32]. Both absorbable and nonabsorbable embolization materials have been used, e.g.…”

Section: Interventional Treatment Of Liver Metastasesmentioning

confidence: 99%

Interventional Treatment of Gastrointestinal Neuroendocrine Tumours

et al. 2000

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Neuroendocrine (NE) tumours of the gastrointestinal tract (carcinoids and endocrine pancreatic tumours) are rare diseases. In the presence of liver metastases these patients may suffer from disabling symptoms due to hormone overproduction. Patients with localized disease can be resected for cure and also patients with liver metastases can undergo potentially curative tumour resection. However, long-term follow-up of the latter cases indicates frequent recurrence of tumour. Using close biochemical monitoring of tumour markers combined with newer techniques for tumour visualization, these recurrences can often be diagnosed at an early stage so that repeat surgical procedures can be performed. During the last years very active surgery has been recommended for NE tumours, many of which have a relatively slow growth. Even in patients not amenable to curative liver surgery, debulking can be considered if the main tumour burden can be safely excised. The primary aim of this type of treatment is palliation of hormonal symptoms. An important question is whether the aggressive treatment actually prolongs survival. No prospective studies have been performed. Such studies are hampered by the lack of strict surgical programs running over long periods and the relative rarity of NE tumours. Liver transplantation may be another treatment modality in selected cases.

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Carcinoid syndrome treated by hepatic embolization

Cited by 24 publications

References 15 publications

Treatment of Liver Metastases of Carcinoid Tumors

Treatment of Liver Metastases of Carcinoid Tumors

Survival of Patients with Disseminated Midgut Carcinoid Tumors after Aggressive Tumor Reduction

Interventional Treatment of Gastrointestinal Neuroendocrine Tumours

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