Ruszniewski P, Rougier P, Roche A, Legmann P, Sibert A, Hochlaf S, Ychou M, Mignon M
Department of Gastroenterology, Hôpital Bichat, Paris, France.
Cancer. 1993 Apr 15;71(8):2624-30. doi: 10.1002/1097-0142(19930415)71:8<2624::aid-cncr2820710830>3.0.co;2-b.
Liver metastases of endocrine tumors are of major prognostic significance. The various therapeutic approaches have given disappointing results; however, locoregional treatment has allowed transient control of hepatic tumor growth.
Twenty-four patients with liver metastases of endocrine tumors (mainly carcinoid tumors [n = 18] and gastrinomas [n = 5]) were included in a Phase II study of hepatic arterial chemoembolization (CE). Metastases were bilateral in all patients and invaded more than 50% of the liver in 12. They were synchronous of the primary tumor in 62.5% of the patients. Seventeen patients had not responded to previous intravenous chemotherapy. CE courses were performed every 3 months using an emulsion of 10 ml of iodized oil and doxorubicin 50 mg/m2 injected into tumor vessels, followed by CE arterial occlusion with gelatin sponge particles. Seventy-one CE courses were performed in 23 patients; there was one technical failure.
Among patients with carcinoid tumors, disappearance of diarrhea and/or flushing was observed in 8 of 11. Serotonin and/or its metabolite 5-hydroxyindoleacetic acid levels decreased by more than 50% in 57% of the patients. The size of liver metastases decreased by at least 50% in 6 of 18 patients, i.e., in 33% (range, 12-54%). Two had complete responses. The median duration of the responses was 14 months (range, 6-40). Among patients with noncarcinoid tumors, minor response or stabilization occurred in three of five patients. Major side effects were bleeding peptic ulcer (one patient) and oligoanuric renal failure (one patient). Abdominal pain, fever, and increases in hepatic enzyme levels were common and transient.
These results suggest that CE is effective in patients with liver metastases of endocrine tumors, mainly in carcinoids. In the latter, CE allows control of the carcinoid syndrome and regression or stabilization of the liver tumors in 80% of patients.
内分泌肿瘤的肝转移具有重要的预后意义。各种治疗方法的效果都不尽人意；然而，局部区域治疗已能暂时控制肝肿瘤的生长。
24例内分泌肿瘤肝转移患者（主要为类癌瘤[n = 18]和胃泌素瘤[n = 5]）纳入肝动脉化疗栓塞（CE）的II期研究。所有患者的转移灶均为双侧性，12例患者的转移灶侵犯肝脏超过50%。62.5%的患者转移灶与原发肿瘤同时出现。17例患者对先前的静脉化疗无反应。每3个月进行一次CE疗程，将10 ml碘化油与50 mg/m²阿霉素的乳剂注入肿瘤血管，随后用明胶海绵颗粒进行CE动脉栓塞。23例患者共进行了71次CE疗程；有1次技术失败。
在类癌瘤患者中，11例中有8例腹泻和/或潮红消失。57%的患者血清素和/或其代谢产物5-羟吲哚乙酸水平下降超过50%。18例患者中有6例肝转移灶大小至少缩小50%，即33%（范围为12 - 54%）。2例完全缓解。缓解的中位持续时间为14个月（范围为6 - 40个月）。在非类癌瘤患者中，5例中有3例出现轻微缓解或病情稳定。主要副作用为消化性溃疡出血（1例患者）和少尿性肾衰竭（1例患者）。腹痛、发热和肝酶水平升高常见且为一过性。
这些结果表明，CE对内分泌肿瘤肝转移患者有效，主要是对类癌瘤患者。对于类癌瘤患者，CE可控制类癌综合征，并使80%的患者肝肿瘤消退或稳定。
