Transarterial Chemoembolization of liver Metastases from well differentiated gastroenteropancreatic endocrine tumors with doxorubicin-eluting beads: Preliminary results
Transarterial Chemoembolization of liver Metastases from well differentiated gastroenteropancreatic endocrine tumors with doxorubicin-eluting beads: Preliminary results
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DOI：
10.1016/j.jvir.2008.01.030
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发表时间：
2008-06-01
影响因子：
2.9
通讯作者：
Hechellhammer, Lukas
中科院分区：
文献类型：
--
作者：
de Baere, Thierry;Deschamps, Frederic;Hechellhammer, Lukas
目的：评价经动脉化疗栓塞（TACE）治疗分化良好的胃肠胰内分泌（GEP）肿瘤进展性肝转移瘤的可行性、安全性和有效性。材料与方法：2004年6月至2005年7月，8名男性和12名女性，年龄34 - 75岁（平均+/- SD， 59 y +/- 12），包括13名双叶疾病患者和7名单叶疾病患者，接受了34次TACE， DEBs （500-700 μ m）加载阿霉素。根据实体瘤反应评价标准，在1个月和3个月用计算机断层扫描（CT）评估形态学反应。临床和实验室数据也进行了评估。结果：在22个TACE疗程中注射了满载100 mg阿霉素的deb，总剂量为4 mL，在12个TACE疗程中注射了1-3.5 mL的deb。TACE治疗3个月后，20例患者中有16例（80%）表现出部分缓解，3例（15%）病情稳定，1例（5%）病情进展。每位患者最大转移灶的平均大小从治疗前的42 mm 24（中位数，39.5 mm）减少到治疗后1个月的33 mm 23（中位数，29 mm）和治疗后3个月的30 mm +/- 21（中位数，26.5 mm）。中位随访15个月（范围6-24个月）后，9例患者病情得到控制，无肿瘤进展，10例患者病情进展。中位进展时间为15个月。栓塞后综合征持续时间少于7天的有23次（67%），超过7天的有7次（22%），4次（11%）未观察到任何症状。TACE后的峰值天冬氨酸转氨酶、丙氨酸转氨酶和胆红素水平分别为35-490 IU（平均125 IU 77，正常，< 35 IU）、20-440 IU（平均149 IU 155，正常，< 45 IU）和8-90 mol/L（平均26 IU 25，正常，< 17 IU），时间为2-3天。5例患者随访1个月CT显示tace诱导的周围性肝坏死。结论：TACE与DEBs的耐受性良好，似乎有效。通过与标准TACE或经动脉栓塞方案的比较研究，确定经动脉治疗GEP肝转移的最佳方案是必要的。
PURPOSE: To evaluate the feasibility, safety, and efficacy of transarterial chemoembolization (TACE) of progressive liver metastases from well differentiated gastroenteropancreatic endocrine (GEP) tumors with drug-eluting beads (DEBs).MATERIALS AND METHODS: From June 2004 to July 2005, eight men and 12 women aged 34 to 75 years (mean +/- SD, 59 y +/- 12), including 13 patients with bilobar disease and seven with unilobar disease, underwent 34 sessions of TACE with DEBs (500-700 mu m) loaded with doxorubicin. Morphologic response was evaluated with computed tomography (CT) at 1 and 3 months according to Response Evaluation Criteria In Solid Tumors. Clinical and laboratory data were also assessed.RESULTS: The complete dose of 4 mL of DEBs loaded with 100 mg doxorubicin was injected during 22 TACE sessions and 1-3.5 mL of DEBs was injected during 12 TACE sessions. Three months after TACE, 16 of 20 patients (80%) exhibited a partial response, three (15%) had stable disease, and one (5%) had progressive disease. The mean size of the largest metastasis in each patient decreased from 42 mm 24 before treatment (median, 39.5 mm) to 33 mm 23 (median, 29 mm) 1 month after treatment and 30 mm +/- 21 (median, 26.5 mm) 3 months after treatment. After a median follow-up of 15 months (range, 6-24 months), nine patients' disease remained controlled without tumor progression and 10 patients had progressive disease. The median time to progression was 15 months. Postembolization syndrome lasted less than 7 days in 23 sessions (67%) and more than 7 days in seven sessions (22%), and no symptoms at all were observed in four sessions (11%). Peak aspartate aminotransferase, alanine aminotransferase, and bilirubin levels after TACE were 35-490 IU (mean, 125 IU 77; normal, < 35 IU), 20-440 IU (mean, 149 IU 155; normal, < 45 IU), and 8-90 mol/L (mean, 26 IU 25; normal, < 17 IU), respectively, at 2-3 days. In five patients, follow-up CT at 1 month revealed TACE-induced peripheral liver necrosis.CONCLUSIONS: TACE with DEBs is well tolerated and appears effective. A comparative study with a standard TACE or transarterial embolization regimen is warranted to define the best protocol for transarterial treatment of GEP liver metastases.