Treatment of Carcinoid Liver Metastases by Hepatic-Artery Embolisation

Allison, David J.; Modlin, Irvin M.; Wj, Jenkins

doi:10.1016/s0140-6736(77)90369-5

Cited by 96 publications

(30 citation statements)

References 4 publications

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“…Embolization has provided tumour regression and symptomatic control in approximately 50% of carcinoid patients during median 7-14 months, and with resulting reduced need of somatostatin analogues and improved effects of interferon treatment [1,5,9,10,[28][29][30].…”

Section: Liver Embolizationmentioning

confidence: 99%

Management of midgut carcinoids

Åkerström

Hellman

Hessman

et al. 2005

Journal of Surgical Oncology

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Midgut carcinoids developing in the small intestine represent the most common cause of the carcinoid syndrome, with severe symptoms of flush, diarrhoea, and fibrotic valvular heart disease. The tumours may be histologically identified with specific chromogranin A or synaptophysine immunostainings, and by serotonin reactivity, which supports a midgut origin. Urinary 5-HIAA excretion and serum chromogranin A measurements are used as biochemical tumour markers for clinical diagnosis, and as important monitors of treatment effects and prognostic predictors. The midgut carcinoids have typically slow proliferation and extended disease course, and surgical treatment has become increasingly important for their management. Surgery should aim to remove primary tumours and mesenteric metastases, which may cause long-term abdominal complications, by typical fibrotic intestinal entrapment and small bowel ischaemia due to encasement of mesenteric vessels. Attempts should also be made to surgically remove or ablate liver metastases, since this may significantly contribute to palliation of the carcinoid syndrome. In patients with this syndrome surgery is combined with continuous biotherapy with long-acting somatostatin analogues and interferon, which may alleviate symptoms and cause stable disease with slow progression. Favourable survival and life-quality can be expected with this treatment also in patients with advanced midgut carcinoids.

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Section: Liver Embolizationmentioning

confidence: 99%

Management of midgut carcinoids

Åkerström

Hellman

Hessman

et al. 2005

Journal of Surgical Oncology

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“…Hepatic arterial embolization using a percutaneous Seldinger technique under radiological control was developed for metastatic GEP tumors in the early 1970s [20]. Firstly, catheterization of the hepatic artery is performed to obtain a hepatic arteriogram which allows the definition of tumor vascularization.…”

Section: Vascular Occlusive Strategiesmentioning

confidence: 99%

Ablative Therapies for Liver Metastases of Gastroenteropancreatic Endocrine Tumors

Ruszniewski

O’Toole²

2004

Neuroendocrinology

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Hepatic metastases are frequent in patients with gastroenteropancreatic (GEP) endocrine tumors. The presence of hepatic metastases affects overall prognosis and quality of life especially in the presence of debilitating functional syndromes. Surgery, although the method of choice for hepatic metastases, is usually impossible due to disease extent. Results of systemic chemotherapy are also disappointing especially in patients with metastases from midgut GEP tumors. These latter patients usually have carcinoid syndrome which can be controlled by somatostatin analogues. Other therapeutic options in the treatment of highly vascular liver metastases from GEP tumors are locoregional strategies by inducing vascular occlusion resulting in ischemia and necrosis of tumoral tissue. Surgical ligation of the hepatic artery or transient hepatic ischemia has been replaced by transcatheter arterial chemoembolization (TACE). TACE has proven effective in controlling symptoms and gives objective tumor response in about half of patients. Other regional destructive methods, used either alone or in combination with surgery, include radiofrequency ablation and cryotherapy. The latter strategies are poorly evaluated to date and are usually adjuncts to surgery and reserved for limited disease.

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“…Hepatic arterial embolization using a percutaneous Seldinger technique under radiological control was developed for metastatic endocrine tumors in the early 1970s (Allison et al 1977). Following catheterization of the hepatic artery, an hepatic arteriogram was obtained demonstrating anatomic hepatic arterialization, tumor vascularization followed by careful appraisal for portal vein patency.…”

Section: Sequential Hepatic Artery Embolizationmentioning

confidence: 99%

Ablative therapies for liver metastases of digestive endocrine tumours.

O’Toole¹,

Maire²,

Ruszniewski³

2003

Endocrine-Related Cancer

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Hepatic metastases are frequently encountered in patients with digestive endocrine tumors and their presence plays an important role in quality of life and overall prognosis. Surgery is the treatment method of choice for hepatic metastases but this is frequently impossible due to the extent of disease. Systemic chemotherapy is offered to patients with diffuse and/or progressive liver metastases but results are disappointing especially in patients with metastases of midgut origin. In the latter patients with carcinoid syndrome, somatostatin analogs are frequently initially effective but their efficacy wanes due to disease progression and development of tachyphylaxis. Other therapeutic options in the treatment of hepatic metastases are locoregional strategies where vascular occlusion induces ischemia in these highly vascular tumors using either surgical or radiological techniques. Available methods include surgical ligation of the hepatic artery, transient hepatic ischemia or sequential hepatic arterialization. Trans-catheter arterial chemoembolization has proven effective in terms of long palliation and objective tumor responses. Other treatments aimed at regional destruction either alone or in combination with surgery include radiofrequency ablation and cryotherapy. The latter are usually important adjuncts to surgery and are usually reserved for limited disease.

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Treatment of Carcinoid Liver Metastases by Hepatic-Artery Embolisation

Cited by 96 publications

References 4 publications

Management of midgut carcinoids

Management of midgut carcinoids

Ablative Therapies for Liver Metastases of Gastroenteropancreatic Endocrine Tumors

Ablative therapies for liver metastases of digestive endocrine tumours.

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