Winkelbauer F W, Niederle B, Pietschmann F, Thurnher S, Wildling R, Prokesch R, Lammer J
Department of Radiology, University of Vienna, Austria.
AJR Am J Roentgenol. 1995 Aug;165(2):323-7. doi: 10.2214/ajr.165.2.7542430.
Transcatheter embolization of the hepatic arterial supply is a well-known palliative treatment of tumor deposits in the liver. We performed a prospective study to evaluate the use of a mixture of N-butyl-2-cyanoacrylate and ethiodized oil with which a permanent vascular occlusion can be obtained, as an embolizing agent for transcatheter hepatic artery embolization for treatment of carcinoid hepatic metastases.
Six patients had clinical symptoms from hormonal release by carcinoid hepatic metastases as well as elevated levels of 5-hydroxyindole acetic acid (5-HIAA) in the urine. Unilobar sequential transcatheter embolization of both the hepatic artery and the segmental hepatic arteries of both lobes of the liver was performed with a mixture of N-butyl-2-cyanoacrylate and ethiodized oil. CT and CT arterial portography (CTAP) were done to assess hepatic metastases and were used to monitor follow-up. Each patient had three CTAP studies; the third CTAP, performed 3 months after complete arterial devascularization, was compared with the first CTAP to evaluate tumor size. CT studies were performed routinely every 3 months thereafter and were compared with the initial CT scan to evaluate further tumor regression or progression. Tumor decrease and biochemical and symptomatic response rates were defined according to World Health Organization criteria. All complications and side effects of the treatment were documented.
All patients showed complete symptomatic relief after embolization. The previously elevated levels of 5-HIAA in the urine returned to normal in three patients and in the other three patients were reduced by a mean of 89% of preembolization values. A decrease in tumor size by more than 50% was demonstrable in one patient; in five patients, hepatic lesions decreased in size by 25-50%. No new sites of metastatic liver disease were demonstrable in any patient during follow-up. No deaths or serious complications were directly attributable to the embolization procedure. All patients are alive after 12, 17, 18, 19, 19, and 19 months (mean, 17.3 months), respectively, with permanent relief of symptoms so far.
Transcatheter embolization of both the hepatic artery and the segmental hepatic arteries with a mixture of N-butyl-2-cyanoacrylate and ethiodized oil provided excellent palliation in patients with carcinoid hepatic metastases. Complete and long-lasting relief of symptoms, a significant decrease or normalization of levels of 5-HIAA in the urine, and a reduction of metastatic tumor in the liver seem most likely to be the effect of sustained ischemia obtained with this permanent embolizing agent.
经导管肝动脉栓塞术是一种治疗肝脏肿瘤转移灶的姑息性治疗方法。我们进行了一项前瞻性研究，以评估使用正丁基-2-氰基丙烯酸酯与乙碘油的混合物作为经导管肝动脉栓塞术的栓塞剂治疗类癌肝转移，该混合物可实现永久性血管闭塞。
6例患者因类癌肝转移导致激素释放出现临床症状，且尿中5-羟吲哚乙酸（5-HIAA）水平升高。采用正丁基-2-氰基丙烯酸酯与乙碘油的混合物对肝动脉及肝脏两叶的节段性肝动脉进行单叶序贯经导管栓塞。行CT及CT动脉门静脉造影（CTAP）以评估肝转移情况并用于随访监测。每位患者进行3次CTAP检查；在完全动脉去血管化3个月后进行的第三次CTAP与第一次CTAP进行比较以评估肿瘤大小。此后每3个月常规进行CT检查，并与初始CT扫描进行比较以评估肿瘤进一步的消退或进展情况。根据世界卫生组织标准定义肿瘤缩小以及生化和症状缓解率。记录治疗的所有并发症和副作用。
所有患者栓塞后症状均完全缓解。3例患者尿中先前升高的5-HIAA水平恢复正常，另外3例患者的5-HIAA水平平均降低至栓塞前值的89%。1例患者肿瘤大小缩小超过50%；5例患者肝脏病变大小缩小25%-50%。随访期间所有患者均未发现新的肝转移灶。无死亡或严重并发症直接归因于栓塞操作。所有患者分别在12、17、18、19、19和19个月（平均17.3个月）后仍存活，症状得到永久性缓解。
使用正丁基-2-氰基丙烯酸酯与乙碘油的混合物对肝动脉及节段性肝动脉进行经导管栓塞，可为类癌肝转移患者提供良好的姑息治疗效果。症状完全且持久缓解、尿中5-HIAA水平显著降低或恢复正常以及肝脏转移瘤缩小，似乎最有可能是这种永久性栓塞剂导致持续缺血的结果。
