Clouse M E, Perry L, Stuart K, Stokes K R
Department of Radiological Sciences, Deaconess Hospital, Boston, Mass 02215.
Digestion. 1994;55 Suppl 3:92-7. doi: 10.1159/000201208.
To evaluate the effectiveness of chemoembolization of the liver with doxorubicin and iopamidol emulsified in ethiodized oil for the treatment of metastatic neuroendocrine tumors.
Twenty patients with hepatic islet cell or carcinoid metastases were treated with selected hepatic arterial embolization consisting of an emulsion of doxorubicin and iopamidol emulsified in ethiodol followed by Gelfoam powder embolization. Fifteen patients had failed intravenous chemotherapy. Two of the patients with carcinoid tumors had three embolizations over 4 and one 6 years earlier with gelatin sponge only.
In 14 patients with hormonally active tumors, hormones secretion decreased 90% (range 69-98%) in 10 days with relief of symptoms in all patients. Average tumor size decrease was 84%. Average hospital stay was 8 days. Six patients are alive and asymptomatic at 14-33 months postembolization. Fourteen patients have died 2-16 months postembolization. Ten patients died 2-37 months postembolization from progressive liver disease. One of these patients was 103 months post-Gelfoam embolization and 13 months postchemoembolization. In 8 patients, the pancreas was the primary site: 5 were nonfunctioning islet cell carcinomas, 1 glucagonoma, 1 gastrinoma and 1 carcinoid. The primary site in 1 patient with carcinoid was the bronchus, and the primary site was unknown in 1 patient with gastrinoma. The remaining 4 patients died with liver disease under control from renal failure, peritonitis, carcinoid heart failure and generalized bone metastases. The response rate was 95% with median duration of response 8.5 months. The median survival was 24 months.
Chemoembolization with doxorubicin and iopamidol emulsified in ethiodized oil is less morbid than embolization with particulate matter alone, is more convenient and less costly, and it is less morbid than the effects of systemic chemotherapy. The median survival, duration and response compare favorably with other reported therapies.
评估阿霉素与碘帕醇在乙碘油中乳化后进行肝动脉化疗栓塞术治疗转移性神经内分泌肿瘤的有效性。
20例患有肝胰岛细胞瘤或类癌转移瘤的患者接受了选择性肝动脉栓塞治疗，栓塞剂为阿霉素与碘帕醇在乙碘油中的乳剂，随后进行明胶海绵粉末栓塞。15例患者静脉化疗无效。2例类癌患者曾在4年前和6年前仅用明胶海绵进行过3次栓塞。
14例激素活性肿瘤患者中，激素分泌在10天内下降了90%（范围为69%-98%），所有患者症状均得到缓解。肿瘤平均大小缩小了84%。平均住院时间为8天。6例患者在栓塞后14至33个月存活且无症状。14例患者在栓塞后2至16个月死亡。10例患者在栓塞后2至37个月死于进行性肝病。其中1例患者在明胶海绵栓塞后103个月、化疗栓塞后13个月死亡。8例患者的原发部位为胰腺：5例为无功能性胰岛细胞瘤，1例为胰高血糖素瘤，1例为胃泌素瘤，1例为类癌。1例类癌患者的原发部位为支气管，1例胃泌素瘤患者的原发部位不明。其余4例患者死于肾衰竭、腹膜炎、类癌性心力衰竭和全身骨转移导致的肝病得到控制的情况下。缓解率为95%，中位缓解持续时间为8.5个月。中位生存期为24个月。
阿霉素与碘帕醇在乙碘油中乳化后的化疗栓塞术比单独使用颗粒物质栓塞的并发症少，更方便且成本更低，并且比全身化疗的影响并发症更少。中位生存期、缓解持续时间和缓解率与其他报道的治疗方法相比具有优势。
