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Embolisation therapy in the midgut carcinoid syndrome: just tumour ischaemia?

Artikel i vetenskaplig tidskrift
Författare Bo Wängberg
K Geterud
Ola Nilsson
Svante Jansson
A Dahlström
Ulf Tylén
Håkan Ahlman
Publicerad i Acta oncologica (Stockholm, Sweden)
Volym 32
Nummer/häfte 2
Sidor 251-6
ISSN 0284-186X
Publiceringsår 1993
Publicerad vid Institutionen för de kirurgiska disciplinerna, Avdelningen för kirurgi
Institutionen för särskilda specialiteter, Avdelningen för radiologi
Sidor 251-6
Språk en
Länkar www.ncbi.nlm.nih.gov/entrez/query.f...
Ämnesord Adult, Aged, Combined Modality Therapy, Embolization, Therapeutic, Female, Hepatic Artery, Humans, Hydroxyindoleacetic Acid, urine, Intestinal Neoplasms, pathology, therapy, Ischemia, etiology, Liver Neoplasms, blood supply, secondary, therapy, Male, Malignant Carcinoid Syndrome, pathology, therapy, Middle Aged, Octreotide, therapeutic use, Prognosis
Ämneskategorier Gastroenterologi, Kirurgi

Sammanfattning

Forty-eight patients with midgut carcinoid tumours and disseminated disease were treated at our unit 1986-1991. All patients underwent primary surgery with optimal tumour reduction. Twenty-seven patients with bilobar liver metastases had subsequent embolizations of the hepatic arteries to further reduce the functional tumour mass and were thereafter treated with a low dose of octreotide. The response to this treatment was evaluated by CT at 3 months postembolization. The patients could then be divided into 13 responders (no visible hepatic tumours or more than 50% reduction, group I) and 14 non-responders (less than 50 reduction or progression, group II). When these patients were studied biochemically and in terms of prognosis, the reduction of 5-HIAA levels postembolization was much more pronounced in group I (80 +/- 3%) then in group II (28 +/- 12%). The biochemical and radiological responses were long-lasting in group I, none of the patients needed further ischaemic treatment. Of specific interest were 3 patients with bilobar disease, who after selective unilobar embolisation normalised their 5-HIAA levels and had bilateral tumour regression. These findings indicate involvement of systemic effects in addition to tumour ischaemia alone. The initial biochemical response with marked decrease of 5-HIAA levels in combination with tumour regression may thus serve as an indicator of good prognosis.

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