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Survival of patients with disseminated midgut carcinoid tumors after aggressive tumor reduction.

Journal article
Authors Bo Wängberg
G Westberg
Ulf Tylén
Lars-Eric Tisell
Svante Jansson
Ola Nilsson
V Johansson
Tore Scherstén
Håkan Ahlman
Published in World journal of surgery
Volume 20
Issue 7
Pages 892-9; discussion 899
ISSN 0364-2313
Publication year 1996
Published at Institute of Surgical Sciences, Department of Surgery
Institute of Surgical Sciences, Department of Anaesthesiology and Intensive Care
Institute of Selected Clinical Sciences, Department of Radiology
Pages 892-9; discussion 899
Language en
Links www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords Adult, Aged, Antineoplastic Agents, Hormonal, therapeutic use, Carcinoid Tumor, pathology, secondary, surgery, urine, Cause of Death, Clinical Protocols, Combined Modality Therapy, Death, Sudden, Cardiac, Embolization, Therapeutic, Female, Follow-Up Studies, Hepatic Artery, Humans, Hydroxyindoleacetic Acid, urine, Indium Radioisotopes, diagnostic use, Intestinal Neoplasms, pathology, surgery, urine, Liver Neoplasms, secondary, therapy, Male, Middle Aged, Octreotide, analogs & derivatives, diagnostic use, therapeutic use, Pentetic Acid, analogs & derivatives, diagnostic use, Radiopharmaceuticals, diagnostic use, Receptors, Somatostatin, analysis, Remission Induction, Risk Factors, Survival Analysis, Survival Rate
Subject categories Cancer and Oncology, Gastroenterology and Hepatology, Endocrinology

Abstract

Sixty-four consecutive patients with disseminated midgut carcinoids were treated during an 8-year period according to a single clinical protocol aimed at aggressive tumor reduction by surgery alone or with subsequent hepatic artery embolization. All patients had markedly elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) levels (581 +/- 79 micromol/24 h) and hormonal symptoms. Fourteen patients (22%) reached anatomic and biochemical cure by surgery alone. At follow-up, the mean 5-HIAA levels were still normal after 69.0 +/- 6. 2 months; two patients had died from unrelated causes. With the introduction of somatostatin receptor scintigraphy, subclinical disease was diagnosed in 7 of these 14 patients. Forty patients with bilobar hepatic disease underwent embolization in combination with octreotide. In this group, 5-HIAA levels were still reduced by 55% after 71 +/- 11 months of follow-up, and the 5-year survival was 56%, estimated from the total death hazard function. After embolization, two subgroups could be identified with marked differences in their long-term response to treatment. Ten patients were not embolized owing to complicating diseases. The 5-year survival for the entire series was 58%. A significantly increased risk of cardiovascular deaths was seen, which underlines the importance of total survival analysis in a disease with multiple hormonal effects. It is concluded that an active surgical approach must be recommended to patients with the midgut carcinoid syndrome. In patients with bilobar hepatic disease, embolization combined with octreotide treatment markedly reduced the 5-HIAA excretion and suggested a prolonged 5-year survival.

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