Prolonged survival after hepatic artery embolization in patients with midgut carcinoid syndrome

Swärd, Christina; Johanson, Viktor; Dijkum, Els Nieveen van; Jansson, Svante; Nilsson, Ola; Wängberg, Bo; Ahlman, Håkan; Kölby, Lars

doi:10.1002/bjs.6587

Cited by 46 publications

(40 citation statements)

References 21 publications

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“…Numerous studies have shown that HAE and HACE are effective in controlling hormonal symptoms and reducing tumor size [14,15,17,19,21,22,23,24,25,26]. The tumor response rates are variable in the literature (33–92%) [14,17,18,19].…”

Section: Discussionmentioning

confidence: 99%

“…The median OS was not evaluable and the analysis of predictive factors of OS was not relevant due to the small number of deaths. In the literature, the 2-year OS rates after treatment of midgut endocrine liver metastases were 67–80%, with a median OS near 40 months (range 31–80) [19,24,26]. The percentages of changes in urinary 5-HIAA and serum chromogranin A levels were correlated with prolonged survival in one study and have been proposed to be used as predictors of long-term outcome [26].…”

Section: Discussionmentioning

confidence: 99%

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Hepatic Arterial Embolization versus Chemoembolization in the Treatment of Liver Metastases from Well-Differentiated Midgut Endocrine Tumors: A Prospective Randomized Study

Maire¹,

Lombard‐Bohas²,

O’Toole³

et al. 2012

Neuroendocrinology

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Background: Liver surgery is the best treatment for endocrine liver metastases, but it is often impossible due to diffuse disease. Systemic chemotherapy is poorly effective. Hepatic arterial embolization (HAE) and chemoembolization (HACE) have shown efficacy but have never been compared. Patients and Methods: Patients with progressive unresectable liver metastases from midgut endocrine tumors were randomly assigned to receive HAE or HACE (two procedures at 3-month interval). The primary end point was the 2-year progression-free survival (PFS) rate. Secondary end points were response rates, overall survival, and safety. Results: Twelve patients were assigned to receive HACE and 14 to receive HAE. The patient characteristics were well matched across the treatment arms. The 2-year PFS rates were 38 and 44% in the HACE and HAE arms, respectively (p = 0.90). Age, gender, previous resection of the primary tumor or liver metastases, extent of liver involvement, and concomitant treatment with somatostatin analogues were not associated with changes in PFS, whereas elevated baseline urinary 5-HIAA and serum chromogranin A levels were associated with shorter PFS. The 2-year overall survival rates were 80 and 100% in the HACE and HAE arms, respectively (p = 0.16). The disease control rate on CT scan was 95%. Grade 3 toxicity occurred in 19% of patients, with no treatment-related deaths and no differences in the treatment arms. Conclusion: HACE and HAE are safe and permit tumor control in 95% of patients with progressive liver metastases from midgut endocrine tumors. The 2-year PFS was not higher among patients receiving HACE, not favoring the hypothesis of an additive efficacy of arterial chemotherapy or embolization alone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hepatic Arterial Embolization versus Chemoembolization in the Treatment of Liver Metastases from Well-Differentiated Midgut Endocrine Tumors: A Prospective Randomized Study

Maire¹,

Lombard‐Bohas²,

O’Toole³

et al. 2012

Neuroendocrinology

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“…Due to the favorable tumor biology of well-differentiated (G1) NETs of the ileum, an elective, palliative operation performed in a specialized center should be discussed as part of a multimodal approach. Please refer to recent review papers for multimodal therapy of neuroendocrine liver metastases [18,[67][68][69][70][71][72] .…”

Section: Management Of Ileal Netsmentioning

confidence: 99%

Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management

Scherübl

Jensen²,

Cadiot³

et al. 2010

WJGE

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Neuroendocrine tumors of the small bowel are on the rise. In the US they have increased by 300%-500% in the last 35 years. At the same time their prognosis is much improved. Today, most neuroendocrine tumors (NETs) of the duodenum are detected "incidentally" and therefore recognized at an early stage. Duodenal NETs which are well differentiated, not larger than 10 mm and limited to the mucosa/submucosa can be endoscopically resected. The management of duodenal NETs ranging between 10 and 20 mm needs an interdisciplinary discussion. Endoscopic ultrasound is the method of choice to determine tumor size and depth of infiltration. Surgery is recommended for welldifferentiated duodenal NET tumors greater than 20 mm, for localized sporadic gastrinomas (of any size) and for localized poorly differentiated NE cancers. Surgery is recommended for any ileal NET. Advanced ileal NETs with a carcinoid syndrome are treated with longacting somatostatin analogs. This treatment significantly improves (progression-free) survival in patients with metastatic NETs of the ileum. For optimal NET management, tumor biology, type, localization and stage of the neoplasm, as well as the patient's individual circumstances have to be taken into account.

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“…Symptomatic response is achieved in 40-80%, biochemical response in 50-60% with overall 5-year survival, and 50-60% post-embolisation , Brown et al 1999, Dominguez et al 1999, 2000, Kim et al 1999, Yao et al 2001, Roche et al 2003, Marrache et al 2007, Sward et al 2009). The mechanism is to induce ischaemia in tumour cells, thus reducing their hormone output.…”

Section: Embolisation and Ablative Methodsmentioning

confidence: 99%

Therapeutic management of patients with gastroenteropancreatic neuroendocrine tumours

Khan

Caplin²

2011

Endocrine-Related Cancer

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Patients with neuroendocrine tumours (NETs) are best managed in a specialist centre as part of a multidisciplinary team comprising gastroenterologists, oncologists, endocrinologists, gastrointestinal and hepatopancreaticobiliary surgeons, pathologists, nuclear medicine physicians and technicians, radiologists, specialist nurses, pharmacists, biochemists and dieticians. This should ideally be led by a clinician with experience and interest in NETs. Although the number of medical treatments and clinical trials has increased in the decade, there is still a lack of prospective randomised trials; thus, management is mainly based on limited often single-centre studies, although there are now formal guidelines based on consensus expert opinion. We have outlined the current optimal management of patients with NETs. We have reviewed therapeutic options including surgery, somatostatin analogues and other biotherapies and peptide receptor-targeted therapy. We have discussed the challenge in managing hepatic metastases including hepatic artery embolisation, ablation and orthotopic liver transplant. In addition, we have briefly reviewed the emerging therapies such as the mammalian target of rapamycin and angiogenic inhibitors and the newer somatostatin analogues.

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Prolonged survival after hepatic artery embolization in patients with midgut carcinoid syndrome

Cited by 46 publications

References 21 publications

Hepatic Arterial Embolization versus Chemoembolization in the Treatment of Liver Metastases from Well-Differentiated Midgut Endocrine Tumors: A Prospective Randomized Study

Hepatic Arterial Embolization versus Chemoembolization in the Treatment of Liver Metastases from Well-Differentiated Midgut Endocrine Tumors: A Prospective Randomized Study

Neuroendocrine tumors of the small bowels are on the rise: Early aspects and management

Therapeutic management of patients with gastroenteropancreatic neuroendocrine tumours

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