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.