Embolization of the liver in the management of metastatic carcinoid tumors

Abstract

Eight patients with metastatic carcinoid tumors and the carcinoid syndrome were treated with gelatin foam embolization of the hepatic arterial tree. The aims were to reduce the tumor mass in the liver and to eliminate the carcinoid syndrome. The effects of the treatment were judged from arteriograms, CT scans, and the levels of serotonin in blood and 5-HIAA in urine, as well as from the clinical symptoms. The mean follow-up time was 12.5 months. In all patients the liver tumor mass was reduced after embolization, and this reduction persisted for at least 6 months in seven patients. After treatment, reduced serotonin levels in blood were measured in four patients and reduced 5-HIAA levels in urine in seven patients. In five patients the carcinoid syndrome disappeared after embolization, but after 6 months two of these five patients had regained symptoms. Adverse reactions were minor consisting of a slight fever, reversibly increased serum levels of liver enzymes, and abdominal pain. In our experience, the hepatic embolization is a simple and safe method of giving relief from the carcinoid syndrome.

The Role of Interventional Radiology for the Treatment of Hepatic Metastases from Neuroendocrine Tumor: An Updated Review

“…These authors reported persistent arterial occlusion on angiograms performed 6 weeks after TAE but did not evaluate other outcomes [ 25 ]. Further studies reported hepatic artery embolization with absorbable gelatin powder (i.e., slurry) with similar results [ 8 , 26 , 27 ]. However, gelatin powder is no longer used because it is associated with a high risk of complication due to non-targeted embolization [ 28 ].…”

“…NELMs of the caudate lobe (i.e., segment I) have a lower radiological response to transarterial therapy than those in other segmental locations (12% vs. 82%, respectively) with consequent lower OS (46 vs. 87 months; p = 0.031) [ 56 ]. When several sessions of TAE or TACE are performed, responses after following sessions are similar to the first one for clinical improvement and biological response [ 26 , 62 ]. However, when NELMS favorably respond to the first session, a repeat session improves the OS [ 26 , 62 ].…”

“…When several sessions of TAE or TACE are performed, responses after following sessions are similar to the first one for clinical improvement and biological response [ 26 , 62 ]. However, when NELMS favorably respond to the first session, a repeat session improves the OS [ 26 , 62 ].…”

Nuclear DNA patterns and survival in metastasizing ileal carcinoids

“…The approach to treatment of liver metastases has become increasingly aggressive and the regimens at present comprise hepatic liver dearterialization, embolization, and chemotherapy. These treatments are usually effective, but expensive and not without complications [21][22][23].…”

Neuroendocrine Tumors: Genomics and Molecular Biomarkers with a Focus on Metastatic Disease

“…Patients with small-intestine NETs or NETs of unknown primary with a urinary 5-HIAA doubling time < 434 days had a significantly higher disease-specific mortality compared to those with longer doubling times [ 83 ]. Several studies have described reduction of 5-HIAA levels after transarterial liver-directed therapy [ 84 , 85 , 86 , 87 ]. Carrasco et al’s study evaluating hepatic artery embolization in patients with malignant carcinoid syndrome found reduction in urinary 5-HIAA levels in all patients who had objective imaging and clinical response [ 86 ].…”