Skip to main content

Advertisement

SpringerLink
Log in

Palliative management strategies of advanced gastrointestinal carcinoid neoplasms

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background/aims

Optimal management of gastrointestinal carcinoid neoplasms that metastasize to the liver is controversial. Although operative resection seems to be the most effective approach to metastatic disease, hepatic metastases are usually multicentric and often non-resectable. We investigated the effectiveness of several forms of palliative tumor cytoreduction followed by administration of somatostatin analogues in advanced carcinoid neoplasms.

Methods

We reviewed our experience with 34 patients with gastrointestinal carcinoid neoplasms. Eighteen patients had metastases and 14 had hormonal symptoms. Twenty-two patients underwent radical surgery, ten with multiple liver metastases were treated with a combination of debulking (resection, radiofrequency ablation, chemoembolization), followed by medical treatment with long-acting octreotide and eventually by radiolabelled somatostatin analogues, and two patients with intractable disease received only biotherapies.

Results

The six patients with metastatic disease who underwent radical curative liver resection had a median survival of 52 months, compared with a median survival of 48 months in the ten patients who underwent palliative debulking. Symptomatic improvement was observed in all the patients after debulking procedures. The two patients who underwent only medical treatment died after 9 and 18 months.

Conclusions

Aggressive tumor debulking should be performed in patients with liver metastases already at diagnosis even when complete resection is not feasible because the combination of cytoreductive procedures followed by biotherapies may provide good long-term survival and achieves symptom control in most patients with advanced disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bax NSD, Woods HF, Batchelor A, Jennings M (1996) Clinical manifestations of carcinoid disease. World J Surg 20(2):142–146

    Article  CAS  PubMed  Google Scholar 

  2. McDermott EW, Guduric B, Brennan MF (1994) Prognostic variables in patients with gastrointestinal carcinoid tumors. Br J Surg 81:1007–1009

    CAS  PubMed  Google Scholar 

  3. Norton JA, Warren RS, Kelly MG, Zuraek B, Jensen RT (2003) Aggressive surgery for metastatic liver neuroendocrine tumors. Surgery 134:1057–1065

    Article  PubMed  Google Scholar 

  4. Nave H, Mossinger E, Feist H, Lang H, Raab H-R (2001) Surgery as primary treatment in patients with liver metastases from carcinoid tumors : a retrospective, unicentric study over 13 years. Surgery 129:170–175

    Article  CAS  PubMed  Google Scholar 

  5. Que FG, Sarmiento JM, Nagorney DM (2002) Hepatic surgery for metastatic gastrointestinal endocrine tumors. Cancer Control 9(1):67–79

    PubMed  Google Scholar 

  6. Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM, Que FG (2003) Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 197:29–37

    Article  PubMed  Google Scholar 

  7. O’ Toole D, Maire F, Ruszniewki P (2003) Ablative therapies for liver metastases of digestive endocrine tumours. Endocr Relat Cancer 10:463–468

    Article  CAS  PubMed  Google Scholar 

  8. Schell SR, Ramsay Camp E, Caridi JG (2002) Hepatic artery embolization for control of symptoms, octreotide requirements and tumor progression in metastatic carcinoid tumors. J Gastrointest Surg 6:664–670

    Article  PubMed  Google Scholar 

  9. Hellmann P, Ladjevardi S, Skogseid B, Akestrom G, Elvin A (2002) Radio-frequency tissue ablation using cooled tip for liver metastases of endocrine tumors. World J Surg 26:1052–1056

    Article  PubMed  Google Scholar 

  10. Paganelli G, Zoboli S, Cremonesi M, Bodei L, Ferrari M, Grana C, Bartolomei M, Orsi F, De Cicco C, Macke HR, Chinol M, de Braud F (2001) Receptor-mediated radiotherapy with 90 Y-DOTA-d-Phe1-Tyr3-octreotide. Eur J Nucl Med 28(4):426–434

    CAS  Google Scholar 

  11. Capella C, Heitz PU, Hofler H, Solcia E, Kloppel G (1995) Revised classification of neuroendocrine tumors of the lung, pancreas and gut. Virchows Arch 425(6):547–560

    CAS  PubMed  Google Scholar 

  12. Solcia E, Kloppel G, Sobin L (2000) Histological typing of endocrine tumors. In: WHO international histological classification of tumors, 2nd edn. Springer, Berlin Heidelberg New York, pp 56–74

    Google Scholar 

  13. Bodei L, Cremonesi M, Zoboli S, Grana C, Bartolomei M, Rocca P, Caracciolo M, Macke HR, Chinol M, Paganelli G (2003) Receptor-mediated radionuclide therapy with 90Y-DOTATOC in association with aminoacidic infusion: a phase 1 study. Eur J Nucl Med 30:207–216

    CAS  Google Scholar 

  14. Solcia E, Fiocca R, Rindi G, Villani L, Cornaggia M, Capella C (1993) The pathology of the gastrointestinal endocrine system. Endocrinol Metab Clin North Am 22:795–821

    CAS  PubMed  Google Scholar 

  15. Dousset B, Saint-Marc O, Pitre J, Soubrane O, Houssin D, Chapuis Y (1996) Metastatic endocrine tumors: medical treatment, surgical resection or liver transplantation. World J Surg 20:908–915

