Carcinoid: TACE - Transarteriële Chemo Embolisatie tegenover systemische chemo:geeft langere overleving - 24 procent haalt de 5 jaar - te zien voor patienten met leveruitzaaiingen ontstaan vanuit carcinoid

29 mei 2012: voor mensen die een aanvraag willen doen voor een vergoeding van TACE - Trans Arteriële Chemo Embolisatie voor levertumoren vanuit carcinoid en darmkanker kunnen wellicht onderstaande studie gebruiken, al is er inmiddels heel veel meer bewijs dat TACE een uitstekende controlerende behandeling is. Zie linkerkolom

13 augustus 2005: Bron: Cancer J. 2003 Jul-Aug;9(4):261-7.

Al in 2003 werd een studie gepubliceerd gedaan naar effecten van trans arteriele embolisatie en gewone embolisatie tegenover systemische chemo bij darmkankerpatiënten met inoperabele uitzaaiïngen in de lever in het overbekende Amerikaanse MD Andersen Cancer Center in Houston. Opvallend is dat 24% van de patiënten waar de behandeling bij aanslaat de 5 jaars overleving haalt. En mediane ziektevrije tijd was bij alle deelnemende patienten 19 maanden na de start van de embolisatie, welke plaatsvond nadat de patiënten al gemiddeld 24,5 maanden waren behandeld met andere behandelingen zoals veelal systemische chemo. Veel van de deelnemende patiënten toonden tijdens de systemische chemo al progressie van hun ziekte. Dat maakt het des te opmerkelijker dat de mediane overall overleving na de embolisaties nog zo hoog ligt. Volgens de onderzoekers is dit zeer hoopgevend.

Cancer J. 2003 Jul-Aug;9(4):261-7.

Comment in:
13 augustus 2005: Bron: Cancer J. 2003 Jul-Aug;9(4):241-3.

Hepatic artery embolization and chemoembolization for treatment of patients with metastatic carcinoid tumors: the M.D. Anderson experience.

Gupta S, Yao JC, Ahrar K, Wallace MJ, Morello FA, Madoff DC, Murthy R, Hicks ME, Ajani JA.

Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. sgupta@di.mdacc.tmc.edu

BACKGROUND: Carcinoid tumors have a predilection for metastasizing to the liver. The presence of liver metastases is associated with poor prognosis and also results in significant deterioration of patient's quality of life. Several reports suggest that hepatic artery embolization or chemoembolization can be used for control of liver disease in these patients. We retrospectively reviewed our experience with the use of hepatic arterial embolization or chemoembolization in patients with liver-dominant metastatic carcinoid disease, evaluating the clinical and radiologic response rates, duration of response, and progression-free and overall survival rates of these patients.

MATERIALS AND METHODS: The medical records of all patients with carcinoid tumors metastatic to the liver who underwent hepatic artery embolization or chemoembolization between January 1992 and December 2000 were reviewed. For the purposes of this study, we compared the follow-up computed tomography or magnetic resonance imaging with the baseline imaging to determine each patient's objective tumor response. The interval between the dates of response and disease progression was considered the response duration. Progression-free survival duration was calculated from the date of initial treatment to the date disease progression was recorded or the date of death. Survival durations were calculated using the Kaplan-Meier method.

RESULTS: Eighty-one patients (48 men and 33 women; age range, 38-79 years) were included in this study. The mean duration of disease from the initial discovery of liver metastases until embolization was 24.5 months. Fifty patients were treated with bland hepatic artery embolization, and 31 underwent chemoembolization. Of the 69 patients in whom radiologic response could be evaluated, partial response was observed in 46 patients (67%), minimal response (MR) in six (8.7%), stable disease in 11 (16%), and progressive disease in six (8.7%). The median duration of response in the 42 patients with partial response was 17 months (range, 4-51 months). Sixty-three percent of patients had a reduction in their tumor-related symptoms. The median progression-free survival duration was 19 months (95% confidence interval, 17-21 months); the probability of progression-free survival was 75%, 35%, and 11% at 1, 2, and 3 years, respectively. The median overall survival time was 31 months (95% confidence interval, 23-38 months); the survival probability was 93% at 1 year, 62% at 2 years, and 24% at 5 years.

CONCLUSIONS: Hepatic arterial occlusive therapy using hepatic artery embolization or chemoembolization results in symptomatic and radiologic response in most patients with carcinoid metastases in the liver. The progression-free survival of 19 months achieved with embolization in our study is encouraging, given that most patients had extensive liver involvement and had shown disease progression while receiving systemic treatment.

PMID: 12967136 [PubMed - indexed for MEDLINE]