Hepatic artery chemoembolization for the treatment of liver metastases from neuroendocrine tumors: a long-term follow-up in 123 patients

Med Oncol. 2011 Dec;28 Suppl 1:S286-90. doi: 10.1007/s12032-010-9750-6. Epub 2010 Nov 24.

Abstract

Neuroendocrine tumors (NETs) of the gastrointestinal tract have a propensity for hepatic metastases. Surgical resection for hepatic metastases remains the gold standard for long-term survival, but many patients present with multifocal tumors, precluding surgery with increasing use of chemoembolization. However, there are few studies examining long-term survival factors. We reviewed our 15-year experience with chemoembolization in 123 patients with unresectable NET liver metastases, whose prognosis was evaluated upon baseline clinical factors. There were 64 males (53%) and 59 females (47%). Average age at presentation was 56 years (range: 14.3-85.5 years). Abdominal pain (44%) was the most common presenting symptom, followed by diarrhea (30%) and weight lost (22%). Patients underwent an average 7.3 cycles of chemoembolization (range 1-32 cycles). Responses: 62% of patients had PR; 24% had stable disease and 14% had tumor progression. Overall 3-, 5- and 10-year survivals were 59, 36 and 20% of patients with a mean follow-up of 3.2 years (range 2 weeks-18.3 years) and mean survival of 3.3 years. Univariate analysis showed that age greater than 60 years had worse outcome (P < 0.01), as did baseline serum albumin of ≤ 3.5 g/dL and prothrombin time >13 s. Location of the primary tumor (P = 0.68), gender (P = 0.4) and serum NET peptide levels did not influence survival. However, multivariate analysis showed that a low baseline serum albumin level was an independent factor for prognosis (P = 0.003). Chemoembolization for unresectable NETs metastatic to liver is useful for tumor size reduction, symptom palliation and can be associated with prolonged survival.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Chemoembolization, Therapeutic / methods*
  • Cohort Studies
  • Doxorubicin / administration & dosage*
  • Female
  • Follow-Up Studies
  • Hepatic Artery*
  • Humans
  • Liver Neoplasms / mortality
  • Liver Neoplasms / secondary
  • Liver Neoplasms / therapy*
  • Male
  • Middle Aged
  • Neuroendocrine Tumors / mortality
  • Neuroendocrine Tumors / pathology*
  • Retrospective Studies
  • Streptozocin / administration & dosage*
  • Survival Rate
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Streptozocin
  • Doxorubicin