Meij Vincent, Zuetenhorst Johanna M, van Hillegersberg Richard, Kröger Robert, Prevoo Warner, van Coevorden Frits, Taal Babs G
Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
World J Surg Oncol. 2005 Nov 17;3:75. doi: 10.1186/1477-7819-3-75.
Hepatic metastases of carcinoid tumors cause incapacitating symptoms, but are usually diffuse and therefore unresectable. In this article we evaluate our experiences with local treatment techniques in the management of carcinoid patients with hepatic metastases and failing systemic treatment.
Fifteen consecutive carcinoid patients (11 men and 4 women; median age 60 years; range 45-71 years) were treated with either hepatic artery embolization (HAE) with Ivalon particles or radiofrequency ablation (RFA) (percutaneously or intra-operatively). Follow-up evaluation was performed by CT scan and 24-hours urinary 5-HIAA excretions.
A total of 18 HAE's was performed in 13 patients, while 10 lesions in 3 patients were treated with RFA. Median follow-up was 12.5 months (2 - 25 months). Median duration of symptoms was 22 months (8 - 193 months). Median overall decrease of 5-HIAA excretion 2 months after HAE was 32% with tumor regression on CT-scan in 4 patients (30%) and improvement of symptoms with a median duration of 15 months in 3 of them (23%). Embolization led to fatal hepatic failure in one patient. The 3 patients treated with RFA showed a decrease of urinary 5-HIAA values of 34, 81 and 93% respectively, with tumor regression in all of them. Improvement of symptoms was reported in 2 patients up to 25 months.
Liver embolization performed late in the clinical course had limited effect on symptoms and biochemical and radiological parameters. First experiences with RFA are favorable and might encourage to apply RFA more widely in metastatic carcinoid.
类癌肿瘤的肝转移会导致使人丧失能力的症状，但通常是弥漫性的，因此无法切除。在本文中，我们评估了我们在治疗肝转移且全身治疗失败的类癌患者时采用局部治疗技术的经验。
连续15例类癌患者（11例男性和4例女性；中位年龄60岁；范围45 - 71岁）接受了用Ivalon颗粒进行的肝动脉栓塞术（HAE）或射频消融术（RFA）（经皮或术中）治疗。通过CT扫描和24小时尿5 - HIAA排泄进行随访评估。
13例患者共进行了18次HAE，而3例患者的10个病灶接受了RFA治疗。中位随访时间为12.5个月（2 - 25个月）。症状的中位持续时间为22个月（8 - 193个月）。HAE后2个月5 - HIAA排泄的中位总体下降率为32%，4例患者（30%）CT扫描显示肿瘤缩小，其中3例（23%）症状改善，中位持续时间为15个月。栓塞导致1例患者发生致命性肝衰竭。接受RFA治疗的3例患者尿5 - HIAA值分别下降了34%、81%和93%，所有患者肿瘤均缩小。2例患者症状改善持续达25个月。
在临床病程后期进行的肝栓塞对症状以及生化和放射学参数的影响有限。RFA的初步经验是良好的，可能会鼓励在转移性类癌中更广泛地应用RFA。
