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Hepatic artery embolization for control of symptoms, octreotide requirements, and tumor progression in metastatic carcinoid tumors

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Hepatic artery embolization (HAE) has been utilized for treatment of advanced hepatic carcinoid metastases, with promising symptom palliation and tumor control. Our institution employs transcatheter HAE using Lipiodol/Gelfoam for treatment of carcinoid hepatic metastases, and this report presents our experience with twenty-four patients, examining symptom control, quality-of-life, octreotide dependence, and tumor progression. Twenty-four (11 male, 13 female, mean age = 59.4 ± 2.5 yr) patients with carcinoid and unresectable hepatic metastases, confirmed by urinary 5-hydroxyindole acetic acid (5-HIAA) measurement and biopsy, were treated with Lipiodol/Gelfoam HAE from 1993–2001. Median follow-up was 35.0 months. Before HAE, 14 patients (58.3%) had malignant carcinoid syndrome, with symptoms quantified using our previously reported Carcinoid Symptom Severity Score, and 13 patients (54.2%) required octreotide for symptom palliation. Following treatment, symptom severity, octreotide dose, and tumor response were measured. Asymptomatic patients did not develop symptoms or require following treatment. Hepatic metastases remained stable (n = 4) or decreased (n = 19) in 23 patients (95.8%). Mean pretreatment Symptom Severity Scores (3.8 ± 0.2), decreased to 1.4 ± 0.1 post-treatment (P < 0.00001), with 64.3% of patients becoming asymptomatic. Mean pretreatment octreotide dosages (679.6 ± 73.0 μg/d), decreased to 262.9 ± 92.7 μg/d (P = 0.0024) post-treatment, with 46.2% of patients discontinuing octreotide. There were no treatment-related serious complications or deaths. This study demonstrates that Lipiodol/Gelfoam HAE produces excellent control of malignant carcinoid syndrome, allowing patients to decrease or eliminate use of octreotide, while controlling hepatic tumor burden.

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Authors and Affiliations

  1. Department of Surgery, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida

    Scott R. Schell M.D., Ph.D. & E. Ramsay Camp M.D.

  2. Department of Radiology, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida

    James G. Caridi M.D. & Irvin F. Hawkins Jr. M.D.

  3. Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida

    Scott R. Schell M.D., Ph.D.

  4. Department of Surgical Service, Malcolm Randall Veterans Affairs Medical Center, Gainesville, Florida

    Scott R. Schell M.D., Ph.D.

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  1. Scott R. Schell M.D., Ph.D.
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Correspondence to Scott R. Schell M.D., Ph.D..

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Schell, S.R., Camp, E.R., Caridi, J.G. et al. Hepatic artery embolization for control of symptoms, octreotide requirements, and tumor progression in metastatic carcinoid tumors. J Gastrointest Surg 6, 664–670 (2002). https://doi.org/10.1016/S1091-255X(02)00044-6

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