Skip to main content
SpringerLink
Log in

Hepatic Arterial Embolization and Chemoembolization in the Management of Patients with Large-Volume Liver Metastases

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

The purpose of this study was to assess the role of hepatic arterial embolization (HAE) and chemoembolization (HACE) in patients with large-volume liver metastases. Patients with metastatic neuroendocrine tumors, melanomas, or gastrointestinal stromal tumors (GISTs) with >75% liver involvement who underwent HAE or HACE were included in the study. Radiologic response, progression-free survival (PFS), overall survival (OS), and postprocedure complications were assessed. Sixty patients underwent 123 treatment sessions. Of the 48 patients for whom follow-up imaging was available, partial response was seen in 12 (25%) patients, minimal response in 6 (12%), stable disease in 22 (46%), and progressive disease in 8 (17%). Median OS and PFS were 9.3 and 4.9 months, respectively. Treatment resulted in radiologic response or disease stabilization in 82% and symptomatic response in 65% of patients with neuroendocrine tumors. Patients with neuroendocrine tumors had higher response rates (44% vs. 27% and 0%; p = 0.31) and longer PFS (9.2 vs. 2.0 and 2.3 months; p < 0.0001) and OS (17.9 vs. 2.4 and 2.3 months; p < 0.0001) compared to patients with melanomas and GISTs. Major complications occurred in 21 patients after 23 (19%) of the 123 sessions. Nine of the 12 patients who developed major complications resulting in death had additional risk factors—carcinoid heart disease, sepsis, rapidly worsening performance status, or anasarca. In conclusion, in patients with neuroendocrine tumors with >75% liver involvement, HAE/HACE resulted in symptom palliation and radiologic response or disease stabilization in the majority of patients. Patients with hepatic metastases from melanomas and GISTs, however, did not show any appreciable benefit from this procedure. Patients with massive liver tumor burden, who have additional risk factors, should not be subjected to HAE/HACE because of the high risk of procedure-related mortality.

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. Carrasco CH, Chuang VP, Wallace S (1983) Apudomas metastatic to the liver: treatment by hepatic artery embolization. Radiology 149:79–83

    PubMed  CAS  Google Scholar 

  2. Ajani J, Humberto C, Wallace S (1994) Neuroendocrine tumors metastatic to the liver: vascular occlusion therapy. Ann NY Acad Sci 733:479–487

    Article  PubMed  CAS  Google Scholar 

  3. Dominguez S, Denys A, Menu Y, Ruszniewski P (1999) Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumours. Ital J Gastroenterol Hepatol 31(Suppl 2):S213–S215

    PubMed  Google Scholar 

  4. Eriksson BK, Larsson EG, Skogseid BM, Lofberg AM, Lorelius LE, Oberg KE (1998) Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 83:2293–2301

    Article  PubMed  CAS  Google Scholar 

  5. Gupta S, Yao JC, Ahrar K, et al. (2003) Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M. D. Anderson experience. Cancer J 9:261–267

    Article  PubMed  Google Scholar 

  6. Gupta S, Johnson MM, Murthy R, et al. (2005) Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors: variables affecting response rates and survival. Cancer 104:1590–1602

    Article  PubMed  Google Scholar 

  7. Hajarizadeh H, Ivancev K, Mueller CR, Fletcher WS, Woltering EA (1992) Effective palliative treatment of metastatic carcinoid tumors with intra-arterial chemotherapy/chemoembolization combined with octreotide acetate. Am J Surg 163:479–483

    Article  PubMed  CAS  Google Scholar 

  8. Perry LJ, Stuart K, Stokes KR, Clouse ME (1994) Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Surgery 116:1111–1116, discussion 1116–1117

    PubMed  CAS  Google Scholar 

  9. Therasse E, Breittmayer F, Roche A, et al. (1993) Transcatheter chemoembolization of progressive carcinoid liver metastasis. Radiology 189:541–547

    PubMed  CAS  Google Scholar 

  10. Roche A, Girish BV, de Baere T, et al. (2004) Prognostic factors for chemoembolization in liver metastasis from endocrine tumors. Hepatogastroenterology 51:1751–1756

    PubMed  CAS  Google Scholar 

  11. Roche A, Girish BV, de Baere T, et al. (2003) Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol 13:136–140

    PubMed  Google Scholar 

  12. Moertel CG, Johnson CM, McKusick MA, et al. (1994) The management of patients with advanced carcinoid tumors and islet cell carcinomas. Ann Intern Med 120:302–309

    PubMed  CAS  Google Scholar 

  13. Bedikian AY, Legha SS, Mavligit G, et al. (1995) Treatment of uveal melanoma metastatic to the liver: a review of the M. D. Anderson Cancer Center experience and prognostic factors. Cancer 76:1665–1670

