Treatment of metastatic carcinoid tumors using multimodality therapy of octreotide acetate, intra-arterial chemotherapy, and hepatic arterial chemoembolization

Diaco, Daniel S.; Hajarizadeh, Homoyan; Mueller, Charles R.; Fletcher, William S.; Pommier, Rodney F.; Woltering, Eugene A.

doi:10.1016/s0002-9610(99)80210-4

Cited by 87 publications

(30 citation statements)

References 16 publications

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“…With a tumour response rate of 37% (CI 95%: 28 -49%), our results are in the range of previous studies regarding treatment's efficacy (Ruszniewski et al, 1993;Therasse et al, 1993;Diaco et al, 1995;Dominguez et al, 2000;Gupta et al, 2003;Kress et al, 2003;O'Toole et al, 2003;Roche et al, 2003). Recently, Roche et al (2004) reported a response rate of 74%, much higher than what we observed.…”

Section: Discussionsupporting

confidence: 82%

“…Post embolisation syndrome was reported only after 47% of procedures in our series, whereas its frequency is usually reported to be higher (Ruszniewski et al, 1993;Therasse et al, 1993;Diaco et al, 1995;Dominguez et al, 2000;Gupta et al, 2003;Kress et al, 2003;O'Toole et al, 2003;Roche et al, 2003Roche et al, , 2004. We can account for this discrepancy by assuming that as this side effect is extremely frequent it was probably not systematically reported, so that we recorded it only when considered significant, that is, responsible for an extension of hospital stay or the use of major analgesics.…”

Section: Discussionmentioning

confidence: 57%

“…Tumour response rate has widely varied between 9 and 60% (Ruszniewski et al, 1993;Therasse et al, 1993;Diaco et al, 1995;Dominguez et al, 2000;Gupta et al, 2003;Kress et al, 2003;O'Toole et al, 2003;Roche et al, 2003Roche et al, , 2004, partly explained by the limited case numbers (most studies involve less than 35 patients) and presumably by some factors related to the patients, their tumours, TACE protocol and previous treatments.…”

mentioning

confidence: 99%

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Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours

et al. 2006

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Transcatheter arterial chemoembolisation (TACE) has been reported to be an efficient treatment of liver metastases of endocrine tumours in short series of patients. However, several factors seem to affect its results. The aim of this work is to identify predictors of response to TACE for liver metastases of endocrine tumours. A total of 163 TACE procedures were performed in 67 patients between 1994 and 2004. Forty-four patients were treated with streptozotocin and 23 with doxorubicin. Primary tumour was located in the pancreas for 19 patients, and had been removed in 43. Thirty-eight tumours were functioning. Response rate was 37% (confidence interval [CI] 95%: 28 -49%). Median time to progression (TTP) was 14.5 months (CI 95%: 9 -41). In multivariate analysis (n ¼ 43), predictors of tumour response were body mass index (BMI) (odds ratio [OR]: 1.3; CI 95%: 1.04 -1.63; P ¼ 0.022), functioning type of tumour (OR: 7.31; CI 95%: 1.26 -42.5; P ¼ 0.027), arterial phase enhancement on abdominal computed tomography (CT) (OR: 8.11; CI 95%:1.06 -62; P ¼ 0.044) and use of streptozotocin for cytotoxic agent (OR: 21.3; CI 95%: 1.48 -306; P ¼ 0.025). Analysis of TTP predictors showed that BMI (hazard ratio [HR]: 0.85; CI 95%: 0.76 -0.86; P ¼ 0.01) and arterial phase enhancement (HR: 0.3; CI 95%: 0.12 -0.73; P ¼ 0.008) were associated with delayed progression. This large study confirms the previously reported results of TACE regarding its efficacy for the treatment of liver metastases of endocrine tumours. Arterial phase enhancement on abdominal CT and BMI are predictors of treatment's efficacy. Streptozotocin should be the preferred cytotoxic agent in order to save anthracycline for systemic chemotherapy.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 57%

mentioning

confidence: 99%

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Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours

et al. 2006

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“…Diaco et al [22] examined the treatment of metastatic carcinoid tumors using multimodality therapy (octreotide, intra- arterial chemotherapy, and hepatic arterial chemoembolization) and reported a 60% tumor regression rate in 10 patients. It is dif®cult to isolate the antiproliferative effect of octreotide from the other treatment modalities in this study.…”

Section: Discussionmentioning

confidence: 99%

Regression of metastatic carcinoid tumors with octreotide therapy: Two case reports and a review of the literature

Leong

Pasieka

2002

Journal of Surgical Oncology

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Background: The antiproliferative effect of the somatostatin analogue, octreotide, on metastatic carcinoid tumors is poorly understood. Partial tumor regression seen radiogaphically has been reported with the use of octreotide therapy for neuroendocrine tumors. Complete regression of carcinoid tumors is rarely reported. Results: Two patients with metastatic midgut carcinoid tumors were treated with subcutaneous octreotide 300 mg/day for symptomatic control of their carcinoid syndrome before debulking palliative surgery. During the laporatomies, both patients were found to have complete macroscopic regression of the metastastatic lesions that had been identi®ed radiologically before surgery, including liver metastases in one patient and periportal and retrocaval lymph nodes in the other. After surgery, the patients were evaluated every 3 months, and had no detectable disease at 30 and 43 months, respectively. Thirty cases of partial tumor regression with octreotide administered with or without other treatment modalities have been reported in the literature. Most of the patients involved received other treatment modalities. Only one other case reported in the literature showed complete regression with octreotide monotherapy. Conclusions: We report two cases of metastatic midgut carcinoid tumors that demonstrated a signi®cant anti-proliferative response to octreotide monotherapy. Review of the literature failed to identify any speci®c prognostic factors with which the response to octreotide can be predicted. Possible mechanisms for this antiproliferative effect of octreotide on carcinoid tumors are discussed.

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“…Moreover, it has not been established whether chemo-embolization is more efficient than embolization alone. Results of (chemo-)embolization in 428 patients (14 trials, not all data are given in each trial) indicate a symptomatic response in 50–100%, biochemical response in 22–92%, and tumor volume response in 25–86% of the patients, overall median survival of 20–80 months and 5-year survival of 40–55% [110,111,112,113,114,115,116,117,118,119,120,121,122,123]. Positive prognostic factors are prior removal of the primary, metastatic liver involvement of less than 75%, diameter of the liver metastases < 5 cm and no extrahepatic metastasis [116, 123].…”

Section: Locoregional Ablative Therapymentioning

confidence: 99%

Well-Differentiated Pancreatic Nonfunctioning Tumors/Carcinoma

et al. 2006

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Treatment of metastatic carcinoid tumors using multimodality therapy of octreotide acetate, intra-arterial chemotherapy, and hepatic arterial chemoembolization

Cited by 87 publications

References 16 publications

Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours

Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours

Regression of metastatic carcinoid tumors with octreotide therapy: Two case reports and a review of the literature

Well-Differentiated Pancreatic Nonfunctioning Tumors/Carcinoma

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