Strosberg Jonathan R, Choi Junsung, Cantor Alan B, Kvols Larry K
Hematology Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612-9497, USA.
Cancer Control. 2006 Jan;13(1):72-8. doi: 10.1177/107327480601300110.
Prognosis in patients with carcinoid and pancreatic endocrine tumors with diffuse, unresectable liver metastases is poor. Palliation is often difficult despite the use of somatostatin analogs, interferon alpha, or systemic chemotherapy. Several reviews have suggested that hepatic artery embolization, with or without intraarterial chemotherapy, can be used for control of symptoms and for cytoreduction in patients with liver dominant metastases.
Between 2000 and 2002, 161 embolizations using polyvinyl alcohol or microspheres were performed on 84 patients with carcinoid or pancreatic endocrine tumors metastatic to the liver. A retrospective review was performed to evaluate symptomatic response, biochemical response, adverse effects, and duration of survival. Baseline and follow-up computed tomography scans were also assessed to determine radiographic response rates. Further analysis of survival was performed to assess the possible impact of various postembolization therapies.
Eighty-four patients underwent bland hepatic artery embolizations during the study period. Among 55 symptomatic patients, 44 patients had fewer symptoms, and among 35 patients whose tumor markers were followed, 28 had a major biochemical response. Objective radiographic responses were observed in 11 of 23 patients. No deaths occurred during therapy, and major toxicities were rare. Median overall survival was 36 months from time of initial embolization.
Hepatic artery embolization frequently results in clinical and radiographic responses in patients with unresectable liver metastases from carcinoid or pancreatic endocrine tumors. Morbidity is low when appropriate supportive care is provided. Hepatic artery embolization often results in regressions in patients with unresectable liver metastases from carcinoid or pancreatic endocrine tumors.
类癌和胰腺内分泌肿瘤伴弥漫性、不可切除肝转移患者的预后较差。尽管使用了生长抑素类似物、α干扰素或全身化疗，姑息治疗往往仍很困难。几项综述表明，肝动脉栓塞术，无论是否联合动脉内化疗，均可用于控制症状以及减少肝转移为主的患者的肿瘤负荷。
2000年至2002年间，对84例发生肝转移的类癌或胰腺内分泌肿瘤患者进行了161次使用聚乙烯醇或微球的栓塞术。进行回顾性分析以评估症状反应、生化反应、不良反应和生存时间。还评估了基线和随访计算机断层扫描以确定影像学反应率。对生存情况进行进一步分析以评估各种栓塞后治疗的可能影响。
在研究期间，84例患者接受了单纯肝动脉栓塞术。55例有症状的患者中，44例症状减轻；35例监测肿瘤标志物的患者中，28例有主要生化反应。23例患者中有11例观察到客观影像学反应。治疗期间无死亡发生，严重毒性反应罕见。从首次栓塞时起，中位总生存期为36个月。
肝动脉栓塞术常常能使类癌或胰腺内分泌肿瘤不可切除肝转移患者产生临床和影像学反应。给予适当的支持治疗时，发病率较低。肝动脉栓塞术常常能使类癌或胰腺内分泌肿瘤不可切除肝转移患者的肿瘤缩小。
