de Baere Thierry, Deschamps Frederic, Teriitheau Christophe, Rao Pramod, Conengrapht Kenneth, Schlumberger Martin, Leboulleux Sophie, Baudin Eric, Hechellhammer Lukas
Department of Interventional Radiology, Institut Gustave Roussy, Rue Camille Desmoulins, Villejuif 94805, France.
J Vasc Interv Radiol. 2008 Jun;19(6):855-61. doi: 10.1016/j.jvir.2008.01.030. Epub 2008 Mar 19.
To evaluate the feasibility, safety, and efficacy of transarterial chemoembolization (TACE) of progressive liver metastases from well differentiated gastroenteropancreatic endocrine (GEP) tumors with drug-eluting beads (DEBs).
From June 2004 to July 2005, eight men and 12 women aged 34 to 75 years (mean +/- SD, 59 y +/- 12), including 13 patients with bilobar disease and seven with unilobar disease, underwent 34 sessions of TACE with DEBs (500-700 mum) loaded with doxorubicin. Morphologic response was evaluated with computed tomography (CT) at 1 and 3 months according to Response Evaluation Criteria In Solid Tumors. Clinical and laboratory data were also assessed.
The complete dose of 4 mL of DEBs loaded with 100 mg doxorubicin was injected during 22 TACE sessions and 1-3.5 mL of DEBs was injected during 12 TACE sessions. Three months after TACE, 16 of 20 patients (80%) exhibited a partial response, three (15%) had stable disease, and one (5%) had progressive disease. The mean size of the largest metastasis in each patient decreased from 42 mm +/- 24 before treatment (median, 39.5 mm) to 33 mm +/- 23 (median, 29 mm) 1 month after treatment and 30 mm +/- 21 (median, 26.5 mm) 3 months after treatment. After a median follow-up of 15 months (range, 6-24 months), nine patients' disease remained controlled without tumor progression and 10 patients had progressive disease. The median time to progression was 15 months. Postembolization syndrome lasted less than 7 days in 23 sessions (67%) and more than 7 days in seven sessions (22%), and no symptoms at all were observed in four sessions (11%). Peak aspartate aminotransferase, alanine aminotransferase, and bilirubin levels after TACE were 35-490 IU (mean, 125 IU +/- 77; normal, <35 IU), 20-440 IU (mean, 149 IU +/- 155; normal, <45 IU), and 8-90 mol/L (mean, 26 IU +/- 25; normal, <17 IU), respectively, at 2-3 days. In five patients, follow-up CT at 1 month revealed TACE-induced peripheral liver necrosis.
TACE with DEBs is well tolerated and appears effective. A comparative study with a standard TACE or transarterial embolization regimen is warranted to define the best protocol for transarterial treatment of GEP liver metastases.
评估经动脉化疗栓塞术（TACE）联合载药微球（DEB）治疗高分化胃肠胰内分泌（GEP）肿瘤所致进展性肝转移瘤的可行性、安全性及疗效。
2004年6月至2005年7月，8例男性和12例女性，年龄34至75岁（平均±标准差，59岁±12岁），其中13例为双侧病变，7例为单侧病变，接受了34次TACE联合载有阿霉素的DEB（500 - 700μm）治疗。根据实体瘤疗效评价标准，于1个月和3个月时用计算机断层扫描（CT）评估形态学反应。同时评估临床和实验室数据。
22次TACE治疗中注入了4mL载有100mg阿霉素的DEB全量，12次TACE治疗中注入了1 - 3.5mL DEB。TACE术后3个月，20例患者中有16例（80%）出现部分缓解，3例（15%）病情稳定，1例（5%）病情进展。每位患者最大转移灶的平均大小从治疗前的42mm±24（中位数，39.5mm）降至治疗后1个月的33mm±23（中位数，29mm）及治疗后3个月的30mm±21（中位数，26.5mm）。中位随访15个月（范围6 - 24个月）后，9例患者病情得到控制，无肿瘤进展，10例患者病情进展。中位进展时间为15个月。栓塞后综合征在23次治疗（67%）中持续时间少于7天，7次治疗（22%）中持续时间超过7天，4次治疗（11%）中未观察到任何症状。TACE术后2 - 3天，天冬氨酸转氨酶、丙氨酸转氨酶和胆红素峰值分别为35 - 490IU（平均，125IU±77；正常，<35IU）、20 - 440IU（平均，149IU±155；正常，<45IU）和8 - 90μmol/L（平均，26IU±25；正常，<17IU）。5例患者1个月时的随访CT显示TACE引起肝周边坏死。
TACE联合DEB耐受性良好且似乎有效。有必要与标准TACE或经动脉栓塞方案进行对比研究，以确定GEP肝转移瘤经动脉治疗的最佳方案。