    Article  PubMed  CAS  Google Scholar 

  14. Kobayashi K, Gupta S, Trent JC, et al. (2006) Hepatic artery chemoembolization for 110 gastrointestinal stromal tumors: response, survival, and prognostic factors. Cancer 107:2833–2841

    Article  PubMed  Google Scholar 

  15. Mavligit GM, Pollock RE, Evans HL, Wallace S (1993) Durable hepatic tumor regression after arterial chemoembolization-infusion in patients with islet cell carcinoma of the pancreas metastatic to the liver. Cancer 72:375–380

    Article  PubMed  CAS  Google Scholar 

  16. Patel K, Sullivan K, Berd D, et al. (2005) Chemoembolization of the hepatic artery with BCNU for metastatic uveal melanoma: results of a phase II study. Melanoma Res 15:297–304

    Article  PubMed  Google Scholar 

  17. Touzios JG, Kiely JM, Pitt SC, et al. (2005) Neuroendocrine hepatic metastases: Does aggressive management improve survival? Ann Surg 241:776–783, discussion 783–775

    Article  PubMed  Google Scholar 

  18. Chamberlain RS, Canes D, Brown KT, et al. (2000) Hepatic neuroendocrine metastases: Does intervention alter outcomes? J Am Coll Surg 190:432–445

    Article  PubMed  CAS  Google Scholar 

  19. Gates J, Hartnell GG, Stuart KE, Clouse ME (1999) Chemoembolization of hepatic neoplasms: safety, complications, and when to worry. Radiographics 19:399–414

    PubMed  CAS  Google Scholar 

  20. Ramsey DE, Kernagis LY, Soulen MC, Geschwind JF (2002) Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol 13:S211–S221

    Article  PubMed  Google Scholar 

  21. Dodd GD, 3rd, Soulen MC, Kane RA, et al. (2000) Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough. Radiographics 20:9–27

    PubMed  Google Scholar 

  22. 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 68:94–101

    Article  PubMed  CAS  Google Scholar 

  23. Carrasco CH, Charnsangavej C, Ajani J, Samaan NA, Richli W, Wallace S (1986) The carcinoid syndrome: palliation by hepatic artery embolization. AJR 147:149–154

    PubMed  CAS  Google Scholar 

  24. Kim YH, Ajani JA, Carrasco CH, et al. (1999) Selective hepatic arterial chemoembolization for liver metastases in patients with carcinoid tumor or islet cell carcinoma. Cancer Invest 17:474–478

    PubMed  CAS  Google Scholar 

  25. Tellez C, Benson AB 3rd, Lyster MT, et al. (1998) Phase II trial of chemoembolization for the treatment of metastatic colorectal carcinoma to the liver and review of the literature. Cancer 82:1250–1259

    Article  PubMed  CAS  Google Scholar 

  26. Brown KT, Koh BY, Brody LA, et al. (1999) Particle embolization of hepatic neuroendocrine metastases for control of pain and hormonal symptoms. J Vasc Interv Radiol 10:397–403

    Article  PubMed  CAS  Google Scholar 

  27. Loewe C, Schindl M, Cejna M, Niederle B, Lammer J, Thurnher S (2003) Permanent transarterial embolization of neuroendocrine metastases of the liver using cyanoacrylate and lipiodol: assessment of mid- and long-term results. AJR 180:1379–1384

    PubMed  Google Scholar 

  28. Charnsangavej C (1993) Chemoembolization of liver tumors. Semin Invest Radiol 10:150–160

    Article  Google Scholar 

  29. Sanz-Altamira PM, Spence LD, Huberman MS, et al. (1997) Selective chemoembolization in the management of hepatic metastases in refractory colorectal carcinoma: a phase II trial. Dis Colon Rectum 40:770–775

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA

    Paresh P. Kamat, Sanjay Gupta, Ravi Murthy, Kamran Ahrar, David C. Madoff, Michael J. Wallace & Marshall E. Hicks

  2. Division of Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA

    Joe E. Ensor

  3. Department of Diagnostic Radiology, Interventional Radiology Section, Unit 325, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA

    Sanjay Gupta

Authors
  1. Paresh P. Kamat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanjay Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joe E. Ensor
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ravi Murthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kamran Ahrar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David C. Madoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael J. Wallace
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marshall E. Hicks
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sanjay Gupta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kamat, P.P., Gupta, S., Ensor, J.E. et al. Hepatic Arterial Embolization and Chemoembolization in the Management of Patients with Large-Volume Liver Metastases. Cardiovasc Intervent Radiol 31, 299–307 (2008). https://doi.org/10.1007/s00270-007-9186-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-007-9186-3

Keywords

Search

Navigation