Eriksson B K, Larsson E G, Skogseid B M, Löfberg A M, Lörelius L E, Oberg K E
Department of Internal Medicine, Uppsala Hospital, Sweden.
Cancer. 1998 Dec 1;83(11):2293-301.
Patients with neuroendocrine gastrointestinal tumors usually present with inoperable metastatic disease and severe hormonal symptoms. Specific chemotherapy, interferon-alpha (IFN), and somatostatin analogs are established therapies for these patients, but all of them eventually fail. Hepatic arterial embolization can provide reduction of both hormonal symptoms and tumor burden in these patients.
Between 1981 and 1995, a total of 55 liver embolizations with gel foam powder were performed on 41 patients with histopathologically verified neuroendocrine tumors; 29 had carcinoid tumors and 12 had endocrine pancreatic tumors (EPTs). All patients had received medical treatment, including chemotherapy (n = 18), IFN (n = 31), and octreotide (n = 19), and were experiencing treatment failure when liver embolization was performed at a median of 37 months after diagnosis of liver metastases. Medical treatment was continued after embolization.
An overall objective response was noted in 15 of 29 patients with carcinoid tumors (52%). The median duration of effect was 12 months in patients with midgut carcinoid tumors. An overall objective response was observed in 6 of 12 patients with EPTs (50%), with a median duration of effect of 10 months. Adverse events were observed, and, in agreement with earlier reports, the rate of serious complications was 10%. Survival analyses showed a median survival of 80 months and a 5-year survival rate of 60% from the performance of embolization on patients with midgut carcinoid tumors, whereas for patients with EPTs the median survival from embolization was only 20 months.
Liver embolizations performed relatively late in the clinical course in our series appeared to be as effective as "early" embolizations in other series of patients with carcinoid tumors. The results for those with EPTs were poorer, and earlier embolizations may result in better outcomes for these patients. Considering the morbidity associated with the procedure, it is imperative to select patients according to extent of liver involvement, severity of carcinoid heart disease, and somatostatin receptor status.
神经内分泌性胃肠道肿瘤患者通常表现为无法手术切除的转移性疾病及严重的激素症状。特定化疗、α干扰素（IFN）和生长抑素类似物是针对这些患者的既定治疗方法，但最终均告失败。肝动脉栓塞可减轻这些患者的激素症状及肿瘤负荷。
1981年至1995年间，对41例经组织病理学证实为神经内分泌肿瘤的患者共进行了55次用明胶海绵粉末的肝脏栓塞术；其中29例为类癌，12例为内分泌胰腺肿瘤（EPT）。所有患者均接受过包括化疗（18例）、IFN（31例）和奥曲肽（19例）在内的药物治疗，在诊断肝转移后中位37个月进行肝脏栓塞术时均出现治疗失败。栓塞术后继续进行药物治疗。
29例类癌患者中有15例（52%）出现总体客观缓解。中肠类癌患者的中位缓解持续时间为12个月。12例EPT患者中有6例（50%）出现总体客观缓解，中位缓解持续时间为10个月。观察到有不良事件发生，且与早期报告一致，严重并发症发生率为10%。生存分析显示，中肠类癌患者自栓塞术后的中位生存期为80个月，5年生存率为60%，而EPT患者自栓塞术后的中位生存期仅为20个月。
在我们的系列研究中，临床病程相对较晚时进行的肝脏栓塞术似乎与其他类癌患者系列中的“早期”栓塞术效果相同。EPT患者的结果较差，早期栓塞术可能会使这些患者获得更好的结局。考虑到该手术相关的发病率，根据肝脏受累程度、类癌心脏病严重程度和生长抑素受体状态选择患者势在必行。
