How is chemoem bolization used to treat metastatic carcinoid syndrome?

How is chemoem bolization used to treat metastatic carcinoid syndrome?

Selective hepatic artery chemoembolization has been used in patients with liver metastases from carcinoid syn-drome for years. It provides palliation of symptoms from hormone-releasing tumors. Embolization-induced tumor ischemia improves the quality of life. The most promising chemotherapeutic agents to date include cisplatinum and doxorubicin. However, 5-fluorouracil (5-FU), mitomycin C, and adriamycin have been used in combination as well.

A   recent study by Douglas          et al.  (1998) treated patients with intra-arterial chemotherapy. Patients received 5 days of intra-arterial 5-FU 1 g/m² followed by adriamycin 60 mg/m², cisplatinum 100 mg, mitomycin C mg, and polyvinyl alcohol (Invalim) 200–710 μm. Patients were given octreotide 150–2000 μg subcutaneously every 8 hours before, during, and after the procedure. Symptoms improved in 8 of 12 patients with diarrhea, in 9 of 12 patients with abdominal pain, in 7 of 12 patients with cutaneous flushing, and in 4 of 7 patients with malaise. Biochemical markers were followed up at 3 months. Improvement occurred in 60% for 5-HIAA levels, 75% for chromogranin A, and 50% for neuron nonspecific enolase titers. Follow-up was at 16 months with 13 deaths occur-ring from 1 week to 71 months after treatment. As for survival, chemoembolization with chemotherapy improved short-term quality of life and not long-term survival in patients with advanced hepatic carcinoid disease.