Treatment of Liver Metastases of Carcinoid Tumors

Abstract

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.

Primary Hepatic Carcinoid Tumor with Carcinoid Syndrome and Carcinoid Heart Disease: A Case Report of a Patient on Long-Term Follow-up

“…To our knowledge, there are no records on peritoneal involvement of carcinoid tumor. Timely intraperitoneal infusion with cisplatin was useful in relieving massive ascites, although it remains controversial whether cisplatin is effective for carcinoid tumors (6,13).…”

“…Otherwise, transarterial embolization (TAE) might be effective for some cases (1,5). For unresectable PHCT, octreotide acetate (OA), a somatostatin analogue, has been used to prevent various symptoms derived from carcinoid (6)(7)(8).…”

Management of patients with differentiated neuroendocrine tumors of jejunum and ileum (according to international guidelines)

“…Средняя выживаемость после первого криза составляет 38 мес и после выявления в моче повышения уровня 5 гидроксииндол уксусной кислоты (5 ГИУК) -23 мес [18].…”

“…Многообещающим является применение новых методов -кап сульной эндоскопии и двойной баллонной энтероскопии. При высокодифференциро ванных эндокринных опухолях выполнение стандартной ПЭТ с 18 ФДГ неэффективно, в отличие от специфических меток, исполь зуемых для диагностики нейроэндокринных опухолей, -11 C 5 гидрокситриптофана (ГТФ) или 18 F дигидроксифенилаланина (ДОФА). Чувствительность метода при вы явлении первичной карциноидной опухоли тонкой кишки составила более 90%, что пре вышает аналогичный показатель СРС, КТ и МРТ [28,29].…”

“…При отрица тельных данных СРС возможно применение ПЭТ с 18 F DOФA или 11 C 5 ГТФ. Использова ние ПЭТ с 68 Ga DOTA octreotide (не требует внутреннего циклотрона, однако метод дос тупен в немногих исследовательских цент рах) позволяет выявить на 30% больше опу холевых изменений, чем СРС [24].…”