    Article  CAS  PubMed  Google Scholar 

  16. Kress O, Wagner HJ, Wied M, Klose KJ, Arnold R, Alfke H (2003) Transarterial chemoembolization of advanced liver metastases of neuroendocrine tumors—a retrospective single-center analysis. Digestion 68(2–3):94–101

    Article  CAS  PubMed  Google Scholar 

  17. Gupta S, Yao JC, Ahrar K, Wallace MJ, Morello FA, Madoff DC, Murthy R, Hicks ME, Ajani JA (2003) Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience. Cancer J 9(4):261–267

    PubMed  Google Scholar 

  18. Roche A, Girish BV, de Baere T, Baudin E, Boige V, Elias D, Lasser P, Schlumberger M, Duceux M (2003) Trans-catheter chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol 13(1):136–140

    PubMed  Google Scholar 

  19. Berber E, Siperstein AE (2003) Laparoscopic radio-frequency ablation of neuroendocrine liver metastases. Probl Gen Surg 20(3):134–142

    Article  Google Scholar 

  20. Imam H, Eriksson B, Lukinius A, Janson ET, Lindgren PG, Wilander E, Oberg K (1997) Induction of apoptosis in neuroendocrine tumors of the digestive system during treatment with somatostatin analogues. Acta Oncol 36:607–614

    CAS  PubMed  Google Scholar 

  21. Sharma H, Patel YC, Srikant CB (1996) Subtype-selective induction of wild-type p53 and apoptosis, but not cell cycle arrest, by human somatostatin receptor 3. Mol Endocrinol 10:1688–1696

    Article  CAS  PubMed  Google Scholar 

  22. Leong WL, Pasieka JL (2002) Regression of metastatic carcinoid tumors with octreotide therapy: two case reports and review of the literature. J Surg Oncol 79:180–187

    Article  PubMed  Google Scholar 

  23. Wilander E, Bengtsson A, Norheim I, Oberg K (1986) Interferon induced nuclear DNA alteration in malignant carcinoid tumours in vivo. J Natl Cancer Inst 76:429–433

    CAS  PubMed  Google Scholar 

  24. Andersson T, Wilander E, Eriksson B, Lindgren PG, Oberg K (1990) Effects of interferons on tumor tissue content in liver metastases of carcinoid tumors. Cancer Res 50:3413

    CAS  PubMed  Google Scholar 

  25. Oberg K, Eriksson B, Janson ET (1994) The clinical use of interferons in the management of neuroendocrine gastroenteropancreatic tumors. Ann N Y Acad Sci 733:471–478

    Google Scholar 

  26. Tiensuu-Janson EM, Ahlstrom H, Andersson T, Oberg K (1992) Octreotide and interferon-alpha: a new combination for the treatment of malignant carcinoid tumours. Eur J Cancer 28:1647–1650

    Article  Google Scholar 

  27. Janson ET, Oberg K (1993) Long-term management of carcinoid syndrome. Treatment with octreotide alone and in combination with alpha interferon. Acta Oncol 32:225–229

    Google Scholar 

  28. Nold R, Frank K, Kajdan U, Trost U, Klose KJ, Arnold R (1994) Combined treatment of metastatic endocrine tumors of gastrointestinal tract with octreotide and interferon-alpha. Z Gastroenterol 32:193–197

    Google Scholar 

  29. Kaidan U, Frank K, Elhenz K, Arnold R (1995) Effect of alpha-interferon plus octreotide on metastasized gastrointestinal endocrine tumours. Gut 37(2):A255–A256. Abstract 2283

    Google Scholar 

  30. Chung MH, Pisegna J, Spirt M, Giuliano AE, Ye W, Ramming KP, Bilchik AJ (2001) Hepatic cytoreduction followed by a novel long-acting somatostatin analog: a paradigm for intractable neuroendocrine tumors metastatic to the liver. Surgery 130:954–962

    Article  CAS  PubMed  Google Scholar 

  31. Mukherjee JJ, Kaltsas GA, Islam N, Plowman PN, Foley R, Hikmat J, Britton KE, Jenkins PJ, Chew SL, Monson JP, Besser GM, Grossman AB (2001) Treatment of metastatic carcinoid tumours, phaeochromocytoma, paraganglioma and medullary carcinoma of the thyroid with 131I-meta-iodobenzylguanidine (131I-mIBG). Clin Endocrinol 55:47–60

    Article  CAS  Google Scholar 

  32. Hoefnagel CA (1994) Meta-iodobenzylguanidine and somatostatin in oncology: role in the management of neural crest tumours. Eur J Nucl Med 21:561–581

    CAS  PubMed  Google Scholar 

  33. Taal BG, Hoefnagel CA, Valdes Olmos RA, Boot H, Beijnen JH (1996) Palliative effect of metaiodobenzylguanidine in metastatic carcinoid tumours. J Clin Oncol 14:1829–1838

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy

    Paola Sartori, Chiara Mussi, Carlo Angelini, Stefano Crippa, Roberto Caprotti & Franco Uggeri

  2. Via Lepontina 1, 20159, Milan, Italy

    Chiara Mussi

Authors
  1. Paola Sartori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiara Mussi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carlo Angelini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefano Crippa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Caprotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Franco Uggeri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chiara Mussi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sartori, P., Mussi, C., Angelini, C. et al. Palliative management strategies of advanced gastrointestinal carcinoid neoplasms. Langenbecks Arch Surg 390, 391–396 (2005). https://doi.org/10.1007/s00423-005-0559-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-005-0559-2

Keywords

Search

Navigation