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CardioVascular and Interventional Radiology
Published in: CardioVascular and Interventional Radiology 2/2008

01-03-2008 | Clinical Investigation

Hepatic Arterial Embolization and Chemoembolization in the Management of Patients with Large-Volume Liver Metastases

Authors: Paresh P. Kamat, Sanjay Gupta, Joe E. Ensor, Ravi Murthy, Kamran Ahrar, David C. Madoff, Michael J. Wallace, Marshall E. Hicks

Published in: CardioVascular and Interventional Radiology | Issue 2/2008

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Abstract

The purpose of this study was to assess the role of hepatic arterial embolization (HAE) and chemoembolization (HACE) in patients with large-volume liver metastases. Patients with metastatic neuroendocrine tumors, melanomas, or gastrointestinal stromal tumors (GISTs) with >75% liver involvement who underwent HAE or HACE were included in the study. Radiologic response, progression-free survival (PFS), overall survival (OS), and postprocedure complications were assessed. Sixty patients underwent 123 treatment sessions. Of the 48 patients for whom follow-up imaging was available, partial response was seen in 12 (25%) patients, minimal response in 6 (12%), stable disease in 22 (46%), and progressive disease in 8 (17%). Median OS and PFS were 9.3 and 4.9 months, respectively. Treatment resulted in radiologic response or disease stabilization in 82% and symptomatic response in 65% of patients with neuroendocrine tumors. Patients with neuroendocrine tumors had higher response rates (44% vs. 27% and 0%; p = 0.31) and longer PFS (9.2 vs. 2.0 and 2.3 months; p < 0.0001) and OS (17.9 vs. 2.4 and 2.3 months; p < 0.0001) compared to patients with melanomas and GISTs. Major complications occurred in 21 patients after 23 (19%) of the 123 sessions. Nine of the 12 patients who developed major complications resulting in death had additional risk factors—carcinoid heart disease, sepsis, rapidly worsening performance status, or anasarca. In conclusion, in patients with neuroendocrine tumors with >75% liver involvement, HAE/HACE resulted in symptom palliation and radiologic response or disease stabilization in the majority of patients. Patients with hepatic metastases from melanomas and GISTs, however, did not show any appreciable benefit from this procedure. Patients with massive liver tumor burden, who have additional risk factors, should not be subjected to HAE/HACE because of the high risk of procedure-related mortality.
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Metadata
Title
Hepatic Arterial Embolization and Chemoembolization in the Management of Patients with Large-Volume Liver Metastases
Authors
Paresh P. Kamat
Sanjay Gupta
Joe E. Ensor
Ravi Murthy
Kamran Ahrar
David C. Madoff
Michael J. Wallace
Marshall E. Hicks
Publication date
01-03-2008
Publisher
Springer-Verlag
Published in
CardioVascular and Interventional Radiology / Issue 2/2008
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-007-9186-3

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